CAP End of Sem 2 Flashcards

Question

Select the correct answer regarding distichia: - Are hairs emerging through the palpebral conjunctiva of the eyelids - Are normal facial hairs that are in contact with the cornea - Are hairs emerging through the Meibomian gland openings along the lid margin - Always require surgical removal

Answer 1

- Are hairs emerging through the Meibomian gland openings along the lid margin

Answer 2

- Pupillary dilation (constriction)

Answer 3

- Anterior lens luxation

Answer 4

- Squamous cell carcinoma

Answer 5

- Reduce stromal collagenase activity

Answer 6

- Glaucoma

Answer 7

- Lipid dystrophy

Answer 8

- Must be treated as an ocular emergency and prompt surgical treatment with a tarsorrhaphy should be undertaken

Answer 9

- Is commonly seen in dogs greater than nine years of age

Answer 10

- Sudden acquired retinal degeneration

Answer 11

- Horner's syndrome

Answer 12

- Check behind the 3rd eyelid for a foreign body

Answer 13

- Pyometra - Diabetes mellitus + insipidus - Hyperthyroid - Cushing's - Iatrogenic

Answer 14

Always ensure oxygenation

Answer 15

- Stabilise patient - Apomorphine to induce vomiting - check the amount of food content removed - The use of activated charcoal - note activated charcoal doesn't affect already blinded toxin only free toxins - Plasma replacements - Monitoring i.e. CBC, biochem, PCV - Check transfusion reactions 10-15ml/15 min increase slowly half maintenance rates > stable then increase > maintained 250ml - Before discharge supply vitamin K for 28 days

Answer 16

Diagnosis: - Use blood panel e.g. lymphocytes, neutrophils, epithelial cells - Neoplastic cells, abnormal shapes, nuclei & size mitotic figrue (high = abnormal > most likely cancer vs something else) Treatment plan: - Piroxicam (Cox-2 inhibitor) is apparently good for transitional cell carcinomas - Thoracic radiographs to check for metastasis before any mast cell tumour or transitional cell carcinoma treatment commences (metastasis = very poor prognosis > likely euthanasia case)

Answer 17

- Differences in USG? - Acute renal failure will be isosthenuria - Clinical signs on blood panels i.e. biochem, hypercalcaemia etc.

Answer 18

- Popliteal lymph node palpation & cytology, abdominal ultrasound examination

Answer 19

- Incisional biopsy for diagnosis, treat initially with castration

Answer 20

- Squamous cell carcinoma

Answer 21

- Cyclophosphamide-induced sterile haemorrhagic cystitis, bacterial cystitis

Answer 22

- Cisplatin

Answer 23

- There is a good medium to long-term prognosis with chemo- or radiation therapy

Answer 24

- Chlorambucil

Answer 25

- The dog's lymph nodes & spleen are normal size, but microscopic disease is likely still present

Answer 26

1. Recheck total calcium. If still high then check ionised calcium. If normal then no further investigation. 2. Neoplasia

Answer 27

1. Mild azotaemia likely pre-renal (1 mark). Inappetence might be related to splenomegaly (1 mark). 2. Fine needle aspiration of spleen is next most logical step (1 mark)

Answer 28

1. What is the main condition it must be differentiated from? (1 mark) - Inflammatory bowel disease 2. What is the best diagnostic test to reach a firm diagnosis? (1 mark)? - Tissue biopsy of the affected intestine with histopathology 3. Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment & what is the prognosis for the cat? (2 marks) - Standard treatment is chemotherapy (chlorambucil) & prognosis is good for medium to longer term survival

Answer 29

Entropion: - Inward folding / turning of the eyelid > rubbing on the eye > ulcers - Breed predispositions - Rottweilers, Labs, Sharpei's, Cocker Spaniels - Often entropion is missed because people stain the eye with fluorescein & then just say it's got an ulcer (but the ulcer is actually being caused by entropion) Treatment: - Puppies <16 weeks - temporary tacking sutures & leave definitive surgical correction once dog is more mature - Adults - Hotz-Celsus procedure (note taking too much can lead to ectropion so better to take too little than too much!)

Answer 30

- Cherry eye is prolapse of the gland of the third eyelid (looks like a pink glob in the inner corner of eye) - *Note - it is not prolapse of the third eyelid itself! Treatment: - Surgery with Morgan Pocket Technique

Answer 31

- Sympathetic denervation - Not painful Protrusion of the third eyelid with 3 key features... - Miosis (pupillary constriction) - Enophthalmos (abnormal displacement of eye caudally into orbit) - Ptosis (drooping of the upper lid) Causes: - Often idiopathic - Middle ear disease - Soft tissue neck injuries - Iatrogenic (caused by surgical procedures) Treatment: - Depends on cause but if not obvious can be ignored & will often improve spontaneously

Answer 32

Distichiasis: - Abnormally positioned cilia that emerge along the eyelid margin usually through the meibomian orifices - The hairs fall into the eyes, if there's only a few they don't tend to cause issued but 10-20 on each lid > irritation Clinical signs: - Usually incidental - Rarely cause ulceration, usually epiphora (watery eyes) & blepharospasm - When distichiasis is the cause of ocular irritation they usually present at young age (<2 years old) Breed predispositions: - Very common in spaniel / bull terriers Treatment: - Usually specialist cryosurgery & surgical excision under magnification

Answer 33

- Ectopic cilia = abnormal hairs arising through the meibomian glands however they emerge THROUGH the palpebral conjunctiva - Usually unilateral & often associated with distichiasis Clinical signs: - Always cause ulceration which is non-responsive to conservative treatment - Almost always young dogs <2 years old - If you get a young dog with an ulcer that's not healing within ~5 days consider ectopic cilia! Treatment: - Surgical excision of the offending hair

Answer 34

Keratoconjunctivitis sicca = dry eye. Very common! Clinical signs: - Reduced aqueous tear production > conjunctivitis & superficial keratitis (neovascularisation, pigmentation, scarring) - Mucopurulent ocular discharge (often yellow) - Secondary corneal ulceration - Clients often don't take very seriously but is very painful & animals can go blind if not reated properly! Causes: - Autoimmune - the most common cause. Usually responsive to Cyclosporin (optimmune) - Drug induced - systemic sulphonamides commonly cause KCS. - Canine distemper & FHV1 Diagnosis: - Low Schirmer Tear Test readings (<15mm per min) Treatment: - Cyclosporine BID (optimmune) or Tacrolimus (compounding pharmacy) - Ocular lubricant QID (viscotears or lacrilube) - Topical antibiotic (fusidic acid - conoptal) - Repeat schirmer tear test after 4-6 weeks - If improvement continue above medication for life - If no improvement consider referral for a Parotid Duct Transposition

Answer 35

Diagnosis: - Close examination & fluorescein staining - Note - very deep ulcers (to Descemets membrane) will not stain with fluorescein Causes: - Traumatic injury - clients will nearly always say trauma but this is rarely the cause - KCS (dry eye) - low STT > ulcer is not resolving due to dry eye > put on Tacrolimus - Entropion - Distichiasis - Ectopic cilia - Foreign body Treatment: - First must identify the cause - Some complicated ulcers require specific types of treatment - if it is not one of these then management depends on depth - Superficial ulcers - topical AB (e.g. tricin TID) + NSAID (carprofen). Surgery not required initially. May require debridement and/or keratotomy / keratectomy - Less than 1/3rd depth - topical AB (Ocuflox or Gentamicin) + NSAID +/- surgery (referral for conjunctival pedicle graft or corneoconjunctival transposition) - Greater than 1/3rd depth - topical AB (Ocuflox or Gentamicin) + NSAID +/- surgery (referral for conjunctival pedicle graft or corneoconjunctival transposition)

Answer 36

- Indolent ulcers are very common - Epithelial loss only. Ulcer remains superficial & underrun but fails to heal due to abnormal re-epithelialisation Predispositions: - Middle aged & older dogs (>5 years) - Boxers, Beagles, Corgis Treatment: Medical: - Will often slough off itself - initially give AB's & re-see in a week Surgical: - Debridement with cotton bud under local anaesthetic then grid keratotomy under sedation (using needle to gently create grid over ulcer) - Corneal burr - rub the surface off. Only use in shallow ulcers. Be careful with pugs / frenchies as eyes prone to melting / rupture! - Cats - debride under topical anaesthetic (DO NOT GRID) - Referral centre- lamellar keratectomy (100% successful in dogs, 95% successful in cats)

Answer 37

- Not very common but requires rapid attention - always offer referral! - Melting ulcer = INFECTED. Rapidly progressive ulcer due to release of proteases by bacteria. Risk of globe rupture - They get very bad within 48-72 hours - so if you're not sure if it is a melting ulcer give them a re-visit for the next day Causes: - Pseudomonas & staph most common Predispositions: - At risk breeds - pugs, shih-tzu's, pekingese, persian cats Treatment: - Autologous serum - an spin down dogs own blood & use every hour for 24hrs - Consider swabbing to check aetiological agent - but waiting 2 days for results is too long so in the meantime start topical AB's - Topical fluoroquinolone (e.g. Ocuflox) or topical Gentamicin - Systemic AB's + NSAIDs - Consider referral for a surgical graft

Answer 38

- Feline Corneal Sequestrum = chronic non-healing shallow corneal ulcer > sequesturm (black dead material) - At risk breeds - Persians, Burmese Diagnosis: - Fluorescein stain - will uptake with vascularisation on surface of cornea Treatment: - Only effective treatment is surgical (does not slough off or if it does it will return) - Referral for lamellar keratectomy & possible conjunctival graft - Correct any underling cause of chronic ulcer e.g. entropion

Answer 39

- Uveitis = inflammation of one or more structures relating to the uvea. - Recognise early as painful & can lead to blindness if treatment is not instigated correctly & rapidly Clinical signs: - Usually acute in dogs - squinting & red - Cats - owners will nearly always say "there's been a colour change in my cats eye" - VKH syndrome in artic breeds of dogs - uveitis is one component of this. An immune response to melanin. Causes: - Dogs mostly blunt trauma - Cats mostly infectious (FIP, FIV, FeLV) Treatment: - Identify & treat underlying cause - Since a large component of anterior uveitis (regardless of aetiology) is immune-mediated damage anti-inflammatory medication is always indicated! - Topical corticosteroids - e.g. Pred Forte (prednisolone acetate) - has good intra-ocular penetration - Topical corticosteroids Amacin & Maxidex - not nearly as suitable. Ointment so only goes on surface, not intra-ocular penetration. - Check no corneal ulceration first! DO NOT USE STEROIDS IN EYES WITH ULCERS! - Initially apply Pred Forte 6x daily until uveitis settles then gradually taper dose down - If they have really bad uveitis with an ulcer put on systemic NSAIDs (Carprofen or Meloxicam) to redue inflammation whilst waiting for ulcer to resolve > then use steroids

Answer 40

- Hyphaema = haemorrhage within the anterior chamber (unilateral or bilateral). - Possible but not common in dogs - Common in cats Diagnosis: - Examine both eyes & perform a retinal exam if possible - Full general physical exam as cause is often systemic disease Causes: - Most common cause in cats = hypertension! - Usually older cats with kidney issues & get spontaneous bleeding in their eye due to hypertension. May present with sudden onset blindness. Immediate treatment with Amlodipine (reduces BP) > can save eyes! If not treated immediately can > retinal detachment > blindness - Hypertension not as common a cause in dogs but can be due to diabetes or Addison's - Secondary to intra-ocular disease - anterior uveitis, chronic glaucoma, intra-ocular neoplasia, collie eye anomaly - Clotting disorders e.g. IMT, warfarin toxicity, clotting factor deficiencies, anaemia

Answer 41

- Glaucoma = high pressure inside the eye - Rapidly progresses in dogs (compared to humans) Diagnosis: - Clinical exam important - PLR, vision testing (menace & dazzle) - Examine intra-ocular structures - Tonometry to check pressure: normal intra-ocular pressure in dogs = 10-25mmHg, cats = 10-25mmHg Signs of glaucoma: - Dogs usually get primary (rapidly progressing) glaucoma > get a red-eye overnight (redder than just uveitis). Pupil will be fixed if pressure is very high, on menace dog can't see & pupillary light reflex will be abnormal - Common signs - acute blindness, ocular pain, initially unilateral but ultimately will affect both eyes, episcleral congestion (red eye), corneal oedema (steamy cornea), mydriasis (dilated pupil) - Cats usually get progressing secondary glaucoma Causes: Inherited primary glaucoma: - More common - Cocker Spaniels, springer spaniels, basset hounds, huskies, golden retrievers - Abnormal formation of the iridocorneal drainage angle - this is diagnosed by gonioscopy (a specialist procedure) - Condition is bilateral - just a matter of time before second eye is affected Secondary glaucoma: - Primary lens luxation (common in terriers) - Lens luxation secondary to hypermature cataract - Chronic uveitis - Intra-ocular neoplasia - Iatrogenic (vitreous prolapse following lens extraction) Treatment: - Referral is best! - Topical anti-glaucoma med - Dorzolamide (Trusopt) 4-6x daily. - Timolol (topical beta antagonist which reduces aqueous humour) - Analgesic (systemic Carprofen) - Treat underlying cause if secondary glaucoma - In many instances of primary glaucoma medical therapy is not sufficient to reduce IOP or to keep it low so surgery is needed - Surgery to reduce aqueous production (laser cyclophotocoagulation or cyclocryotherapy - freezing of ciliary body) - Many glaucoma cases progress to blindness & require salvage procedure = enucleation or cyclopharmacoablation (intra-ocular Gentamicin > retains the globe & permanently decreases IOP > blind but comfortable eye)

Answer 42

- The lens sits just behind the pupil - usually you can't see it because it's clear - Lens luxation = lens has moved in front of the iris into the anterior chamber > usually blinding - Lens luxation can lead to glaucoma Diagnosis: - To examine lens use Mydriacyl (E.g. Tropicamide) - 2 drops takes about 15 mins for effect > turn lights off > use Finhoff transluminator Predispositions: - Inherited disease of TERRIERS (especially Jack Russell Terriers) - Older cats can get lens luxation Clinical signs: - History of acute onset ocular pain / redness (usually unilateral) - Conjunctival / episcleral reddening - Cloudy cornea (corneal oedema) - If anterior lens luxation should be visible within the anterior chamber Treatment: - Surgical emergency - REFER asap! - Early surgical intervention is vital since irreversible glaucoma will develop if lens is not removed - Treatment is removal of entire lens within its capsule (intracapsular lentectomy) - The dog becomes long-sighted following lens removal - Cost is ~$2000 for 1 lens & $3000 for both

Answer 43

- Causes sudden onset blindness - The detached retina can be seen from a distance with a pen light - Bilateral retinal detachment is more common in cats - due to hypertension (BP so high it pushes off retina!) Causes: - Systemic hypertension - most common in cats, usually due to chronic renal failure, sometimes hyperthyroidism > hyphaema or acute vision loss or both. Treat with Amlodipine (reduce BP) immediately - Inherited retinal disease in dogs e.g. collie eye anomaly, retinal dysplasia - Trauma - unlikely! - Posterior uveitis - Iatrogenic after lens or cataract surgery

Answer 44

- Most common of the canine inherited retinal disorders Clinical signs: - Middle aged dogs with gradual loss of vision as retina slowly dies off - History of initial night blindness (nyctalopia) progressing to complete vision loss - very slow to progress - Usually dilated pupils, poor PLR's, poor obstacle negotiation but comfortable eyes Diagnosis: - Turn lights off, drop swabs or some object on the ground to get them to track it with their eyes

Answer 45

Ocular causes: - Retinal detachment - e.g. cats with systemic hypertension - Glaucoma (not usually bilateral) - Optic neuritis - idiopathic, infectious, lymphoma (not common) - Acute retinal degeneration - Enrofloxacin toxicity in cats (do not exceed 5mg/kg SID) - SARDS (sudden acquired retinal degeneration) in dogs Central causes: - Head trauma - Cerebral hypoxia (e.g. hypoxic episode during anaesthesia in cats) - Hepatic encephalopathy - Raised intracranial pressure (hydrocephalus, intracranial mass) - Meningitis - Cortical brain tumour - Systemic toxins e.g. lead poisoning

Answer 46

Otitis externa: - Pruritus - Pain - Inflammation - Head shaking - Visible discharge - Smell Otitis media: - Same as otitis externa PLUS: persistent, recurrent, hearing impairment Otitis interna: - Deafness - Vestibular disease - head tilt, nystagmus, ataxia

Answer 47

Pathogenesis: - Spontaneous - excessive circulating cortisol due to ACTH-secreting pituitary tumour (85-90% dogs) or functional adrenal tumour (10-15% of dogs) - Iatrogenic - administration of excessive exogenous glucocorticoid Clinical signs: Systemic signs (4P's): - Polyuria - cortisol inhibits action of ADH on the kidney - Polydipsia (>100ml/kg/day) - compensatory due to polyuria - Polyphagia - animal thinks it is starving - Panting - anxiety? feeling hot? Other signs: - Abdominal enlargement (pot belly) - redistribution of fat, weakness of abdominal muscles - Muscle atrophy (catabolic effects) - abdominal wall, head "pred head", shoulders, thighs, pelvis - Bacterial UTI's - very common in Cushing's dogs (10-15%) - Pancreatitis - because they're polyphagic & eat stupid things - Diabetes mellitus - certain breeds are predisposed to both Cushing's & Diabetes - Hypertension / CHF - increased cortisol > fluid retention > high BP - Myopathy - they get muscle loss & a form of muscle disease secondary to Cushing's - Poor coat / alopecia - effect of cortisol on hair follicle cycle - Cutaneous atrophy / skin thinning - inhibition of epidermal proliferation & collagen production - Poor wound healing / fragile skin - weakness of dermis / lack of collagen - Easy bruising - weakness of blood vessel walls (collagen) - Calcinosis cutis - calcium deposition in the skin

Answer 48

Diagnosis: - Haematology - stress leukogram: leukocytosis, mature neutrophilia, eosinopenia, lymphopenia +/- monocytosis - Biochem - increased ALP+++ (cortisol stimulates ALP release), increased ALT (vacuolar hepatopathy > increased leakage of ALT), hypercholesterolaemia, hyperglycaemia (not very often), decreased total T4, normal TSH - Urinalysis - low USG (<1.010, isosthenuria or even hyposthenuria as not concentrating urine), evidence of UTI (bacteriuria, blood, protein, abnormal pH) - ACTH stim test - Synacten IV 5ug/kg tested at 0 & 1hr - Low dose dexamethasone suppression test - Urine cortisol: creatinine ratio - 100% sensitive (normal / negative result = dog does not have HAC), less specific (elevated / positive result = dog could have HAC or stress of illness, emotional stress etc) - Abdominal U/S - CT & MRI Treatment: - Trilostane - 1mg/kg BID (works better BID than SID). Adverse effects are Addison's signs = lethargy, decreased appetite, vomiting, diarrhoea - Monitor with ACTH stim test - at 10-14 days, 30 days & every 90 days. Do test 4-6 hrs after Trilostane dose.

Answer 49

Pathogenesis: - The immune system destroys the adrenal gland - It is a very serious illness but once diagnosed it can usually be treated / managed quite easily - Most dogs with Addison's will get both glucocorticoid deficiency & mineralocorticoid deficiency (i.e. all but the adrenal medulla which produces catecholamines has been destroyed) Signs of glucocorticoid deficiency: - Lethargy - GI signs - vomiting, diarrhoea, abdominal pain, weight loss - Hypoglycaemia Mineralocorticoid (aldosterone) deficiency: - The ones with mineralocorticoid deficiency get the sickest - Weakness - from electrolyte abnormalities - Hypovolaemia - Hypotension - Decreased cardiac output

Answer 50

Diagnosis: - CBC - results are essentially opposite to Cushing's = anaemia (mild to moderate), neutropenia, eosinophilia, lymphocytosis, hypoglycaemia, hypercalcaemia, hypoalbuminaemia, azotaemia - ACTH stim test - in Addison's there's nothing (i.e. no adrenal gland) to stimulate cortisol so cortisol will be low on both tests Immediate management: - Acute life-threatening condition (Addisonian crisis) - Fluid therapy - normal saline, balanced electrolytes - Insulin, glucose or calcium may be required for hyperckalaemia >8.0 - Correct acid-base imbalances - Correct glucocorticoid deficiency - Dexamethasone Long term management: - Prenisolone (low maintenance dose) - Fludrocortisone acetate (aldosterone analogue) - Desoxycorticosterone Privalate (DOCP) = mineralocorticoid hormone

Answer 51

Path: - Hypothalamus stimulates pituitary gland > pituitary gland stimulates thyroid gland > thyroid gland produces thyroid hormona > decrease in TRH & TSH - Majority of dogs that have hypothyroidism have lymphocytic thyroiditis (low thyroid function which doesn't get better > need supplementation) Drugs that suppress thyroid function: - Potentiated sulphonamides e.g. trimethoprim sulpha - Glucocorticoids (common!) - Diazepam - Aspirin - Phenylbutazone - Phenobarbital (common!) Cx: - Reduced activity, chronic lethargy - Weight gain (thyroid hormone regulates metabolism) - Heat seeking (reduced metabolism > they get cold) - Bradycardia - Mild anaemia - "Tragic face" - Non-pruritic bilaterally symmetrical alopecia - trunk, flanks, ventrum, bridge of nose, tail - Dull dry hair coat, fading coat colour - Seborrheoea = greasy / oily skin Dx: - History & physical exam - Haematology - mild normocytic, normochromic non-regenerative anaemia - Biochem - hypercholesterolaemia = hallmark of hypothyroidism (if they don't have hypercholesterolaemia its unlikely hypothyroid) - Thyroid function testing - low T4 (on it's own is not diagnostic but with high cholesterol it is) Treatment: - Sodium-levothyroxine (T4) = Thyroxine 0.02mg/kg BID > then drop to SID if good response. If you start on a dose but not getting a good repsonse then increase dose. Conversely if dog is losing weight then decrease the dose. Adverse effects (rare) include: anxiety, panting, PU, PD, polyphagia, diarrhoea, tachycardia, heat intolerance - Post-pill testing - blood sample 4-6 hrs after most recent dose of Thyroxicne to check T4 is within normal range

Answer 52

- Very common in cats! - Generally a disease of geriatric cats (12+) Cx: - Weight loss & polyphagia - PU/PD - Hyperactivity & restlessness - Vomiting & diarrhoea - Tachycardia - Unkempt coat - Palpable thyroid mass (one or both) Complications: - Hypertrophic cardiomyopathy (increased BP > thickening of heart) - Retinal detachment (systemic hypertension > retinal detachment) - Chronic kidney disease - having high thyroid function will improve kidney function. Once you treat the thyroid disease all of a sudden the kidneys don't work as well. Dx: - CBC: normal or stress leukogram - Biochem: elevated ALT, ALP, AST, 25% have azotaemia (elevated urea + creat) - Total T4 (TT4) - high levels of TT4 strongly suggests hyperthyroidism Tx: - Oral anti-thyroid drugs (e.g. Carbimazole or transdermal Methimazole). Used for long term management or short term controil prior to thyroidectomy or radioactive iodine therapy - Surgical thyroidectomy - treat with anti-thyroid medication prior to surgery to stabilise the disease. Risk of hypocalcaemia from inadvertent parathyroidectomy causing hypoparathyroidism - Radioactive iodine therapy - gold standard if cat is likely to live several more years then it is cost effective. Need to be otherwise well (no cardiac / renal failure etc.) so best for younger cats. Advantage over oral / transdermal drugs = one & done treatment. Don't have to tablet BIT & then regularly check bloods. - Iodine restricted diet e.g. Hills y/d. Decreasing T4 concentrations through limiting dietary iodine availability.

Answer 53

Type 1: - Absolute insulin deficiency - Immunological destruction of beta cells > failure to produce appropriate levels of insulin - Mostly occurs in dogs Type 2: - Relative insulin deficiency - Dysfunctional beta cells > insulin resistance - Failure of the insulin that is produced to function properly Insulin dependent diabetes: - Require exogenous insulin permanently - Most dogs, some cats Non-insulin dependent diabetes: - Cats can switch between the two states depending on DM progression - Some cats only need insulin therapy temporarily

Answer 54

Aet: - Irreversible B cell loss - Lack of insulin results in - impaired glucose transport, impaired glycolysis, accelerated hepatic glycogenolysis, accelerated hepatic gluconeogenesis, increased proteolysis in skeletal muscle, increased lipolysis - > hyperglycaemia from impaired cellular glucose utilisation & increased glucagon levels Signalment: - Most commonly between 4-14 years, peak 7-9 years - Females more likely than males - Australian terriers predisposed Cx: - PU, PD, polyphagia - Weight loss - *Note - there are not many disorders that make animals eat more but still lose weight (others include exocrine pancreatic insufficiency but EPI doesn't have PU/PD) Dx: - Appropriate clinical signs - Persistent fasting hyperglycaemia on blood test - Glucosuria (glucose on urinalysis) - +/- Ketones on urinalysis Complications: - Cataracts - Lens induced uveitis - Diabetic neuropathy - Diabetic nephropathy - Systemic hypertension

Answer 55

Types of insulin: - Short acting insulin = Actrapid. Stops working within 3-4hrs administration - Intermediate acting = Caninsulin, Humulin - Long acting = Glargine (Lantus) - standard for cats, lasts >12hrs Deciding on insulin: - Caninsulin (intermediate acting) = most common for dogs - Glargine (Lantus) (long acting) = most common for cats Insulin syringes: - U40 = 40 units/mL - use for Caninsulin - U100 = 100 units/mL - use for Glargine, Actrapid, Humulin - Make sure to use the right syringe with the right insulin or you can accidentally overdose! Protocol for starting insulin: - Admit the patient to hospital for min 12hrs (fed at home as usual shortly before) - Check baseline BG level - Administer 0.25 U/kg of Caninsulin SC - Check BG at 2, 4, 6, 8 & 10 hrs - If there is no evidence of hypoglycaemia (BG of <4.4 mmol/L) during this time then patient can be sent home on that dose of insulin BID - Alternatively can now use continuous glucose monitors at home to avoid the stress of hospital stay & continuous needle pricks Diet: - Feed BID 10-12hrs apart - Give insulin 20-30 mins before eating to give it time to absorb (if you know the animal will definitely eat) - If the animal can be fussy with food then give the insulin after eating so you know they've definitely eaten - Feed high fibre, low carb, high protein diet e.g. Hills or RC diabetic food

Answer 56

d) Caninsulin

Answer 57

a) Reflects the average blood glucose in the last 6-8 weeks

Answer 58

c) Low Fat (might want low fat if they have pancreatitis too but it’s not important for diabetes management)

Answer 59

- Nadir = lowest blood glucose result during the day time period - Ideally want blood glucose curve to be flat between 5.5 & 13.8 mmol/L - The Nadir should be between 4.4 - 7.2 mmol/L Dosing: - If Nadir is >7.2 mmol/L increase insulin dose - If Nadir is <4.4 mmol/L reduce insulin dose Duration: - Only assess duration when nadir is between 4.4 & 7.2 mmol/L - If duration <8hrs then change to a longer acting insulin - If duration >12hrs then change to a shorter acting insulin

Answer 60

Aet: - Islet specific amyloid deposition - Islet beta cell degeneration - Feline pancreatitis Diabetic remission: - Most cats presenting with DM appear to be insulin dependent (type I) but are actually type II (non insulin dependent) - If the glucose toxicity can be reversed quickly enough before the islets are permanently damaged then they become non-insulin dependent or a subclinical cat Signalment: - May occur at any age but mostly >9yr - More common in neutered males - Burmese predisposed Cx: - PU/PD, polyphagia - Weight loss - May present with diabetic neuropathy - May present in DKA - may exhibit plantigrade stance in both legs Dx: - Appropriate clinical signs - Persistent fasting hyperglycaemia - Glycosuria - "Non-stressed" urine sample - won't get glucose in the urine until the blood glucose has passed the renal threshold (won't occur with stress hyperglycaemia) - Serum fructosamine - tells us what glucose was doing at home over last week Treatment: - Glargine is recommended as first choice insulin for cats - long acting - Diet - high protein, low carb. Timing of food doesn't matter (tend to be grazers anyway) Complications: - Diabetic neuropathy - Cataracts - Uveitis - Hypertension - DKA

Answer 61

Path: - Insulin deficiency > chronic inability to metabolise glucose > lipolysis & free fatty acid oxidation - Promotes ketogenesis > excessive ketone production leads to signs of DKA - Ketones contribute to osmotic diuresis > concurrent loss of electrolytes & water > profound dehydration, hypovolaemia, decreased perfusion of tissue - Ketones stimulate the CTZ in the brain to induce vomiting - Rapidly develop acidosis, dehydration & life threatening collapse Cx: - History of undiagnosed / unmanaged DM - Severe dehydration - Weakness - Collapse - Altered mentation (dull, lethargy) - Tachypnoea - Vomiting Dx: - Hyperglycaemia - Glycosuria - Metabolic acidosis - Ketones - b-hydroxybutyrate in blood, acetoacetic acid in urine (most urine dipsticks won't detect this) Management: - Correct dehydration - IV fluids with 0.9% NaCl, LRS or Plasmalyte 148 - Correct electrolyte imbalance - based on serum K+ or add 40mmol/L KCl. Do not exceed 0.5mmol/kg/h - Correct acid-base imbalance - IVFT + insulin. Bicarb? - Commence insulin therapy (give rapid acting insulin + then insulin CRI) - 4-6hrs after starting IVFT. Short acting insulin (Actrapid) - Identify & treat concurrent disease - snap CPL & abdo U/S to test for pancreatitis, urine bacterial culture for UTI, abdo U/S to screen for cushing's, peritonitis, pyelonephritis, neoplasia, intestinal foreign body

Answer 62

- Start IV fluids, full blood test and urinalysis, abdominal u/s A. CBC B. Biochemistry C. Electrolytes D. Blood gas analysis E. Urinalysis F. Fasting blood glucose G. Blood ketones J. Abdominal u/s

Answer 63

Urea: - Synthesised in liver from ammonia - Excreted via glomerular filtration - Passively reabsorbed in renal tubules - Not a reliable of GFR because some is reabsorbed back into renal tubules + liver function & protein intake influence production of BUN Creatinine: - Formed at a constant rate from muscle breakdown - Excreted via glomerular filtration - Not reabsorbed in renal tubules - Reliable marker of GFR - Insensitive marker of early renal disease SDMA: - Not impacted by lean body mass (as is creatinine) - Creatinine doesn't increase until up to 75% loss of kidney function whereas SDMA increases with as little as 25% loss of kidney function

Answer 64

- Hyposthenuria = USG <1.008 (dilute) - Isosthenuria = USG 1.008-1.012 - Hypersthenuria = USG >1.012 - Concentrated = USG >1.030 (dog), USG >1.035 (cat)

Answer 65

Polydipsia = water intake >80-100ml/kg/day Polyuria = urine production >40-50ml/kg/day

Answer 66

- Intact bitch in season 3-6 weeks prior = suggests possible pyometra - Male cat that has undergone removal of a urethral obstruction = suggests post-obstructive diuresis - History of corticosteroid or diuretic drug administration = suggests iatrogenic hyperadrenocorticism - PD/PU with increased appetite & weight loss = suggests diabetes mellitus or hyperthyroidism - PD/PU with increased appetite & weight gain = suggests hyperadrenocorticism (cushings) - PD/PU with decreased appetite & weight loss = suggests renal structural disease or extra-renal conditions such as neoplasia - Basenji dog breed = suggests Fanoni syndrome in Basenji dogs - Generalised lymphadenopathy = suggests lymphoma with hypercalcaemia - Perineal mass = suggests anal sac adenocarcinoma with hypercalcaemia - Vaginal discharge = suggests pyometra - Cataracts = suggests diabetes mellitus - Symmetrical alopecia on the trunk, pendulous abdomen & hepatomegaly = suggests hyperadrenocorticism (cushings) - Thyroid nodule (suggests hyperthyroidism) - Small irregular kidneys = suggests chronic kidney disease - Retinal oedema, detachment, haemorrhage or vascular tortuosity = suggests hypertension secondary to renal disease - Ascites or subcutaneous oedema = suggests hypoproteinaemia & possibly Fanconi syndrome

Answer 67

Pre-renal: - Will get azotaemia (increased BUN + creat) but urine is still concentrated i.e. >1.030 in dogs or >1.035 in cats - Caused by reduced renal perfusion (hypovolaemia, cardiac failure, severe dehydration, hypotension) - if blood is not flowing adequately through the kidneys then urea, creat & other waste products cannot be filtered adequately - Large meat meal - urea production & excretion increase after a high protein meal - Gi bleeding - blood can be considered a high protein meal so also increases urea production - Hyponatraemia - water follows sodium so if sodium is low then total body water & blood volume is low > reduced renal perfusion > azotaemia - Hypercalcaemia - causes constriction of the afferent arteriole in the glomerulus > decreases renal perfusion > azotaemia Renal: - <25% normal no. of functional nephrons - The ability to concentrate urine is lost once >66% of the nephron population has become non-functional. The ability to eliminate nitrogenous waste products (urea + creat) is lost once >75% of the nephron population has become non-functional - Will have azotaemia & isosthenuric or minimally concentrated urine - Causes of acute renal failure: ischaemia, toxins (e.g. grapes, lillies) - Causes of chronic renal disease: immune disorders, amyloidosis, neoplasia, ischaemia, toxins, inflammation / infection, hereditary / congenital, blocked urine outflow, idiopathic Post renal: - Occurs when there is a problem with urine excretion after the kidneys - Animals with post renal azotaemia will likely have other blood parameters which are abnormal e.g. high K+ levels - Causes: obstruction to urine flow (e.g. blocked male cat), rupture of excretory pathway (kidney, ureters, bladder) with urine accumulation in the body of the patient (uroperitoneum)

Answer 68

- Pollakiuria = urinating small volumes frequently - Dysuria = difficulty urinating associated with straining - Stranguria = straining to urinate - These disorders often occur together & indicate disease affecting the urinary bladder, urethra or both (lower urinary tract)

Answer 69

Transitional cell carcinoma

Answer 70

- Cystocentesis

Answer 71

- 9-year-old male neutered JRT with polydipsia with normal creatinine on blood test

Answer 72

- Hyperadrenocorticism (Cushing's) - Hypoadrenocorticism (Addison's) - Diabetes mellitus - Hyperthyroidism - Primary hyperparathyroidism

Answer 73

Common pathogens (from most to least common): - E. Coli - Staph spp - Proteus spp - Klebsiella spp - Enterococcus spp - Strep spp - *They all ascend to the bladder via the urethra Aet: - Host factors that prevent infection: normal voiding, urinary tract structure, antibacterial properties of urine & prostatic secretions, colonisation of genetalia by non-pathogenic organisms, functional immune system Uncomplicated UTI's: - Occur in the absence of abnormalities of host factors that normally inhibit infection - Perform urine C & S - Empiric AB selection - Trimethoprim sulfa & Amoxicillin - Clinical signs & complete urinalysis improve within 48hr - If signs don't improve or they do initially but then it re-occurs don't just put the animal back on the same AB's at different dose, must do C & S! - Repeat urine culture 5-7 days after finishing AB's Complicated UTI's: - Recurrent UTI's or UTI's in a young animal that shouldn't be getting them - Always perform urine C & S - work out if the animal has been getting the correct AB's & has the owner been giving the right dose? - Attempt to identify & eliminate underlying conditions e.g. disorders or micturition, mechanical / chemical damage to urothelium & mucosal barrier, altered urine composition, defective host defences

Answer 74

- Urolithiasis = presence of stones anywhere in the urinary tract (most commonly bladder or urethra) - 2 most common types = struvite & calcium oxalate (seen 50/50) - Other less common types = urate (dalmatians predisposed), crystine & silicate - Cx: stranguria, dysuria, pollakiuria, haematuria or obstruction - Uroliths will appear when conditions are 'right' - pH, USG, diet, pre-existing UTI & breed Treatment: - Relieve urethral obstruction if present - Remove stones surgically - Dissolve stones with appropriate diet - note only struvite, won't work for calcium oxalate (but can use diet to prevent recurrence of calcium oxalate). E.g. Hills s/d, Hills c/d, RC urinary s/o - Treat UTI if present (C & S) - Monitor urine pH & USG

Answer 75

- Collection of conditions with lower urinary tract signs +/- inappropriate urination - Common causes: idiopathic (>50%), uroliths, urethral plugs, anatomic defect, behaviour disorder, infection, trauma, neoplasia Aet: - Resembles human interstitial cystitis = sterile urine, increased bladder wall vascularity & fragility, increased sensory innervation & mast cell numbers, decreased mucosal production of glycoasminoglycans - Contributing factors = decreased urine volume & frequency of micturition due to decreased water intake and/or dirty / unavailable litter tray, decreased physical activity, stress - More common in young to middle aged cats Diagnosis: - History of: haematuria, dysuria / stranguria, pollakiuria, inappropriate urination - Bladder palpation - usually small, may show discomfort on palpation - CBC & biochem = normal - Urinalysis - increased RBC's, proteinuria, crystalluria?, usually concentrated, pH variable - Plain & contrast radiographs or U/S to check for stones, tumour or other underlying cause - Urine C & S to check for UTI - Cystoscopy? Treatment: - 95% of young cats have sterile urine & clinical signs will resolve spontaneously in many cats within 5-7 days - No controlled studies have demonstrated efficacy for any drug - Analgesia (oral buprenorphine or NSAIDs) - Increase water intake (e.g. tinned food, water fountain) - Decrease stress – e.g. clean litter box, environmental enrichment & perhaps pheromone therapy (Feliway, CEVA Animal Health) -Weight loss if obese

Answer 76

Aet: - Typically male cats - Causes - urolithiasis, urethral plugs Cx: - Stranguria, dysuria, haematuria - Appears uncomfortable & restless - Vocalises during urination or licks the penis - Lethargy, depression, then comatose, shock in late stages - Enlarged, firm to hard painful bladder on palpation - Bradycardia may be present in hyperkalaemic patients Dx: - Increased urea + creat (post-renal azotaemia) - Hyperkalaemia - +/- Severe metabolic acidosis - Urinalysis (careful cystocentesis) > haematuria Treatment: Before unblocking... - Stabilise the cat – IV fluid therapy - Analgesia – methadone / buprenorphine IV - Hyperkalaemia - IV fluid, IV glucose, IV insulin - Calcium gluconate - cardioprotective? - Acidosis - bicarbonate? Unblocking... - Heavy sedation or anaesthesia - Clip & prep genitals - Use open ended tom cat catheter, lubricated, gently insert into the penis until you hit the obstruction - Attempt to flush the obstruction into the bladder using sterile saline - Cystocentesis may be needed to relive bladder distension if severe - Once obstruction dislodged, insert the catheter into the bladder to allow it to decompress & collect a urine sample - Flush the bladder & suture the urinary catheter in place (make sure animal is wearing an E-collar so they can’t remove it themselves) Hospital plan: - Closed collection system with indwelling urinary catheters - Correct water & electrolyte imbalances with fluid therapy - Monitor urea & creatinine (post-renal azotaemia) - Monitor urine output (post-obstructive diuresis) - Hypokalameia - Urinary catheter removed after 24 hours & cat should be observed in hospital for urination for another 12-24 hours

Answer 77

- CKD may progress to renal failure when compensatory mechanisms cannot maintain normal renal function - A diagnosis of CKD can be made when abnormalities associated with CRF have been present for >3 months Cx: - Slow onset PU/PD - Anorexia, vomiting, diarrhoea & weight loss - Dehydration - Poor body condition & dull dry haircoat - Pale MM (non-regenerative anaemia) - Small irregular kidneys Diagnosis: - Urinalysis - USG 1.008-1.012 isosthenuric (but if the animal is dehydrated & you get isosthenuric urine you know something is wrong with the kidneys as should be concentrated if dehydrated). Proteinuria +/- Pyuria or bacteriuria - Haematology - non-regen anaemia (may be masked by dehydration), mature neutrophilia & lymphopenia (stress leukogram) - Biochem - azotaemia, elevated SDMA, hyperphosphataemia, hypokalaemia, normal to low calcium Staging: - IRIS staging - Chronic kidney disease is staged according to serum creatinine & SDMA concentrations in the hydrated patient - Purpose to provide treatment & monitoring recommendations Treatment: - Provision of a commercial ‘renal’ diet (decreased protein, phosphorus & sodium & supplemented with omega-3 fatty acids) - May need to add enteric phosphate binders - Metoclopramide, H2 blockers, gastrostomy or oesophagostomy tubes - Systemic hypertension, use ACE inhibitors +/- amlodipine - For proteinuria, use ACE inhibitors such as benazepril / enalapril or angiotensin receptor blocker such as telmisartan - Intermittent supplementary fluid therapy

Answer 78

- Rodenticide - Snail bait

Answer 79

- Creatinine, blood pressure, urine protein creatinine ratio (UPC) – can also include SDMA

Answer 80

- Magnesium, ammonium, phosphate

Answer 81

- Ectopic ureter = congenital abnormal exiting of the ureter - Intramural (most common in dogs) = ureter enters trigone region but fails to open at mucosal surface of bladder > continues to run within bladder wall to its exit point - Extramural (most common in cats) = ureter runs completely separate to bladder wall then enters caudal bladder or urethra Cx: - Urinary incontinence as urine isn't stored & goes directly to ureter > leaking, recurrent UTI Affects: - Congenital - high incidence in female Labs / Golden Retrievers Dx: - Excretory urogram via rads or CT +/- cystoscopy - most have hydroureter Treatment: - Intramural - side to side neoureterocystostomy or laser ablation - Extramural - end to side neoureterocystostomy (reimplantation) - Nephrectomy - if kidney is non-functional (usually severe hydronephrosis)

Answer 82

- Erythema = red skin - Due vasodilation of blood vessels & inflamed skin - Dermatitis = inflammation of skin, hence erythema & dermatitis can usually be used interchangeably Possible causes: - Parasites - Infections - Allergies - Environmental insults e.g. sunburn

Answer 83

Rash = blotchy / spotty redness with normal skin in between Dermatitis = red all over

Answer 84

Papule = a red spot up to half a centimetre in diameter. Pustule = a red spot but with a pus-filled centre (neutrophils > micro-abscessation)

Answer 85

Hyperpigmentation: - Skin that should be white or pink but goes balck - Due to increased melanin in epidermis - Occurs commonly in dogs, very rarely in cats - Causes: post-inflammatory (chronic) is the most common cause, endocrine (cushing's) Hypopigmentation: - Skin or hair that should be black or dark but goes white - Due to decreased melanin - Much less common than hyperpigmentation - Causes: congenital / hereditary (e.g. albinos), vitiligo (acquired skin disease where pigment is lost), immune-mediated (e.g. lupus), environmental injury (e.g. freeze branding > patch of white skin / hair)

Answer 86

Scaling (called dandruff in humans): - Grossly visible corneocytes - Abnormality of cornification - Comes off & sticks to the hair Crust: - Mixture of stratum corneum cells (e.g. neutrophils) & tissue fluid - Crust is attached to the skin surface unlike scaling - Causes: pustular diseases, draining exudates, healing wounds

Answer 87

- Comedones are also known as blackheads - Caused by an accumulation of keratin in the hair follice - Abnormality of follicular cornification in the follicle, not on skin surface - Causes: Demodex (mites > excessive scale production in follicle), hormonal skin diseases (e.g. hypothyroidism / cushings > hair loss from loss of hair cycle > plugging of hair follicle with this black material)

Answer 88

Taking a history: - Questionnaire to be filled out prior to appointment Physical exam: - Examine skin using - vision, touch, smell (e.g. odour from skin or ears) - Examine animal from a distance - scratching, swellings, obvious hair loss - Look for skin lesions (abnormality in the skin) - visually assess skin, palpate - Determine distribution (where the lesions are) - look all over - Check for parasites Assessment: - Based on the data you have from the history & physical exam tell us what you think is going on (i.e. what's the predominant problem & what are the differential diagnoses) Plan: - Diagnostic plan > leads to treatment plan Diagnostic tests: - Tests to find microscopic parasites - hair plucks, skin scrapings - Tests to find bacteria & yeast - cytology, culture - Tests to find dermatophytes (ringworm) - woods lamp, cytology, hair plucks, culture - Tests to investigate allergies - skin testing, IgE blood testing - Tests to investigate alopecia - hair plucks, blood tests, hormone tests, biopsy - Tests to investigate nodules, masses & swellings - FNA, biopsy Treatment: - Should be specific if possible - i.e. kill a parasite or treat an infection - Sometimes is non-specific i.e. treating itch - Antiparasitics - Antibiotics - Antifungals - Glucocorticoids (steroids) - Anti-allergic drugs - Topical therapy

Answer 89

Ectoparasites: - Fleas - most commonly affect body - Lice - most commonly affect body - Sarcoptes - affects ears & sometimes paws - Demodex - affects the paws. Can lead to pruritus but a lot of dogs that have demodicosis don't have itching. More likely causes loss of hair (follicular disease) - Otodectes - affects the ears - unlikely in adults, common in young animals - Trombicula - small orange dots in between toes & on ears. Seasonal. More likely in rural areas. - Ticks - Insect bites - tend to bite animals around face / ears Infections: - Staphylococcal pyoderma - commonly affects paws & ears - Malasezzia overgrowth - commonly affects paws & ears Allergies: - Atopic dermatitis - Food allergy - Contact dermatitis - usually causes rash on stomach Miscellaneous: - Otitis - Acute moist dermatitis - Acral lick dermatitis - Anal sac problem - Grass seeds

Answer 90

- Examination of hair plucks and tape strips to rule out ectoparasites and infections

Answer 91

- Flea allergy dermatitis - this particular location is characteristic of flea allergy dermatitis

Answer 92

- Lesions on medial pinna of ear = allergy dog - Lesions on outside of pinna = sarcoptic mange - Lesions at proximal end of the limb (around elbow, hock, stifle) rather than distal end = sarcoptic mange Diagnosis: - By skin scraping (only ~50% of cases are able to be diagnosed by skin scraping, easily missed!)

Answer 93

Isoxazolines (deal with all parasites - use to rule out parasites as a cause): - Afoxolaner (e.g. Nexgard by Merial) - Fluralaner (e.g. Bravecto by MSD) - Sarolaner (e.g. Simparica by Zoetis) - Lotilaner (e.g. Credelio by Elanco) Others: - Spinosad (e.g. Comfortis by Elanco) - Fipronil (e.g. Frontline by Merial) - Imidocloprid (e.g. Advantage or Advocate by Bayer) - Moxidectin (e.g. Advocate by Bayer) - Selamectin (e.g. Revolution by Zoetis) - Indoxacarb (e.g. Activyl by MSD)

Answer 94

Path: - Diverse range of bacteria that inhabit the skin (including Staph) - Something causes dysbiosis of the skin (e.g. allergic or genetic predisposition to poor skin defence mechanism) > inflammation of the skin > suddenly the Staph are overgrown > if you get enough of them > lesion (papule or pustule) Cx: - Papules +/- pustules, epidermal collarettes (characteristic "Staph rings"), scaling - You will see lesions with a Staph infection, not just red skin! Treatment: - Try to avoid using antibiotics where possible (go to treatment in the past was Cephalexin) - Try to use topical treatments - Need to address underlying allergy o Apoquel – if a dog is on Apoquel for allergy it will stop the dysbiosis > Staph overgrowth - Need to treat the inflammation – bacteria thrive on the inflammation > overgrowth so need to stop this

Answer 95

Path: - Malasezzia pachydermatitis = budding yeast - Oval, russian doll, peanut or snowman shaped. - Malasezzia is still caused by a dysbiosis - Can be secondary to allergy but usually Malasezzia is primary cause Cx: - Causes erythema, greasy skin, yellow scale, yeasty smell, hyperpigmentation, lichenification - Tends to affect moist areas - ears, in between toes, armpits, under neck - Basset Hounds predisposed Treatment: - Apoquel doesn't work well for yeast dermatitis! - Generally try to avoid systemic treatment - Topical treatment - Itraconazole, ketoconazole (no longer available) - Best treatment = Miconazole / Chlorhexidine shampoo e.g. Malaseb

Answer 96

Atopic dermatitis = a genetically predisposed inflammatory & pruritic allergic skin disease with characteristic clinical features, associated most commonly with IgE antibodies to environmental allergens. Path: - Sensitised T cells go back into the skin & produce cytokines which trigger the ongoing inflammation > trigger the nerves > sensation of itch (IL-31 cytokine = mediator of itch) Cx: - Erythema on the ears, interdigital skin, muzzle, ventrum / abdomen - Porphyrin staining on paws = what people think is saliva staining Dx: - Skin biopsies don’t tell you anything useful (just tells you it has red & inflamed skin) - History - Clinical signs - Rule out other causes of pruritus (e.g. parasites, infections) - Allergy testing – skin test: Inject allergen into dermis > Allergen binds to IgE on mast cell > Mast cell degranulates releasing inflammatory mediators > Vasodilation, erythema, wheal formation - Allergy testing – IgE serology results = Preferred option in cats Treatment: - If severe initially use a course of steroids to get inflammation under control - Transition to Apoquel (Oclacitinib = medium anti-inflammatory action) or Cytopoint (Lokivetmab = doesn't provide much anti-inflammatory action) in the last week of the steroids (once inflammation has reduced)

Answer 97

- Apoquel (Oclacitinib) = janase kinase inhibitor > stops signal from being passed into cell > cell isn't activated - Cytopoint (Lokivetmab) = binds to IL-31 before it gets to the receptor

Answer 98

Clinical features: - Same as atopic dermatitis (erythema on ears, interdigital skin, muzzle, ventrum, porphyrin staining on paws) but may also be GI signs Dx: - Laboratory tests – unreliable - Diet trials: o Commercial diets  Hydrolysed diets – e.g. Anallergenic (Royal Canin), Z/d (Hills)  Anallergenic (RC) is preferrable over Z/d (Z/d can produce allergic response in a handful of dogs despite the fact it’s hydrolysed chicken) o Allergy diets – e.g. skintopic (RC) or derm complete (Hills)  Not nearly as effective as commercial diets but can have some benefits o Home cooked diets - May need to be 6-8 weeks long - Challenge with original food at end - Peter’s method of food trial: have the dog on medication for the first few weeks of the trial & then stop the medication. If the allergy returns it is likely related to the food.

Answer 99

Cx: - Hot spots, pyotraumatic dermatitis, acute exudative dermatitis, wet eczema - Highly pruritic, well circumscribed, red, exudative erosion surrounded by matted fur, caused by self-trauma Possible causes: - Flea allergy - Anal sacculitis - Otitis externa - Atopic dermatitis - Food allergy - Staphylococcal pyoderma - Spontaneous - *Most commonly in dogs with allergies that are uncontrolled > dogs starts biting itself Treatment: - Topical steroid cream with an anti-biotic in it o Main goal is to break the itch > scratch cycle - Avoid using systemic antibiotics

Answer 100

- Dogs that lick their extremities “acral” (i.e. distal limbs) > granulomas - Well circumscribed ulcerated plaque caused by self-trauma Possible causes: - Is there underlying skin disease causing the dog to lick? - Staphylococcal pyoderma, demodicosis, fungal infection, trauma, foreign bodies, atopic dermatitis, food allergy, neoplasia - Is there underlying musculoskeletal disease? Joint disease, nerve dysfunction / pain - Is it simply a behavioural issue? Boredom, separation anxiety, obsessive compulsive disorder Treatment: - Apoquel & Cytopoint typically don’t work - Need a physical barrier e.g. bandage, E-collar - Use steroids initially to get the inflammation down - Might need to look into some behavioural training – is very difficult to get dogs to stop licking!

Answer 101

Miliary dermatitis: - Associated with fleas - Not very common anymore due to widespread use of anti-parasitics - Clinical signs - Crusted papules, most commonly over the dorsal back & around the neck Feline symmetrical alopecia: - Alopecia due to the cat overgrooming - Question as to whether it’s a dermatological issue, behavioural issue or both - Can be seasonal due to allergy - Most common site = ventral abdomen (can then spread up their sides & down their legs) - Under microscope – the ends of the hairs have been barbered / chewed off - These cats may be more prone to hairballs as they are ingesting so much hair Eosinophilic granuloma complex: - Infiltration of eosinophils into the skin > lesions - Typically associated with allergic skin disease in cats (atopic dermatitis, food allergy, flea allergy) - Most common site = upper lip next to canine teeth (indolent ulcer) - Eosinophilic plaques in sites where the cat can lick e.g. axilla, caudal thigh - Cats contain a very allergenic protein in their saliva (Fel d1) Head or neck pruritus: - Cats scratching themselves around the head / neck with their back claws - Approach the same as a dog with an itchy skin condition - Diagnosis: o Rule out parasites (fleas) o Check for any evidence of infection (neutrophils, cocci, malasezzia etc. on cytology) o Rule out ringworm o Consider this an allergic skin condition – diet trial, consider allergy testing Treatment: - Can’t use Cytopoint in cats (it is a canine antibody – will have no effect) - Use of Apoquel in cats is only off-label (tend not to use it unless we really have to) - Can use Cyclosporin in cats - Can use immunotherapy in cats - Can use Prednisolone in cats – you have to double the dose you would use in dogs (otherwise it won’t work)

Answer 102

FOLLICULITIS: - Can progress into furunculosis - Superficial infection confined to hair follicle - Small papule or pustule - No bleeding - No scarring - Typically associated with Staph infection FURUNCULOSIS: - Typically associated with Staph infection - Deep infection - Hair follicle ruptured - Swelling or nodule potentially with some exudate / crusts - When you squeeze the skin you express exudate up to the surface (looks like blood but an impression smear would reveal predominantly neutrophils & macrophages = pus) - O's might describe as the skin is bleeding - Much more common in short haired breeds e.g. English Bull Terriers, Dogue de Bordeaux's PLUS GSD's (immune related) - Treatment: if put on AB's will initially improve but then not resolve completely. Need sterois as well to combat intense inflammatory reaction

Answer 103

- Diffuse infection beneath the skin’s surface - Primarily occurs in young puppies around the age of first vaccination (8-16 weeks) - Can affect multiple puppies in a litter - It is a pyogranulomatous inflammation (combination of macrophages + neutrophils). It is not caused by bacteria (so called sterile). - Can also be called sterile pyogranulomatous dermatitis - Can make the animal systemically unwell - Clinical signs: o Lethargic, anorexic, pyrexic, swelling of the face around the muzzle & eyes, purulent otitis, enlarged submandibular lymph nodes +/- swelling of other areas (paws, prepuce) - Diagnosis: o Characteristic clinical signs o Can appear like a bacterial infection but if you do cytology on the pus there will be hardly any bacteria in it o Rule out demodicosis – hair pluck, skin scraping, impression smear from pus - Treatment: o Gets better with steroids – but can get permanent scarring

Answer 104

- Pretty much exclusive to German Shepherds – it is related to immune system o Whenever you examine a GSD examine the anus area for this condition! - Involves the development of fistulae (tract) around the anus - It is immune-mediated (lymphocytic) - A lot of them seem to cope very well with the condition not appearing to be in pain - Severe cases can look as though the anus is almost free-floating / eroding away - Treatment: o Responds to immunosuppressive therapy, not anti-bacterial therapy o Treatment of choice = Cyclosporin o Start off on Cyclosporin first & then transition to Tacrolimus (topical cream) either on its own or in conjunction with Cyclosporin o It is costly to treat

Answer 105

- Often breed specific o E.g. Pugs, French bulldogs will often get it in the skin fold on their face o E.g. Cocker Spaniels will often get it in the loose gum on the outside of their mouth o E.g. Bulldogs in the tail fold o E.g. Sharpei – skin folds anywhere - Can occur around the vulva - Treatment: o Conservative option = keep them clean & dry. Wash them with Chlorhex, apply a barrier cream e.g. nappy rash o Curative option = surgical removal of folds

Answer 106

- Probably the most common autoimmune causing skin condition - Due to an immune-mediated attack on the basal cell layer of the nose > separation of epidermis from underlying dermis - Risk factor = UV exposure - Common site = bridge of the nose at the junction where the nose meets the skin - Common signs: o Get loss of cobblestone (spotty appearance of nose) > nose texture smooths out o Ulcerative o Will often see depigmentation due to melanocytes residing in basal cell layer o If it occurs for too long it can turn into squamous cell carcinoma - Treatment: o Topical steroid cream or topical Tacrolimus o If topical treatment doesn’t work then need systemic treatment: Atopica or Cyclosporin o Some new research suggesting Apoquel works

Answer 107

- High negative inspiratory pressure

Answer 108

- Is a salvage procedure

Answer 109

- Medical management including anti-inflammatories and antitussives

Answer 110

- All stages of laryngeal collapse

Answer 111

- Caudal margin of the tonsil crypt

Answer 112

- Penetrating the chest wall at the 7th or 8th intercostal space

Answer 113

- Along the ventral floor of the chest

Answer 114

- None of the above

Answer 115

- A synthetic pheromone that mimics the natural familiarity pheromone

Answer 116

- 2-9 weeks

Answer 117

- Providing an alternative structure to scratch

Answer 118

- The foetal heart rate is greater than 200bpm indicating foetal distress

Answer 119

- After two oestrous cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing

Answer 120

- Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated

Answer 121

- Squamous cell carcinoma is the most commonly identified oral tumour in cats

Answer 122

- Dehydration

Answer 123

- Hypothermia

Answer 124

Route of administration: intravenous (catheter in place) Analgesic: Methadone

Answer 125

- Turn down the inhalant agent, if possible

Answer 126

Elmo is rebreathing CO2 (should be going back down to baseline) Increase O2 flow rate

Answer 127

Prevention: - Prewarming prior to any induction, warm IV fluids, blankets / drapes to cover during surgery. Warm air blanket during surgery. Minimise surgery time. Warm pad on the surgery table. Treatment: - More difficult than prevention, all above mechanisms should be employed if hypothermia occurs. Regular monitoring is important.

Answer 128

Ventricular asystole Manage with CPRC (chest compressions, cardiac pump model, continuous and effective – most important aspect of CPRC). Adrenaline and/or vasopressin and check airway for signs of obstruction.

Answer 129

- Any of the above

Answer 130

- An atypical immune response of unknown cause

Answer 131

- Extraction

Answer 132

- 4/0 Glyconate (monosyn)

Answer 133

- They have never been reported in the cat

Answer 134

- Bronchodilators (acute), corticosteroids (chronic)

Answer 135

- Laryngeal paralysis

Answer 136

- Thorough physical examination, followed by skull radiographs or CT and then rhinoscopy

Answer 137

- Stridor is a high pitched inspiratory noise, stertor is snoring or snorting.

Answer 138

- All of the above

Answer 139

- Benzodiazepines

Answer 140

False (pregnant animals are more sensitive to anaesthetic drugs)

Answer 141

1. What is the major ocular abnormalities and what is the recommended treatment? - Cataracts - treatment? 2. What is a differential diagnosis of this condition in an elderly dog that was 10 years old. What is its recommended treatment? - Nuclear sclerosis. No treatment for nuclear sclerosis, degenerative disease in older animals. 3. What ophthalmic examination technique could you employ in this dog to tell the difference between your two possible diagnoses? - Ophthalmoscopy

Answer 142

Pulses electrical activity: consistent and repeated QRS complexes, narrow complexes, no pulses associated with complexes and heart rate 126 bpm Perfusing rhythm: consistent and repeated QRS complexes (can’t see rest of ans) Ventricular fibrillation: consistent and repeated QRS complexes not present, random and non-repeatable ECG trace, no pulses detectable Asystole: Consistent and repeated QRS complexes not present (cant see the rest) Pulseless ventricular tachycardia: Consistent and repeated QRS complexes, wider complexes, no pulses associated with the complexes and a heart rate of 228

Answer 143

- Atropine should be used every cycle of CPR

Answer 144

- Chest compressions

Answer 145

- Minimum number of trays = number of cats + 1 - Must be at least 1.5x length of the cat from nose to tail - Daily cleaning required - Complete disinfectant wash with enzymatic cleaner at least weekly - Litter type of cats preference - Tray where somewhere cat wont be disturbed

Answer 146

- The dog may have a mental health disorder best addressed through behavioural consultation

Answer 147

- Stop taking the dog for walks as it is currently not beneficial and likely making the dog worse

Answer 148

Medication Behaviour modification Environmental management Monitoring progress

Answer 149

- Continue to the fluoxetine for another 4 weeks before reassessing its effect

Answer 150

- Oropharyngeal foreign body or injury

Answer 151

- Inflammatory bowel disease, giardiasis, intestinal lymphoma, food intolerance

Answer 152

- A 5 day course of fenbendazole

Answer 153

- Barium radiographic contrast study

Answer 154

- Prednisolone and a limited antigen diet

Answer 155

- Pre-digestion of protein results in peptides that are too small to aggregate IgE

Answer 156

- Analysing a blood sample for evidence of metabolic disease

Answer 157

- Pancreatitis

Answer 158

- Admit the dog for abdominal radiography

Answer 159

- It can be associated with dental disease in small breed dogs

Answer 160

- Pancreatitis, IBD, cholangitis

Answer 161

- It causes release of pancreatic lipase into the circulation

Answer 162

- Persistent right aortic arch

Answer 163

- Anaesthesia

Answer 164

- Nodular hyperplasia

Answer 165

- ALP and GGT

Answer 166

- Stimulates bile flow

Answer 167

- Normocytic normochromic non-regenerative anaemia due to lymphosarcoma

Answer 168

Petechiae, thrombocytopaenia

Answer 169

To extend your initial blade scalpel stab incision into the linea alba to open up the abdomen in a 3kg cat: Straight metzenbaum’s To make the stab incision into the linea alba of a 2kg cat: Scalpel blade (no. 15) To hold the linea alba whilst making the initial stab incision to enter the abdomen in a 3kg cat: Adson forceps To hold up the linea alba, whilst making the initial stab incision to enter the abdomen in a 30kg dog: rat tooth forceps The instrument used to make a subcutaneous tunnel, by elevating the subcutaneous tissue from the external rectus sheath, exposing the linea alba, in a 15kg dog spay: curved Metzenbaum scissors To extend your initial scalpel blade stab incision into the linea alba and to open up the abdomen in a 30kg dog: straight mayo scissors To clamp the ovarian pedicle before ligation in a 40kg dog spay: curved Rochester Carmalt’s To clamp the ovarian pedicle before ligation in a 10kg dog spay: curved crile forceps To clamp the ovarian pedicle before ligation in a 6 month old prepubescent kitten spay weighing 2kg: Halstead mosquito forceps To clamp the uterine body before ligation in a 4kg cat: Curved crile forceps To provide temporary haemostasis of a small bleeding vessel in the subcutaneous tissue: Halstead mosquito forceps The forceps used to atraumatically grasp abdominal contents in a cat (e.g. bladder or intestines): DeBakey forceps To grasp the proper ligament to assist manipulation of the uterine horn and ovary during a spey: Halstead mosquito forceps After ligation of the spermatic cord, the instrument used to grasp the ductus deferens only, immediately before releasing the pedicle back into the tunics: Halstead mosquito forceps To retract both medial edges of the subcutaneous tissue to improve visualisation during linea alba sututing: Allis tissue forceps Grasping the subcutaneous tissue during a simple continuous layer closure in a dog castrate: Adson brown forceps Tissue forceps used when applying skin sutures in a cat: Adson Brown forceps

Answer 170

- Along the ventral floor of the chest

Answer 171

- None of the above

Answer 172

- The flail chest segment collapses on inspiration

Answer 173

- Placing a plastic splint on the rib cage extending past the rib fractures and suturing it around the ribs within the flail chest segment

Answer 174

- A condition that develops when several adjacent ribs are fractured, in two or more places along each rib.

Answer 175

3 H’s: history / hello, help, hazard ABCDE: Air, breathing, circulation, demeanour, everything else

Answer 176

- Vasoconstriction - pale MM, prolonged CRT, peripheral temp < core temp, reduced urine output - Decreased mentation - Tachycardia (cats may present with bradycardia) - Hypotension (poor pulse quality) - Reduced oxygen saturation (low SpO2) - Lactate >2 mmol/L - Metabolic acidosis

Answer 177

- Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat

Answer 178

- Where there is evidence of foetal distress

Answer 179

- Pyometra in oestrus typically 4-10 weeks after last diestrus

Answer 180

- Squamous cell carcinoma is the most commonly identified oral tumour in cats

Answer 181

- Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated

Answer 182

- Wide surgical excision with rostral mandibulectomy may be curative for a small squamous cell carcinoma associated with the lower central incisor teeth

Answer 183

- Regurgitation after eating and drinking, dehydration, coughing

Answer 184

- Attempt endoscopically oral intervention first, if unsuccessful perform a cervical oesophagotomy

Answer 185

- Close the mucosa and muscularis in two layers, leaving the mucosal knots intraluminally

Answer 186

- Tension on an oesophageal wound closure is likely to result in stricture formation

Answer 187

- The pup probably has a complete intestinal obstruction

Answer 188

- Hypoproteinaemia will increase the risk of dehisence of the bowel if resection is needed

Answer 189

- Dogs with a lactate level over 6 have a worse prognosis, due to a higher chance of gastric necrosis

Answer 190

- Intravensouly at induction to obtain high circulating blood levels at the time of surgery

Answer 191

- Place the bowel between moistened laparotomy sponges

Answer 192

- Incising on the antimesenteric border from point C to D (towards aboral side)

Answer 193

- Manually reduce the intussusception via gentle traction and assess the viability of the bowel prior to resecting any tissue that appears to be non-viable

Answer 194

- All of the above

Answer 195

- The dog will have a decreased functional transit time (speeds up passage)

Answer 196

- Appositional

Answer 197

- Long acting monofilament (e/g Polydiaxanone)

Answer 198

- Placing active suction drains in the abdomen at the time of surgery and performing cytology and glucose levels on the abdominal fluid

Answer 199

- External rectus sheath

Answer 200

- Lidocaine has a rapid onset (2-5min) but limited duration (20-120min)

Answer 201

- Right infraorbital nerve block

Answer 202

- Complicated crown fracture

Answer 203

- Both extraction and root canal options should be offered to the client

Answer 204

- Many or all of the teeth are affected, but this may only be microscopic

Answer 205

2nd molar Periodontal disease Complete extraction

Answer 206

- None of the above

Answer 207

- A 5 year old cat has received a tick anti-toxin serum only once before

Answer 208

- Low respiratory score on presentation

Answer 209

- Canine adenovirus

Answer 210

- Feline immunodeficiency virus

Answer 211

- Using the intranasal vaccine subcutaneously avoids causing clinical disease

Answer 212

- Vaccination prevents carriers from shedding the virus

Answer 213

- Chlamydia felis

Answer 214

B and D B. Recently infected cat D. Overwhelming end stage disease in an infected cat

Answer 215

- Myoclonus (facial ticks)

Answer 216

- Stomatitis, gingivitis

Answer 217

- Visualise with laryngoscope blade on top of tube to see both arytenoids - Look for condensation in the ETT - Use a capnograph

Answer 218

1. Which of the following is the best explanation? - Normocytic normochromic non-regenerative anaemia due to lymphosarcoma. 2. Suppose normocytic normochromic non regenerative anaemia due to lymphosarcoma was the correct answer. Which of the following is the most appropriate anaemia management strategy - No specific therapy for anaemia continue treating lymphosarcoma 3. Suppose microcytic hypochromic poorly regenerative anaemia indicating chronic blood loss was the correct answer, which of the following is the most appropriate next management step for anaemia? - Re-evaluate the case to determine the source of chronic blood loss 4. Which of the following statements is the best assessment of the dogs 1 week neutropenia? - Neutropenia is an expected adverse effect of vincristine and is likely to be temporary.

Answer 219

What is the single most important abnormality? (1 mark) - Marked lymphocytosis What is the likely diagnosis? (1 mark) - Lymphocytic leukemia What drug is recommended to treat this condition? (1 mark) - Chlorambucil

Answer 220

Petechiae Thrombocytopaenia

Answer 221

Popliteal lymph node palpation and cytology, abdominal ultrasound

Answer 222

Incisional biopsy for diagnosis, treat initially with castration

Answer 223

Squamous cell carcinoma

Answer 224

Cyclophosphamide induced sterile haemorrhagic cystitis, bacterial cystitis

Answer 225

c. Doxorubicin Doxorubicin is known for its cardiotoxic effects, which can be particularly problematic in breeds like Doberman Pinschers that are prone to heart conditions such as dilated cardiomyopathy (DCM). Administering doxorubicin in a dog with even early asymptomatic DCM could exacerbate cardiac issues, increasing the risk of worsening heart disease and potentially leading to congestive heart failure

Answer 226

c. There is a good medium – long term prognosis with chemo or radiation therapy

Answer 227

b. Chlorambucil Chlorambucil is an alkylating agent that is well-tolerated in cats, making it suitable for low-grade alimentary lymphoma, which typically requires long-term, less aggressive treatment. It’s often combined with prednisolone for a synergistic effect and can help achieve long-term remission in many cases. Vincristine and Cisplatin are not commonly used for low-grade alimentary lymphoma in cats. Vincristine is more often used in high-grade lymphoma protocols, while Cisplatin is generally avoided in cats due to its high nephrotoxicity.

Answer 228

The dogs lymph nodes and spleen are normal size, but microscopic disease is still likely present

Answer 229

Briefly outline the approach to determining if this abnormality is significant (2 marks) - Recheck total calcium, if still high then check ionised calcium. If normal, no further investigation needed. What pathologic process is the single most likely cause of hypercalcaemia in dogs (1 mark) - Neoplasia

Answer 230

What is the best interpretation of the cats problems? (2 marks) - Mild azotaemia, likely pre-renal, inappetence may be due to splenogmegaly What is the next most logical investigation to obtain a diagnosis? (1 mark) - Fine needle aspiration of spleen

Answer 231

What is the main condition it must be differentiated from (1 mark) - Inflammatory bowel disease What is the best diagnostic test to reach a firm diagnosis (1 mark) - Tissue biopsy of the affected intestine with histopathology Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment and what is the prognosis for the cat? (2 marks) - Standard treatment is chemotherapy (chlorambucil) & prognosis is good for medium-long term survival

Answer 232

b. Small intestinal obstruction, intussusception, pancreatitis, gastric FB

Answer 233

c. Marked elevation in ALT and mild elevation in ALKP

Answer 234

Maropitant and s-adenosyl methionine

Answer 235

c. Hypercalcaemia Hyperglycemia can occur with pancreatitis due to stress and possible disruption of pancreatic insulin regulation. Elevated ALKP is often seen with pancreatitis, as inflammation can affect nearby liver and biliary structures, causing an increase in ALKP. Hypercalcemia is unusual in pancreatitis and can actually be a risk factor for its development rather than a common concurrent finding. Pancreatitis is more likely to be associated with hypocalcemia due to the precipitation of calcium in areas of fat necrosis.

Answer 236

B. Hepatic failure Renal failure can cause gastric ulceration due to the accumulation of uremic toxins, which irritate the gastrointestinal mucosa. NSAID treatment is a well-known cause of gastric ulceration due to its inhibition of prostaglandin production, which is essential for maintaining the protective gastric mucosal barrier. While hepatic failure can lead to gastrointestinal issues, including ulceration, it is less commonly a direct cause of gastric ulcers compared to renal failure and NSAID use. However, severe liver disease can predispose to GI bleeding due to coagulopathies and altered blood flow, but it is generally less associated with direct ulcer formation

Answer 237

Haemolytic anaemia

Answer 238

Omeprazole

Answer 239

b. Enrofloxacin Apomorphine is an emetic agent commonly used to induce vomiting in dogs, making it highly likely to cause this effect. Cyclosporin can cause gastrointestinal upset, including vomiting, especially when first introduced or if given on an empty stomach. Enrofloxacin (a fluoroquinolone antibiotic) is less commonly associated with vomiting compared to the other two drugs, though it may cause GI upset in some cases.

Answer 240

c. Identify the underlying cause Anorexia in dogs can be due to a wide range of medical issues, and addressing the underlying cause is essential for effective treatment and for ensuring that appetite stimulants or feeding tubes are used appropriately

Answer 241

Intussusception

Answer 242

Exocrine pancreatic insufficiency

Answer 243

b. Analysing a blood sample for evidence of metabolic disease

Answer 244

Provide dietary advice and antiemetics

Answer 245

Admit the dog for abdominal radiography

Answer 246

Pancreatitis, IBD, cholangitis

Answer 247

It causes release of pancreatic lipase into circulation

Answer 248

Anaesthesia

Answer 249

Nodular hyperplasia

Answer 250

Low respiratory score on presentation

Answer 251

Neurotoxin: inhibits release of presynaptic AcH from neuromuscular junction (flaccid paralysis) Myotoxin: binds skeletal muscle fibres causing progressive destruction of cells

Answer 252

1. List 4 differential diagnosis. - Urolithiasis - Neoplasia - Benign prostatic hyperplasia - Prostatitis - Toxins 2. Describe your diagnostic approach for the above case. - Full physical examination - Full blood test, urinalysis with urine culture and sensitivity - Abdominal radiographs to assess urinary tract and rule out obstruction - Abdominal ultrasound to rule out neoplasia and examine prostate

Answer 253

Increased ADH secretion

Answer 254

B. Stage 3: substage non-proteinuric and normotensive CKD Staging (based on serum creatinine after rehydration): Mitzi’s serum creatinine is 200 µmol/L after rehydration. According to IRIS: - Stage 2 CKD: creatinine 140-249 µmol/L. - Stage 3 CKD: creatinine 250-439 µmol/L. - Therefore, Mitzi falls into Stage 3 CKD.

Answer 255

a. Bacterial infection Feline Lower Urinary Tract Disease (FLUTD) is a term used to describe a group of urinary tract disorders in cats. The most common causes include: - Idiopathic cystitis (commonly referred to as feline idiopathic cystitis or FIC), which is the most common cause and often has no known underlying cause. - Urethral plugs, which are typically composed of a mixture of mucus, inflammatory cells, and crystals and can cause obstruction and discomfort.

Answer 256

SDMA levels start to increase when there is a 75% loss of kidney function

Answer 257

The colonic mucosa is sutured to the lateral abdominal wall

Answer 258

Thin and small stature, low albumin and urea, increased pre and post prandial bile acids

Answer 259

e. None of the above a. Bladder is palpable: While palpation of the bladder may give some insight into its size and tone, it cannot definitively rule out a rupture or leakage. In some cases, a ruptured bladder may still be palpable if it is not fully emptied or the rupture is small. b. The animal is able to urinate normally: The ability to urinate does not rule out a bladder rupture. Some dogs may still be able to pass urine if the rupture is small or the leak is not severe. c. There is no abdominal effusion visible on abdominal radiographs: While abdominal effusion (fluid accumulation) can be seen in cases of bladder rupture, its absence does not definitively rule out a rupture, as the fluid may not accumulate in a detectable amount, or the rupture may be localized. To definitively confirm bladder rupture or leakage, diagnostic tests like contrast cystography, ultrasonography, or abdominal fluid analysis (to detect urine) are typically required. These tests can provide more accurate information regarding the integrity of the bladder.

Answer 260

1. What is the most appropriate initial treatment? - Evaluate the dogs medical status and stabilise the dog before attempting to relieve the urethral obstruction 2. The same dog presents to you 1 year later with another urethral obstruction at the same location. You decide to perform a permanent urethrostomy. At what location is it best to perform this? - Scrotal Easier to access surgically. Provides wider urethral opening and better postoperative healing. Less likely to cause complications such as stricture formation when compared to the perineal location. The scrotal area provides a less traumatic approach, with a good outcome in terms of function and comfort. Perineal urethrostomy is another option but is typically used for cases where scrotal urethrostomy is not feasible or desirable. It involves a more challenging approach and has a higher risk of complications such as stricture. Pre-pubic urethrostomy is less commonly performed and is used in very specific cases, typically involving severe trauma or anatomical abnormalities of the pelvic region

Answer 261

- Initial stabilisation: begin with IV access and continual monitoring. - Bloodwork: CBC, chemistries, electrolytes, coagulation profile, blood gasses - Oxygen delivery - Fluid therapy - Analgesia / sedation - Radiographs - AFAST / TFAST ultrasound

Answer 262

a. Labrador with a lytic lesion in the distal radius and pathologic fracture

Answer 263

The lymph node may be the sentinel lymph node for this tumour and should be evaluated by palpation and biopsy

Answer 264

a. During surgery care must be taken with haemostasis as mast tumour sites have increased risk of haemorrhage Mast cell tumours (MCTs) can be highly vascular, meaning they may bleed more than other types of tumours. During surgery, careful haemostasis is needed to manage this bleeding risk. Option b: Margins of at least 3cm in all directions are generally considered ideal for complete excision of high-grade mast cell tumours or tumours in high-risk locations (e.g., near vital structures). However, for low-grade MCTs, a 2cm margin is often adequate for complete excision, particularly in well-defined, isolated tumours. 3cm margins are typically not required unless the tumour is high-grade or in a location where aggressive behaviour is expected. Option c: Adjuvant chemotherapy is not always required for low-grade cutaneous MCTs, especially if the tumour is completely excised with clean margins and there is no evidence of metastasis. Surgery alone can often provide a cure. Chemotherapy is generally more important in cases of high-grade tumours or those with metastasis or incomplete excision.

Answer 265

The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment

Answer 266

Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy

Answer 267

b. Secondary intention healing is characterised by formation of granulation tissue, wound contraction and epithelialization Second intention healing occurs when a wound is allowed to heal without surgical closure (i.e., no sutures are used). It involves: Granulation tissue formation: This tissue forms in the wound bed and provides a foundation for further healing. Wound contraction: The wound edges gradually move toward each other, reducing the size of the wound. Epithelialization: New epithelial cells migrate across the wound surface, covering the defect

Answer 268

- Cat bite abscesses are best treated by drainage and lavage

Answer 269

c. A suitable treatment option is to manage infection, close the wound and immobilise the area Axillary skin wounds in cats are particularly challenging to manage due to the region’s limited skin mobility and lack of subcutaneous tissue, which can make closure difficult and may delay healing

Answer 270

Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat

Answer 271

Where there is evidence of foetal distress

Answer 272

Pyometra occurs in oestrous typically 4-10 weeks after last diestrus

Answer 273

c. Along with salivary gland, removal the secretory lining of the mucocoele should be removed

Answer 274

The oral cavity contains normal bacterial flora comprising mainly gram positive aerobes and anaerobes

Answer 275

Wide surgical excision with rostral mandibulectomy may be curative for a small squamous cell carcinoma associated with the lower central incisor teeth

Answer 276

Fluid is more hypoechoic than the surrounding parenchymal organs such as the spleen

Answer 277

The glide sign of the B lines and/or lung surface is abnormal and indicative of pneumothorax

Answer 278

Collapsing trachea

Answer 279

c. Idiopathic

Answer 280

1. What is your first step in clinical examination of Thor? - Provide supplemental oxygen and obtain a brief history 2. What is the single best diagnostic procedure to perform now? - Thoracic radiographs 3.Suppose Thor’s diagnosis is idiopathic allergy bronchitis. What therapy should be administered, and what is the short term (12-14h) prognosis? - O2 therapy, corticosteroids, bronchodilators. Good prognosis with rapid response

Answer 281

Fluticasone Albuterol

Answer 282

1. Name the single most likely diagnosis for these cats. - Feline Herpes Virus 1 (FHV-1) - The recent introduction of a dog could have caused stress in the cats, potentially leading to a reactivation of latent FHV-1 in previously infected cats, or it could have been a source of stress that contributed to an outbreak of clinical signs. FHV-1 can remain latent in cats and reactivate under stress or immunosuppression 2. What tests can be done to confirm the diagnosis. - PCR (Polymerase Chain Reaction): This is the most sensitive and specific test for detecting FHV-1 DNA from nasal, ocular, or oropharyngeal swabs. PCR can detect both active and latent infections. - Virus Isolation: Although not commonly used in routine practice, virus isolation from conjunctival or nasal swabs can confirm the presence of the virus, but it requires specialized laboratory facilities and can be time-consuming. - Serology (Antibody Titers): FHV-1 antibody titers can be tested, but this method is less useful for diagnosing active infection since many cats are already seropositive due to prior exposure or vaccination. It may be more useful for assessing the history of exposure rather than acute infection.

Answer 283

Respiratory: mild pyrexia fits respiratory infection, harsh respiratory sounds and mild lethargy (cardiovascular would be soft crackles), normal heart rate (cardiovascular would expect tachycardia), sinus arrhythmia heart

Answer 284

Serous nasal discharge, tachycardia, tachypnoea, audible respiratory crackles, pulmonary oedema, decreased O2 saturation, ascites, polyuria, exophthalmos, decreased packed cell volume, total plasma protein

Answer 285

Heart rate: bradycardia (body aims to maintain cerebral perfusion by slowing HR) Blood pressure: hypertension (the body increases systemic vascular resistance to try to ensure adequate blood flow to brain) Respiratory rate: irregular or abnormal (due to impaired brainstem function which controls the respiratory centres)

Answer 286

Canine adenovirus 2

Answer 287

b. FeLV antigen and FIV antibody

Answer 288

a. Feline infectious peritonitis

Answer 289

Feline calici virus

Answer 290

Clindamycin

Answer 291

1. Name the route of infection for canine parvovirus (1 mark) - Faecal oral route 2. Name the 2 anatomical regions in the body where rapidly dividing cells are targeted by canine parvovirus (1 mark) - GI tract & bone marrow 3. List 4 clinical pathology findings that may be seen on haematology and biochemistry in a dog with parvoviral enteritis (2 marks) - Leukopenia - Polycythemia - Hypoglycaemia - Panhypoproteinaemia 4. What is the most commonly used in-clinic diagnostic test for canine parvoviral enteritis (1 mark) - Faecal antigen ELISA test

Answer 292

Acute phase: fever, lethargy, lymphadenopathy Asymptomatic phase: minor recurrent infections Terminal phase: stomatitis, gingivitis, periodontitis, upper respiratory tract infection, chronic renal failure, persistent diarrhoea, chronic skin and ear infections, fever and wasting, neoplasia, ocular disease, neurologic abnormalities

Answer 293

Premature separation from the queen and kittens may lead to some behavioural problems such as frustration and aggression

Answer 294

Complex aetiology of lower urinary tract signs and other stress related signs like gastrointestinal upsets

Answer 295

Urine spraying

Answer 296

Related females and their offspring

Answer 297

In entire cats, but not desexed cats

Answer 298

a. Be caused by a monoxamine oxidase inhibitor medication with a selective serotonin reuptake inhibitor medication Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonin activity in the central nervous system. It can occur due to the interaction of medications that increase serotonin levels, most notably: Monoamine oxidase inhibitors (MAOIs), which inhibit the breakdown of serotonin, and Selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels by blocking its reuptake into nerve cells. Treatment typically involves discontinuing the offending drugs, providing supportive care, and using serotonin antagonists like cyproheptadine to block serotonin receptors. Benzodiazepines may also be used for agitation

Answer 299

Fight, flight, fiddle, freeze

Answer 300

Both have some therapeutic actions at serotonin receptors by blocking serotonin re-uptake into the pre-synaptic membrane

Answer 301

- Trazodone

Answer 302

Epinephrine: every 3-5 minutes early in CRP

Answer 303

Inefficient chest compressions

Answer 304

ECG, EtCO2

Answer 305

Compressions, airway, breathing

Answer 306

Call for help

Answer 307

b. Unstable ventricular tachycardia, ventricular fibrillation *Can't do in asystole or pulseless electrical activity!

Answer 308

b. High negative inspiratory pressure

Answer 309

a. Chondrosarcoma

Answer 310

Sutures re placed through cartilaginous tracheal rings for best support

Answer 311

a. Pleural effusion and ascites *Pulmonary oedema is more associated with left sided heart failure

Answer 312

Tachypnoea

Answer 313

d. Tricuspid valve dysplasia

Answer 314

b. Right to left shunting atrial septal defect Right to left shunting atrial septal defect (ASD): In some cases, an ASD (a hole between the atria) can allow blood to bypass the lungs and flow from the right atrium to the left atrium, leading to a right to left shunt. This can result in cyanosis because deoxygenated blood from the right side of the heart is being pumped into the systemic circulation without being oxygenated.

Answer 315

Atrioventricular closure

Answer 316

A dirty acoustic shadow occurs due to the sound wave bouncing back and forth between the gas bubble and the probe surface generating an acoustic shadow that is made up of hyperechoic reverberation lines.

Answer 317

Left forelimb and right hindlimb

Answer 318

d. Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread

Answer 319

c. The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment

Answer 320

b. Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy

Answer 321

- Cranial nerves II and VII

Answer 322

1. What is the most likely differential diagnosis? - Hydrocephalus 2. Assuming the owner has no financial constraints, list 3 diagnostic tests you could perform to confirm your most likely differential diagnosis? - Ultrasound of the brain through the open fontanelles - CT - MRI

Answer 323

- History of access to toxins - Physical examination - Neurological examination - CBC - Serum biochemistry - Urinalysis - Fasting blood glucose

Answer 324

- Permethrin, metaldehyde, strychnine, and some mycotoxins

Answer 325

- Naloxone

Answer 326

- It has a large surface area, some toxins adsorb to it (only unbound toxin)

Answer 327

- Head and limb weakness, vomiting and diarrhoea

Answer 328

- Hypoglycaemia and sometimes hepathopathy

Answer 329

1. List two clinical signs that may be seen. - Weight loss, PU, PD, inappetence, vomiting, diarrhoea, dehydration, lethargy, pale mm, dull dry coat, poor BCS, oral ulceration 2. Apart from azotaemia, list two other possible clinicopathological abnormalities you might find on haematology or biochemistry profiles in Sammy if he has chronic kidney disease. - Non regenerative anaemia, stress leukogram, hyperphosphataemia, hypokalaemia, elevated SDMA, hypocalcaemia 3. You diagnose Sammy with stage III chronic kidney disease with hypertension. Describe an appropriate treatment plan for Sammy. - Renal diet, treatment for hypertension (amlodipines, ACE inhibitors – benazepril), Fluids, anti-emetics, gastric protectants, appetite stimulants

Answer 330

- The recommended treatment for osteosarcoma is limb amputation followed by chemotherapy

Answer 331

- Zoledronate and meloxicam

Answer 332

- Approximately 30% of dogs survive at least 12 months after surgery with adjuvant chemotherapy for splenic hemangiosarcoma *Even with treatment survival is poor, typically <6 months!

Answer 333

- Bone marrow and gastrointestinal tract

Answer 334

- Fibrocartilagenous embolism

Answer 335

Option 1: Surgical re-implantation of the ectopic ureter into the bladder This surgery involves relocating the abnormal, extramural ectopic ureter into the bladder so that it enters at a more normal anatomical site. It can be performed via laparotomy or, in some cases, laparoscopy. The goal is to restore proper drainage of the kidney into the bladder and resolve urinary incontinence. In this procedure, the ectopic ureter is sutured into the bladder at the trigone, allowing it to rejoin the urinary system normally. Option 2: Nephrectomy of the affected kidney If the ectopic ureter is severe or has caused other complications, such as significant damage to the kidney, nephrectomy (removal of the affected kidney) may be considered. This would leave the normal right kidney to continue functioning. However, in this case, both kidneys are reportedly normal, so this option would not be ideal unless there were additional, undetected kidney issues. Preferred option: Option 1 - Surgical re-implantation of the ectopic ureter into the bladder Why this is preferred: Given that the right kidney is normal and the left kidney has no apparent damage or disease, the optimal choice is to correct the anatomy of the left ectopic ureter so it drains properly into the bladder. This surgery has a high success rate in resolving incontinence in dogs with extramural ectopic ureters and can restore normal urinary function, which is the ultimate goal. Since the kidneys are both healthy and there are no signs of infection or renal damage, nephrectomy would not be warranted.

Answer 336

- Resorption of bone from the fracture gap will decrease the inter-fragmentary strain

Answer 337

- It should be removed to allow fracture fragments to contact one another

Answer 338

- Osseous structural support

Answer 339

- In second degree sprain injury to the medial collateral ligaments of the hock of a dog, stressed radiographs of the region will show no instability of the tibiotarsal joint

Answer 340

- Surgical stabilisation is always required if all 4 metatarsals are fractured

Answer 341

- The most common indication is carpal hyperflexion injury from falls

Answer 342

- You perform and arthrocentesis and submit for cytology and bacterial culture, and start the dog on cephalexin and firocoxib in the interim and advise repeat radiographs in 3-4 weeks.

Answer 343

- External skeletal fixator

Answer 344

- Intramedullary pin and circumferential cerclage wires

Answer 345

- Relocation into the acetabulum

Answer 346

- Craniodorsal hip luxation

Answer 347

- Medial patella luxation

Answer 348

- Biopsy is indicated in almost every case except if the biopsy will not alter treatment or carries the same risk as definitive surgery

Answer 349

1. What do you use to fixate? Prognosis & stability of each treatment. - Locking plates or dynamic compression plates - used to provide internal fixation in fractures of long bones or joints. Good for complex comminuted fractures. Prevents compressive, bending & rotational forces. Provide excellent stability - they are generally more stable than external fixators & offer a more permanent solution. - External fixators - Consists of pins inserted into the bone through the skin connected to a stabilising frame outside the body. Ideal for fractures with soft tissue involvement or open fractures. Prevents compressive, bending & shearing forces. Prognosis & stability only good. 2. Contraindications of casting. - Casting is commonly used for fractures that do not involve joints, soft tissue injury, or complex fracture patterns. However, it has limitations and contraindications - Fractures Involving Joints: Casting may not be appropriate if the fracture involves a joint, as the immobilization can affect joint movement and healing. - Comminuted Fractures: For highly fragmented fractures, casting may not provide adequate stability, and surgical fixation may be needed - Open Fractures: If a fracture is open (exposed bone), a cast may trap bacteria and worsen infection. External fixation or surgery is preferred in these cases - Fractures in Highly Active Cats: For some fractures, especially in younger or more active cats, a cast may not provide sufficient immobilization and may fail to prevent displacement of the bone fragments

Answer 350

Active stabilisers: - Active Stabilizers (e.g., muscles and tendons): These contribute to joint stability when contracting and can control motion actively. - - For example, the biceps tendon provides active stability to the shoulder joint. It prevents cranial displacement of the humeral head in the shoulder joint. It works as an active stabiliser when the muscle contracts, helping to hold the humeral head in the glenoid cavity Passive stabilisers: - Passive Stabilizers (e.g., ligaments): These structures provide stability by resisting forces when the muscles are not actively engaged. Ligaments help prevent excessive joint movement by limiting range of motion. - E.g. Medial and lateral collateral ligaments (passive stabilizers): These ligaments are key passive stabilizers in the elbow and knee, restricting excessive lateral or medial movement of the joint. They provide stability by resisting forces that could displace the joint. Shape of ligaments: - Cranial Ligaments (e.g., cranial cruciate ligament) are often straight as they resist cranial translation or other unidirectional forces - Caudal Medial Ligaments (e.g., caudal cruciate ligament) may be Y-shaped or bifurcated to offer support in multiple directions and resist forces from both cranial and caudal directions.

Answer 351

- Primary lens luxation is generally unilateral

Answer 352

- The early development of a focal tan coloured central corneal lesion

Answer 353

- Retinal detachment

Answer 354

- Schirmer tear test of 15-20mm/min

Answer 355

- Stromal melting

Answer 356

- Fluorescein stain

Answer 357

- Lagophthalmos

Answer 358

- Topical and systemic corticosteroids

Answer 359

- Keratoconjunctivitis sicca

Answer 360

- 1% Tropicamide

Answer 361

- Prostaglandin analogues

Answer 362

- Long term topical cyclosporin

Answer 363

- Immediate eyelid "tacking" surgery

Answer 364

- Debride the ulcer bed & continue with topical antibiotics & lubricants

Answer 365

- Are hairs emerging through the Meibomian gland openings along the lid margin

Answer 366

- Pupillary dilation

Answer 367

- Anterior lens luxation

Answer 368

- Reduce stromal collagenase activity

Answer 369

- Glaucoma

Answer 370

- Lipid dystrophy

Answer 371

- Must be treated as an ocular emergency & prompt surgical treatment with a tarsorrhaphy should be undertaken

Answer 372

- Sudden acquired retinal degeneration

Answer 373

- Horner's syndrome

Answer 374

- Check behind the 3rd eyelid for a foreign body

CAP End of Sem 2 Flashcards

(420 cards)