DOGS Flashcards
Campylobacteriosis
Gram negative motile, thin, S-shaped or gull shaped rod. It can occur singly, in pairs or in chains. C. jejuni is the most commonly isolated.
Clinical signs: mucus-laden diarrhea
What needs to be monitored after the removal of an insulinoma?
Hyperglycemia; monitoring blood glucose is important. When performing mass resections of the pancreas the ideal situation is a mass associated with the tail of the pancreas. Otherwise they can be very difficult to excise in their entirety and you run the risk of disrupting the flow of pancreatic enzymes into the duodenum. The pancreas is responsible for secreting insulin which is what stimulates glucose to be removed from the blood stream and taken into the cell. A patient with a mass in the pancreas that is causing hypoglycemia has an insulinoma. Removal of an insulinoma can occasionally lead to hyperglycemia and diabetes mellitus requring insulin administration in dogs.
Salmonella
Gram-negative bacillus
C. difficile
Gram positive rod
Cryptosporidium
Coccidian parasite
Struvite urolithiasis
Large bladder stones in the presence of a UTI and alkaline urine are usually struvite, particularily when accompanied by struvite (magnesium ammonium phosphate) crystalluria. The infecting organisms are usually urease-producers (Staphylococus, Proteus, Klebsiella, some E. coli) which alkalinize the urine and favor struvite formation. The single most important long-term management is prevention of infection.
Calcium oxalate stones
are usually small (1cm or less), are often present in the absence of a UTI and can’t be dissolved
Cystine stones
occur most often in Newfoundland dogs, dachshunds, and bulldogs. They are radiolucent and occur due to metabolic defects.
Urate stones
are usually small and many. They are frequently radiolucent and can be related to underlying liver disease.
What is the most common urinary bladder tumor?
Transitional Cell Carcinoma
Transitional Cell Carcinoma
most common urinary bladder tumor.
Clinical signs: stranguria, pollakiuria, hematuria
Diagnosis: abnormal cells often seen on urinalysis, but can’t diagnose on UA alone. Biopsy is needed for definitive diagnosis.
Treatment: chemotherapy can help these patients shrink the tumor for time (for a better quality of life); however the prognosis is grave.
What is the blood parasite that looks similar to microfilariae of Dirofilaria immitis?
Acanthocheilonema reconditum
What is the difference in treatment between Acanthocheilonema reconditum and Dirofilaria immitis?
Acanthocheilonema reconditum is not pathogenic and is therefore not treated.
What is Central Venous Pressure a measure of?
direct measure of blood pressure in the cranial vena cava. Venous blood volume, venous vessle tone, and cardiac output determine the CVP. CVP is an estimate of preload, not a direct measurment.
What test is both a screening test and a differentiating test for hyperadrenocorticism?
Low dose dexamethasone suppression test. If the 8 hour sample is above 1.4ug/dL, the test is diagnostic for hyperadrenocorticism (either pituitary or adrenal dependent). If the 4 hour sample is below 1.4ug/dL or less than half of the baseline value, it is diagnostic for pituitary dependent hyperadrenocorticism.
What are the different screening tests for hyperadrenocorticism?
-Low dose dexamethasone suppression test
-urine cortisol:creatinine ratio
-ACTH stimulation test
What tests can be used to differentiate pituitary versus adrenal dependent hyperadrenocorticism?
-low dose dexamethasone suppression test
-Endogenous ACTH
-high dose dexamethasone suppression tests
What is the most common direction of luxation in a coxofemoral luxation?
Craniodorsal
What imaging modality is best to identify the lesion in an IVDD suspected patient?
MRI; best imaging modality to visualize the spinal cord
A 4yr old Dachshund has just presented for an acute onset of hind limb ataxia. On PE, there is a lack of voluntary motion of the pelvic limb along with conscious proprioceptive deficits. There is no panniculus reflex caudal to L3.
What diagnosis do you suspect?
Type 1 disc herniation
-this is acute while type 2 is slow and chronic
-Dachshunds are very predisposed to disc disease (particularly type 1)
What is the most common complication following an intestinal resection and anastomosis surgery?
Septic peritonitis
What is the most common time frame for an anastomosis failure?
3-5 days postoperatively; this is due to the timing of degradation of fibrin at the site prior to deposition of sufficient collagen
Negative reinforcement as a behavioral principle
occurs when a behavior is followed by the removal of an aversive stimulus thereby increasing that behaviors frequency. An example is a loud noise continuously sounding until a lever is pressed, upon which the loud noise is removed. This will encourage the behavior of pressing the lever.
Negative punishment as a behavioral principle
also called punishment by contingent withdrawal, occurs when a behavior is followed by the removal of a favorable stimulus, such as taking away a child’s toy following an undesired behavior, resulting in a decrease in that behavior.
Avoidance learning as a behavioral principle
is when a behavior results in the cessation of an adversive stimulus. For example, holding your ears to shield them from a loud, high-pitched sound helps avoid the aversive stimulation of that obnoxious sound
Noncontingent reinforcement as a behavioral principle
is the delivery of reinforcing stimuli regardless of the animal’s behavior. This causes that behavior to decrease because it is not required in order to receive the reward.
Extinction of operant conditioning as a behavior principle
when a behavior is inconsequential, producing neither favorable nor unfavorable consequences, it will occur with less frequency. When a previously reinforced behavior is no longer reinforced with either positive or negative reinforcement, it leads to a decline in the response
What type of pH do struvite/magnesium ammonium phosphate crystals form in?
Alkaline urine (pH above 7)
What is the appropriate treatment for a dermatitis known to be caused by a food allergy?
Feed a diet with a novel protein and carbohydrate sources or a hydrolyzed diet. Hydrolyzed diets are a good alternative to novel protein diets when the diet history is unknown or the pet has been exposed to many proteins. Hydrolyzed diets reduce the size of the protein and thus minimize the ability to cross link with IgE and cause mast cell degranulation.
Transmissible Venereal Tumor (TVT)
Cause, appearance, diagnosis
TVT is a sexually transmitted tumor found throughout the world, particularily in areas with high populations of stray dogs. The tumor cells are transferred from one dog to the next by physical contact, which typically consists of sniffing, licking, and copulation. In male dogs, it can present as a mass on the penis. On FNA there will be a large number of round cells with vacuoles in the cytoplasm present.
Prolapsed glands of the third eye lid (cherry eye)
cause, treatment
Congenital defect that will likely be passed on to future generations if the dog is bred. Repair consists of replacing the prolapsed gland and tacking it to the periorbital rim or using the Morgan pocket technique. Surgical removal is not recommended as you will remove the tear gland and predispose the dog to iatrogenic keratoconjunctivitis sicca.
Treatment for urate stones
Alkalizing diet and allopurinol therapy; urate stone formation is promoted by acidic urine and diets high in purines which are metabolized to uric acid. Generally a low-purine alkalizing diet is recommended. Allopurinol therapy may also be used to reduce uric acid production, but it requires monitoring as it may predispose dogs to different types of stones (Xanthine).
What percentage of mammary masses are malignant?
50%; before taking to surgery important to do chest radiographs to check for metastasis.
Which disorder is most commonly associated with an increased risk of thromboembolism?
a. immune mediated hemolytic anemia
b. hypoadrenocorticism
c. wobbler syndrome
d. idiopathic epilepsy
Immune-mediated hemolytic anemia
What is the main clinical sign of Hookworms in dogs and people?
Dogs: Anemia
Humans: Cutaneous larval migrans
What parasite is this?
Hookworms; thin walled appearance with 2-8 cells present
How do hookworms infect dogs?
They penetrate through the skin in young pups and migrate to the lungs where they are coughed up and swallowed and mature in the small intestine. There, the worms suck blood and cause bleeding ulcers; up to 0.1ml of blood per worm can be lost per day.
What parasite causes visceral and ocular larva migrans in people?
Toxocara (Roundworms)
Progressive Retinal Atrophy (PRA)
Inherited retinal disease seen in several breeds, but most common in Toy and Mini Poodles. Age of onset is variable.
Clinical signs: night blindness progressing to complete blindness due to loss of rods prior to cones.
Diagnosis: retinal lesions including on fundic examination tapetal hyperreflectivity, gray, vermiform lines on the fundus, retinal vascular attenuation, and a pale optic disc.
Immune-mediated polyarthritis (IMPA)
Cause, Signs, Diagnosis, Treatment
Cause: can be associated with a variety of systemic diseases or precipitating factors including systemic infectious, inflammatory or neoplastic disease or reactions to drugs or vaccines but it is most commonly idiopathic with no association to another disease process.
Clinical signs: anorexia, weight loss, fever, lethargy, and lymphadenopathy
Diagnosis: synovial fluid analysis (normal fluid is clear and viscous with <2.5g/dl protein and <3,000 cells/ul with predominantly mononuclear cells) with IMPA may be thin, turbid, and increased in volume with higher amounts of protein and cells, often primarily nondegenerate neutrophils
Treatment: immunosuppressive therapy (prednisone) and sometimes including an additional immunosuppressive drug such as azathioprine or cyclophosphamide
Type I Salter-Harris fracture
fracture through the physis
Type II Salter-Harris Fracture
fracture partway through the physis extending up into the metaphysis
Type III Salter-Harris Fracture
fracture partway through the physis extending down into the epiphysis
Type IV Salter-Harris Fracture
fracture through the metaphysis, physis, and epiphysis
Type V Salter-Harris Fracture
crush injury to the physis
When a patient has a septic abdomen (for example a perforated colon) what is the likely abdominal fluid glucose level?
At least 20mg/dl less than the blood glucose. If the difference is not that great it is indicative of nonseptic peritoneal effusion.
If a patient has upper motor neuron signs in the hind limbs, where is the lesion?
a. C6-T2
b. C1-C5
c. Caudal to L4
d. T3-L3
T3-L3; hyper-reflexive spinal reflexes and increased muscle tone in the pevlic limbs are consistent with UMN lesion
What type of signs would an L4 and caudal lesion result in?
Lower motor neuron signs in the pelvic limbs - decreased reflexes and decreased tone
What type of signs does a C1-C5 lesion cause?
Upper motor neuron signs in all limbs
What type of signs does a C6-T2 lesion cause?
Lower motor neuron signs in the thoracic limbs and upper motor neuron signs in the pelvic limbs
What muscle should the surgeon incorporate in the closure of the abdominal incision of a male dogs intestinal foreign body removal?
a. gluteal muscle
b. gracillis muscle
c. pectineus muscle
d. preputialis muscle
Preputialis muscle; this muscle is usually cut when making a midline incision in male dogs and should be incorporated into the closure to avoid penile deviation
Which of the following is most suggestive of pyelonephritis?
a. bacterial or WBC casts in urine
b. pain on abdominal palpation
c. bacteria or WBC in the urine
d. small, irregular kidneys on ultrasound
Bacterial or white blood cell casts in the urine; highly suggestive of a past or present bacterial infection in the kidneys. Bacteria or WBC in the urine may be due to cystitis. Small, irregular kidneys may be due to any chronic pathology in the kidneys. Pain on abdominal palpation can be caused by pain from any abdominal organ or structures adjacent to the abdomen. Other signs associated with pyelonephritis include: fever, anorexia, depression and vomiting.
What is the prognosis of Pemphigus vulgaris with treatment?
Poor; long-term therapy is generally required and the treatment causes serious side-effects long-term
What is the treatment for Phemphigus vulgaris?
2-4 mg/kg of prednisolone twice daily with the possible addition of azathioprine is recommended
What is Pemphigus vulgaris?
An autoimmune disorder causing vesicles, ulceration and crusting. It can affect the whole body, but it especially affects the mucocutaneous junctions and oral mucosa. The onset of the disease can be sudden or gradual. The disorder is caused by an IgG autoantibody that binds to intracellular adhesion molecules (desmoglein) causing a loss of cohesion between kratinocytes resulting in acantholysis, vesicle formation and eventually ulceration.
What findings are shown on this echocardiogram?
a. left ventricular concentric hypertrophy
b. right ventricular concentric hypertrophy
c. pulmonic stenosis
d. mitral valve prolapse
e. tricuspid valve endocarditis
Mitral valve prolapse; the mitral valve is bending back into the left atrium consistent with mitral valve prolapse. The valve is also thick and mitral regurgitation is likely. The left ventricular lumen is dilated and walls appear of normal thickness, so concentric hypertrophy is not present. The pulmonic valve is not seen in this image plane. The right ventricle is not well seen either, but in the very near field, the right ventricular wall appears normal. What can be seen of the tricupsid valve does not appear to have any vegetations consistent with endocarditis.
What radiographic changes are indicative of pleural effusion?
pleural fissure lines on both lateral and ventrodorsal projections
What are possible causes of a lobar sign on radiographs?
hemorrhage, edema or pus in the lobes of the lungs
Osteochondritis Dissecans (OCD)
Cause, signs, diagnosis, treatment
Causes: young and growing large breed dogs
Signs: limping and painful on palpation
Diagnosis: radiographic evidence of effusion when compared to the contralateral limb. May see a widened joint space
Treatment: removal of the flap and curettage
What is the most common ocular tumor?
Meibomain adenoma and it is usually benign; located on the margin of the eyelid
What is a Chalazion?
is an obstruction of the meibomian gland and appears as a swelling within the eyelid rather than projecting from it.
Puppy strangles
Cause: unknown, but thought to be immune-mediated
Predisposed breeds: labs, goldens, beagles, dachshunds, pointer breeds
Clinical signs: febrile, anorexic, lethargic, generalized lymphadenopathy, pustules around the muzzle, pinnae, and eyes
Diagnosis: skin scraping to rule out demodex
Treatment: prednisone
What is the diagnostic test to diagnose Addison’s disease?
ACTH Stimulation test
What are the 4 classical signs of diabetes mellitus?
PU, PD, Polyphagia, and weight loss
FNA of a mass on the digit of a 10 yr old GSD; What is the most likely diagnosis?
Melanoma; cells with large nuclei, stippled chromatin with prominent and sometimes multiple nucleoli
Treatment: if there is no evidence of metastasis the affected digit should be amputated
If a dog has a positive menace response and dazzle reflex is visual but lacks a palpebral reflex, where does he have a lesion?
CN V; no visual deficits as evidenced by his menace and dazzle which rules out lesions in CN II or the visual cortex. The normal menace response indicates that CN VII is functioning as well. The lack of a palpebral then indicates a sensory deficit for which CN V is responsible.
Which of the following is an indication for performing a urine culture?
a. low urine pH
b. isosthenuria
c. bilirubinuria
d. calcium crystalluria
Isosthenuria; or low specific gravity, makes it difficult to identify bacteria in the sample since it is so dilute. A culture is the most sensitive way to determine if there is an infection present.
What is the most likely name of the organism pictured?
a. malassezia globosa
b. malassezia pachydermatis
c. staphylococcus hyicus
d. staphylococcus pseudintermedius (Staphylococcus intermedius)
Staphylococcus pseudintermedius; intracytoplasmic coci from a dog’s skin are most likely Staphylococcus pseudintermedius which is the species host-adapted to canines
What breed of dog is predisposed to forming urate uroliths due to a metabolic defect?
Dalmatians; have a metabolic defect where they are unable to convert uric acid to allantoin, a much more soluble compound. As a result, urate levels in the urine reach high levels and frequently form stones.
What is the reason that Yorkies tend to make urate stones?
they frequently have a portosystemic shunt
What is a bunny-hopping gait suggestive of?
hip dysplasia
What is the likely diagnosis of the following case: a 1 yr old male neutered Newfoundland presents for a physical exam. Cardiac auscultation reveals a 3/6 systolic murmur at the left heart base. Thoracic radiographs show mild left-sided cardiomegaly with left atrial enlargement and segmental enlargement of the ascending aorta.
Subaortic stenosis
Proestrus
clincial signs: valvular swelling with mild to moderate hemorrhagic vaginal discharge
Vaginal cytology: <90% cornified cells; predominantly parabasal and intermediate cells; It is common for early proestrus to be characterized by these cells and gradually transition until nearly 100% of the cells are cornified by estrus
What is the most likely diagnosis for a dog that presents for left pelvic limb lameness and the medial aspects of both stifles are thickened. On manipulation of the left stifle it reveals cranial motion of the tibia relative to the femur and a clicking sound from the joint on flexion and extension
left cranial cruciate ligament rupture with meniscal cartilage tear
A dog has a head tilt to the left; where would you localize the lesion to if he has paradoxical vestibular syndrome?
Right cerebellum; since the left ear is closer to the ground and the question is asking for paradoxical localization the lesion is in certain regions of the cerebellum or caudal cerebellar peduncle and produces signs to the opposite sides from which is seen with peripheral and classic central disease.
What is the post-exposure prophylaxis protocol after being exposed to rabies for a vaccinated human?
Two injections of approved rabies vaccine at Day 0 and Day 3.
What is the post-exposure prophylaxis protocol after being exposed to rabies for a non-vaccinated human?
An injection of human rabies immunoglobulin immediately after exposure followed by 4-5 injections of an approved rabies vaccine IM over the course of 2-4 weeks.
In dogs with normal kidneys, when does glucose begin to spill into the urine?
when the blood glucose is around 180mg/dL
Is diabetes mellitus suspected in a dog that has PU/PD and a blood glucose consistently around 160mg/dL (normal 76-119mg/dL)?
No, another cause for the PU/PD should be sought in this patient. When the blood glucose is high enough to spill into the urine (~180mg/dL), the polyuria seen is caused by an osmotic diuresis resulting from the osmotic pull of the glucose in the urine.
What is the time frame for the contralateral eye to follow the development of primary glaucoma in the inital eye?
6-12 months
What is the most common primary bone tumor in the dog?
Osteosarcoma
What are the different primary bone tumors in the dog?
Osteosarcoma, chondrosarcoma, fibrosarcoma, and hemangiosarcoma
What is the radiographic diagnosis and appropriate treatment?
This patient has metastatic lesions throughout the lungs and only pallative treatment can be recommended.
What is the treatment of choice for a primary lung tumor in the dog?
Excision with wide surgical margins; if a primary lung tumor can be excised with wide margins, usually with a lung lobectomy, this is the best chance for a cure. Chemotherapy may be useful in cases where the tumor can’t be excised. Long-term prognosis is still guarded because benign pulmonary neoplasia is uncommon.
What is this ECG representative of?
3rd Degree AV Block
What is Tetralogy of Fallot?
A congenital defect of the heart which includes pulmonic stenosis, dextro-positioned aorta (over-riding), RIGHT ventricular hypertrophy, and a ventricular septal defect. It causes shunting of venous blood across the VSD into the arterial circulation which leads to hypoxemia, and an increased drive for erythropoiesis, causing polycythemia (increase in the absolute RBC mass in the body). Affected animals tend to be underdeveloped in size and have a history of exercise intolerance, dyspnea, tachypnea, or syncope due to hypoxemia. Thoracic radiographs usually show a normal to mildly enlarged cardiac silhouette with right ventricular enlargement and pulmonary hypoperfusion due to the shunting of venous blood into the arterial circulation.
How does emphysematous cystitis occur?
Caused by the presence of gas forming bacteria
What are possible underlying causes of emphysematous cystitis?
Cushing’s disease, diabetes mellitus, chronic urinary tract infections and bladder stones
A 10-year-old male castrated standard poodle presented for possible foreign body ingestion. The dog has otherwise been normal as far as the owners can tell. Abdominal radiographs are taken and the only abnormality you find is in the bladder. Based on your radiographic findings, you discuss possible causes of the abnormality and diseases to rule out. What test do you recommend?
a. T4
b. Basal cortisol
c. ACTH stimulation test
d. Tick titers
ACTH stimulation test
A 12yr old male intact English bulldog presents for a drop of blood noted coming from the penis. The dog has no other prior medical history. On exam, both testicles are descended and palpate normal in size. A rectal exam reveals a large, but symmetrical prostate gland. You extrude the penis and note the following. What is your recommendation?
a. There is a mass at the tip of the penis, you should amputate the tip and submit to histopathology.
b. There is an abscess of the penile tip, antibiotic therapy should be begun after a culture is obtained.
c. This is a urethral prolapse and can be repaired by performing a urethropexy
d. There is a mass at the tip of the penis, which will likely respond to radiation therapy.
This is a urethral prolapse and can be repaired by performing a urethropexy; this conditon is almost exclusive to young English bulldogs. The cause of urethral prolapse is not always determined but may be secondary to excessive masturbation, sexual excitement, or an infection. Treatment involves either urethropexy to replace the prolapse or amputation of the tip.
Oral surgery in conjunction with another elective surgery (such as growth removal) in an otherwise healthy dog is usually not recommended due to what reason?
Oral surgeries cause significant bacteremia, which may be an endogenous source of wound infection. The order in which the procedures are performed does not eliminate the risk of infection associated with the bacteremia. Changing gloves and instruments between procedures helps maintain sterility exogenously, but does not eliminate risk of infection associated with the endogenous bacteremia.
Which is a sign of anesthesia being too deep?
a. Swallowing
b. Elevated PaCO2
c. Hypertension
d. Deep breathing
e. Lacrimation
Elevated PaCO2; as anesthetic depth increases, hypoventilation occurs due to shallower breathing.
What are signs that a patient is too light under anesthesia?
Lacrimation, hypertension and swallowing
Which clinical finding would you expect in a case of lymphangiectasia in a Belgian Sheepdog as depicted in the photo?
a. Lymphocytosis
b. Hypercalcemia
c. Hypercholesterolemia
d. Panhypoproteinemia
Panhypoproteinemia (deficiency of all proteins in the blood)
What is lymphangiectasia a classic example of?
Protein losing enteropathy; characterized by the dilation and dysfunction of intestinal lymphatics and leakage of protein-rich lymph into the intestinal lumen. As a result, protein, cholesterol, and lymphocytes are all lost. Calcium is also frequently low due to either low albumin or Vitamin D and calcium malabsorption.
A 5 year old male mixed breed dog presents with PU/PD, polyphagia and weight loss. What is the most likely diagnosis?
a. Exocrine pancreatic insufficiency
b. Diabetes mellitus
c. Hypothyroidism
d. Hyperadrenocorticism
Diabetes mellitus
What pressure should the anesthetist not exceed if manually bagging a patient during anesthesia?
20cm H2O
A 1yr old male Shar-Pei presents with the clinical signs below. Recognizing this condition, what other finding would you expect to find?
Elevated body temperature; this presentation is classic for Familial Shar-Pei Fever. It is characterized by high fever and unilateral or bilateral tarsal swelling. This swelling affects tissues around the joint, rather than within the tarsus itself, meaning that we would expect normal synovial cytology.
What is the best test to monitor proteinuria long term?
a. BUN:Creatinine Ratio
b. Urine Culture and sensitivity
c. Urine protein:creatinine ratio
d. Blood pressure
e. abdominal ultrasound
Urine protein:creatinine ratio
What is a symbolic loss?
Symbolic pet losses occur when companion animals represent another loss in a client’s life.
What is primary loss?
primary loss is felt following the death of a client’s personal pet
What is secondary loss?
Secondary losses include the disruptions to the life of the client that are created by the primary loss.
What is the best material to close this incision?
a. Polydioxanone
b. Ethilon
c. Catgut
d. Vicryl
Polydioxanone; this suture material is absorbable and monofilament, PDS is broken down by hydrolysis and will last longer than catgut, which is better when working with the bladder. On the other hand, you do not want a non-absorbable material as this predisposes the patient to urinary tract infections as a result of the permanent presence of foreign material. Vicryl is a multifilament suture which also has a higher likelihood of failing due to the ability of bacteria to lodge in between the filaments.
What treatment would you not recommend?
a. dips
b. burn off
c. manual removal
d. pour on
Burn off; this may cause the ticks to become agitated and regurgitate their stomach contents into the surrounding tissues they are feeding from. This would cause severe inflammation and pruritis and can also lead to tick borne diseases. Burning could also harm the patient. The correct removal would be to grasp the ticks with forceps just behind their heads and gently apply traction until they release. Twisting will cause the heads to stay lodged under the skin. For larger numbers as seen in the image, Fipronil pour-ons and Permethrin topicals can be used to kill off the ticks.
Interpret the following blood gas results from a 4 year old female spayed dog:
a. normal
b. metabolic alkalosis; respiratory alkalosis
c. metabolic alkalosis; respiratory acidosis
d. metabolic acidosis; respiratory alkalosis
e. metabolic acidosis; respiratory acidosis
Metabolic acidosis; respiratory alkalosis - the normal base deficit/excess of a dog is about (-5-0mmol/L). This means that this dog has a base deficit and therefore a metabolic acidosis. Although this dog has a base deficit, she still has a normal anion gap (8-25mmol/L). There is a slight acidemia as normal pH is approximately between 7.35-7.45. Finally, a normal pCO2 is approximately 40. This dog is hyperventilating and blowing off CO2. In other words, she is blowing off acid; therefore she has respiratory alkalosis.
What disease do you suspect?
Melanoma; large cell with black melanin pigment
What type of repair is this?
a. genicular flap
b. caudal superficial epigastric flap
c. microvascular free transfer flap
d. full thickness skin graft
e. deep circumflex iliac flap
Caudal superficial epigastric flap - this is an axial pattern flap and as with all axial pattern flaps, it is named after its primary blood supply. The caudal superficial epigastric flap provides the primary blood supply to the 3rd, 4th, and 5th mammary glands. With familiarity of the dog’s anatomy you can preserve the blood supply and rotate the area of skin to cover a defect as was done with this patient.
A 9 month old pitbull presents for hindlimb lameness that developed suddenly several days ago. He is painful on the left tibia. What is the most appropriate treatment?
Carprofen; this is a case of panosteitis based on the young age of the patient and the radiographic presence of focal intramedullary densities within the tibial diaphysis. Panosteitis is a self-limiting, painful condition characterized by limping and lameness. Typically affects the long bones of young dogs, usually between the ages of 5-18 months.
What is the cause for these findings?
a. chronic myelogenous leukemia
b. acute myelogenous leukemia
c. chronic lymphocytic leukemia
d. acute lymphoid leukemia
e. high grade lymphoma
Chronic lymphocytic leukemia; chronic describes the clinical course of the diseaase, which is considered indolent or slowly progressive. The neoplastic cells of chronic leukemias are well differentiated or mature cells therefore, CLL is considered a chronic or indolent form of leukemia made up of SMALL, MATURE LYMPHOCYTES. These are difficult to distinguish from normal lymphocytes. The mildly prominent lymph nodes and prominent spleen are classic findings for chronic leukemias. The large disease burden within the bone marrow and relatively less affect lymphoid tissues (relative to lymphoma) makes this a lymphocytic leukemia as opposed to a small cell or low grade lymphoma.
A 7yr old FS Spaniel presents for difficulty breathing and lethargy. PE shows pale mm and increased RR. You collect blood for a CBC and Chem and place a drop of blood with a drop of saline on a glass slide. What’s your diganosis?
IMHA; image shows a positive agglutination test. The dark patches in the sample are caused by antibodies attached to the surfaace of the erythrocytes cross linking the cells together causing these clumps.
A 4 yr old FS Husky presents for crusting and hyperkeratosis around the eyes, nose, and mouth. A skin scraping did not identify an etiology. How would you treat the dog?
a. daily wiping with chlorhexidine pads
b. zinc supplementation
c. corticosteroids
d. ivermectin
Zinc supplementation; zinc responsive dermatopathy occurs most frequently in the siberian husky. The exact cause is unknown, but it has been linked to defective intestinal absorption of zinc.
A 2 yr old mix presents for a mass on her upper lip that the owners noticed 3 weeks ago. It has not grown in size and doesn’t bother the dog. On PE the dog is BAR, and no other significant findings. The mass is smooth, less than 1cm in diameter and localized to the skin. How do you recommend confirming your tentative diagnosis and what is the prognosis?
a. biopsy, prognosis fair
b. FNA, prognosis good
c. surgical excision, no prognosis without histopathology
d. monitor, prognosis likely guarded
FNA, prognosis likely good; in young dogs small localized masses along the head, ears and limbs are often histiocytomas, a benign collection of histiocytes with a few other inflammatory cells present. They can occur in younger dogs and often resolve after a few months. A few histiocytomas can ulcerate, and multiple histiocytomas can be found on one animal. Those that do not regress on their own can be surgically excised.
KCS as seen in the image, comes from an abnormality in what structure?
a. conjunctival goblet cells
b. lacrimal gland and gland of the third eyelid
c. meibomian gland
d. nasolacrimal ducts
lacrimal gland and gland of the third eyelid; KCS comes from a decrease of the aqueous portion of the tear film. This is produced by the lacrimal gland and the gland of the third eyelid.
When examining the eye of a 6 yr old Lab, you see the brown, round circular masses shown in the image free floating in the anterior chamber. What is the most likely diagnosis?
Uveal cyst; cysts are free floating or may be attached to the pupillary margin or posterior iris. Cysts will also transilluminate whereas melanomas will not. Cysts are also very spherical or ovoid and smooth while melanomas are usually fleshier-appearing masses.
A 12 yr old, MN, mix presents with progressive exopthalmos and third eyelid protrusion of the left eye over the past month. On palpation, no pain is elicited but the eye does not retropulse. Otherwise the dogs is acting normally. What is the most likely diagnosis?
a. Orbital neoplasia
b. Retrobulbar abscess
c. Intraocular neoplasia
d. Endophthalmitis
Orbital neoplasia; somewhat common in older dogs. Infections woulld have more systemic signs, localized pain and erythema. Endophthalmitis and intraocular neoplasia would not cause exopthalmos but would manifest with intraocular signs.
An 8 yr old, MN, mix canine presents with a several-month history of lethargy, hair loss, and greasy skin. The patient’s face, feet and tail are not clinically affected and he is not pruritic. What is the most likely cause of the hair loss?
a. Sarcoptes
b. Flea allergy
c. Malignant melanoma
d. Endocrinopathy
Endocrinopathy. Flea allergy and sarcoptes would be extremely pruritic. The dark coloration of the skin reflects hyperpigmentation associated with inflammation not neoplasia.
An 11 yr old, MN, Golden presents for collapse with muffled heart sounds on examination. You ultrasound the heart and obtain the following image; the right atrium and right ventricle are labeled. A large mass is seen in the right atrioventricular groove with pericardial effusion. What is the likely diagnosis?
a. Hemangiosarcoma
b. Lymphoma
c. Chemodectoma
d. Pulmonary adenocarcinoma
e. Idiopathic pericardial hemorrhage
Hemangiosarcoma; it has a predilection for the right auricle of dogs, with Goldens being predisposed. Stabilization of this patient will require pericardiocentesis; prognosis is guarded and may include chemotherapy, pericardiectomy, or rarely auriculectomy. Chemodectoma arises from the ascending aorta and heart base; lymphoma is rare in the heart of dogs and is more commonly metatstic than a single mass. Idiopathic pericardial hemorrage is incorrect because there is clear evidence of a mass.
This is an ECG recording of a 9 yr old, MN, Golden that had a bleeding splenic mass surgically removed approximately 4 hours ago. The heart rate is currently 186 bpm. The patient received 0.08 mg/kg of hydromorphone approximately 45 minutes ago. PCV is currently at 24% (normal 33-58%). What is shown on the ECG below?
a. Ventricular Premature Complexes (VPCs)
b. 3rd Degree AV Block
c. Supraventricular Tachycardia
d. 1st Degree AV Block
Ventricular Premature Complexes (VPCs)
This image is from an aspirate taken from a lytic bone lesion seen on radiographs of a nine year old female Vizsla dog. What is the cell type of origin and classification?
a. mesenchymal origin; carcinoma
b. epithelial origin; sarcoma
c. mesenchymal origin; sarcoma
d. epithelial origin; carcinoma
e. leukocyte origin; round cell tumor
Mesenchymal origin; sarcoma - this is an osteosarcoma. Sarcoma: these tumors come from mesenchymal cells and are named by the spcific cell type such as fibroblasts (fibrosarcoma) and osteoblasts (osteosarcoma). Cytologically, they tend to appear as isolated spindle-shaped cells with elongated cytoplasm and often oval nuclei. Those are the features identifable in the image.
This dog has been on chronic steroid therapy and has now developed this lesion seen in the photo. Biopsy results of the skin show a broad based budding organism. What is the diagnosis?
a. aspergillosis
b. blastomycosis
c. coccidioidomycosis
d. cryptococcosis
blastomycosis; being on chronic steroids resulted in immunosuppression and acquiring subsequent infection.
A 5 yr old, MN, West Highland White Terrier presents for skin lesions. He has a history of lethargy and poor appetite. The lesions partially responded to antibiotics initially, but then began to progress again. You take a biopsy of the skin which shows cutaneous blastomycosis. What is the next most important diagnostic test?
a. thoracic radiographs
b. deep skin scraping
c. blastomyces antigen test
d. blastomyces antibody titer
e. abdominal radiographs
Thoracic radiographs; pulmonary involvement occurs in the majority of cases, so thoracic rads are an important step to staging the patient. Blastomycosis is caused by a dimorphic fungus and generally occurs in the Missouri, Mississippi, Tennessee, and Ohio river valleys. Other organs that can be affected besides the skin and lungs include the lymph nodes, eyes, bones, CNS, and urinary tract.
You have been managing a 7 yr old, M, Cocker Spaniel for IMHA and recurrent UTIs with prednisone and trimethoprim sulfa antibiotics. He now presents for ocular abnormalities. What test is most likely to confirm your tentative diagnosis?
a. corneal biopsy
b. PLR
c. dilated fundic exam
d. Schirmer tear test
e. Tonometry
Schirmer tear test; the dog has severe mucoid ocular discharge and corneal changes that are most consistent with keratoconjunctivitis sicca (dry eye). The history of TMS antibotics is a likely etiology.
A 10 yr old, FS, Dachshund presents for further evaluation of progressive lameness in the hind. The owner notes that she has begun intermittently scuffing her hind limbs, has somewhat of a weak or drunken gait in the hind as she walks, and is having trouble rising. What is the best treatment?
a. prolonged antibiotic therapy with clindamycin
b. femoral head ostectomy
c. dorsal laminectomy
d. total hip replacement bilaterally
Dorsal laminectomy; the patient’s clinical signs are consistent with neurological deficits. Although you do not have all the information necessary to reach a definitive diagnosis, you should have been able to deduce that this patient probably needs a dorsal laminectomy to relieve disc compression. In order to definitively diagnose this condition you would want to proceed with a complete exam, basic bloodwork, and a CT or MRI of the lumbosacral region. Although this patient does exhibit evidence of hip dysplasia radiographically, the clinical signs are not characteristic of a dog with pain secondary to hip dysplasia. There is no indication of osteomyelitis on these radiographs and the clinical signs are not necessaarily suggestive of osteomyelitis.
A 2yr, FS, Spaniel presents with sneezing and ocular discharge. On PE, the dog appears systemically healthy with normal vital parameters. You are suspicious of a viral upper respiratory tract infection with possible secondary bacterial infection and prescribe a 2-week course of cephalexin. 10 days later, the dog returns with a fever and severe cutaneous ulcerations as shown in the image which the owner says began just 3 days ago. Skin biopsy confirms coagulative necrosis of the epidermis with mixed inflammation in the dermis and epidermis. What should the owner be told?
a. concerned that the dog has nasal lymphoma that has now disseminated systemically including to the skin; she should be fully staged and treated for lymphoma
b. concerned about a severe and potentially life-threatening cutaneous drug reaction and the dog should be hospitalized for supportive care and testing
c. concerned that the dog has an aspergillus infection which was not susceptible to cephalexin and she now has systemic aspergillus; the dog should be hospitalized and started on antifungals.
d. concerned about the development of a drug-resistant and aggressive form of streptococcus and the dog should be quarantined with additional antibiotics prescribed pending cultures
Most concerned about a severe and potentially life-threating cutaneous drug reaction and the dog should be hospitalized for supportive care and testing; the history and clinical appearance are very concerning for toxic epidermal necrolysis which is usually associated with an adverse reaction to a drug. In severe cases such as the dog shown in this image, there is concern for extensive loss of fluids, electrolytes, and colloids as well as secondary bacterial infection of the skin. Concurrent medications should be withdrawn and aggressive supportive care, analgesia, and use of a different antibiotic protocol are indicated. The prognosis is guarded depending on response to removal of a suspected inciting cause. The other possibilities listed in this question are less consistent with the cutaneous lesions shown and the very rapid onset and progression as well as the histopathologic findings.
What is usually the cause of glaucoma as depicted in this dog?
a. increased production of vitreous
b. decreased outflow of aqueous
c. increased production of aqueous
d. decreased outflow of vitreous
e. increased outflow of aqueous
Decreased outflow of aqueous; glaucoma is an increase in IOP which is dependent on production of aqueous and outflow of aqueous. Clinical increases are always from decreased outflow although treatment can be aimed at either increaseing outflow or decreasing production of aqueous.
A 6yr, F, Cocker spaniel presents to ER for lethargy and anorexia. On PE, icteric MM are noticed. PCV is 13 (normal 35-57%). And a blood smear is checked and spherocytes are seen. There appear to be adequate platelets and WBC. What is the most likely cause of anemia?
a. hemangiosarcoma
b. myelophthisis
c. onion toxicity
d. immune mediated disease
e. chronic disease
Immune mediated disease; the finding of spherocytes on blood smear distinguishes this from onion toxicity (Heinz body anemia) and chronic disease. Also, hemangiosarcoma and myelophthisis would not have spherocytes and should not cause icterus.
A 12 yr old, English Bulldog presents with anorexia and severe, generalized pain. What is the best description of the lesion in the radiograph?
a. polyostotic, aggressive
b. monostotic, non-aggressive
c. monostotic, aggressive
d. polyostotic, non-aggressive
Polyostotic, aggressive; there are multiple lytic lesions in the cervical and thoracic vertebrae, especially visible in C2 and in the spinous processes of the T1-T8. There are also lytic lesions in the proximal humerus of one leg and in the bones of the skull.
A 1yr, F, Golden presents with bilateral exophthalmos that has taken place over the past 2 days. T = 102.2F, HR = 140bpm, RR = 30bpm and lab work is unremarkable. She does not seem painful, and no swelling around the eyes is evident. Pupillary light response is normal in both eyes and there is minimal resistance to retropulsion of the globes. The masticatory muscles do not appear to be affected and there is no difficulty opening the mouth. What conditon is suspected?
a. lymphoma
b. extraocular polymyositis
c. retrobulbar abscess
d. orbital neoplasia
Extraocular polymyositis; this is a condition seen in young Golden’s. It is kind of similar to masticatory muscle myositis in that it occurs due to an autoimmune reaction against muscle antigens. It is treated with prednisone +/- azathioprine. The condition can be differentiated from these other conditons because orbital neoplasia and retrobulbar abscesses are usually unilateral. Abscesses are usually accompanied by more systemic signs. Orbital neoplasia is usually more slowly progressive and seen in older animals. Lymphoma could present in a similar fashion but is less likely in such a young dog with no other signs.
A 1yr old, MN, chihuahua presents for a 3 month history of intermittent limping and non-weight bearing on the left hind limb. On PE, it is difficult to determine the source of pain as the patient seems to try to bite on any manipulation of the left hind limb. The patient was sedated and these radiographs were obtained. What is your diagnosis and treatment?
a. avascular necrosis of the femoral head. Perform femoral head and neck ostectomy or total hip replacement.
b. left hip septic arthritis. Perfrom joint culture and begin appropriate antibioic therapy.
c. left hip dysplasia. Perfrom femoral head and neck ostectomy or total hip replacement
d. left patellar luxation. Perfrom trochlear wedge recession with tibial tuberosity transposition
Avasculaar necrosis of the femoral head, perfrom femoral head aand neck ostectomy or total hip replacement; based on the breed and age of the patient, avascular necorsis of the femoral head should immediately be the top differential. This conditon is also known as Legg-Calve-Perthes disease and results in a collapse or fragmentation of the femoral epiphysis because of a disruption in blood flow. The cuase of blood flow interruption is unknown. The condition occurs in young small-breed dogs prior to closure of the captial femoral physis. The condition can be seen bilaterally in 10-17% of patients. Dogs are usually 6-7 months of age when they first start showing clinical signs but the age may range from 3-13 months. Treatment with a femoral head and neck ostectomy (FHO) generally yields excellent results. Alternatively, if owners demand perfect biomechanics a total hip replacement may be considered but most veterinarians tend to recommend an FHO.
A 7 month old, M, GSD became acutely lame on the right forlimb 5 days ago. The dog presents on ER due to acute exacerbation of lameness. On exam, the dog has a temp of 103.6F and was toe touching lame on the right forelimb and reluctant to stand or walk. There was no evidence of external trauma. Deep plapation of the right humerus elicited pain and you take radiographs of the right humers which are shown bleow. Based on the most likey diagnosis, what is the prognosis for this conditon with supportive treatment only?
a. Excellent, >95% of dogs recover
b. Grave, <5% of dogs recover
c. Poor, 10-20% of dogs recover
d. Fiar, 40-60% of dogs recover
e. Good, 80-90% of dogs recover
Excellent, >95% of dogs recover; this is a case of panosteitis based on the young age of the patient and radiographic presence of focal intramedullary densities within the humeral diaphysis . Mino differentials could include osteomylepitis. Panosteitis is a self-limiting, painful condition, characterized by limping and lameness. It typically affects the long bones of young doesg, usually between the ages of 5-18 months. It can occur with any breed, but is more common in medium - large breeds.
Pictured is a cytology of a ruptured pustule from a dog with pruritus. What is the most common etiologic agent causing pyoderma in the dog?
a. Staphylococcus pseudintermedius
b. Staphylococcus aureus
c. Streptococcus canis
d. Mycoplasma canis
Staphylococcus pseudintermedius; pyoderma is common in dogs because the canine stratum corneum is a less efficient barrier to bacteria than in other species. Dogs lack an ostial plug in their follicles, a characteristic which allows bacteria to invade and colonize more readily. Mixed bacterial infections are possible, but Staph. pseudintermedius is the most common primary bacterial invader.
A 5yr old, MN, Welsh corgi presents with the complaint of mild lethargy and reluctance to play for 1 week. He is decreased weight bearing on the left pelvic limb and has swelling of the stifle. Radiographs confirm the presence of effusion but no bony changes. On arthrocentesis of the left stifle 1.0ml of cloudy fluid is withdrawn. What additional diagnostic test is most important?
a. total protein of the fluid
b. echocardiogram
c. arthroscopy
d. culture of the fluid
e. urinalysis
Culture of the fluid; this is a description of septic arthritis based primarily on the cytologic findings of neutrophils and bacteria in the joint fluid cytology. The bacteria are within the neutrophils (intracellular bacteria) which assures that this is not contamination on your slide. All of the other answer choices might be reasonable recommendations but the most important diagnostic test is to culture the joint fluid to determine the etiologic agent and its antibiotic susceptibility as this will most directly impact your choice of therapy. The treatment of choice for septic arthritis is a prolonged (at least one month) course of an appropriate antibiotic. In some cases, drainage/lavage of the joint or surgery may be necessary.
Which of the following is most likely to cause the abnormality seen in this radiograph?
a. Blastomycosis
b. Pyometra
c. Osteosarcoma
d. Aspiration Pneumonia
e. Penetrating thoracic trauma
Osteosarcoma; the abnormality in the radiograph is multiple pulmonary nodules consistent with metastatic neoplasia. Systemic fungal disease would be a reasonable differential for this radiographic pattern but is not as good of a choice, especially with no evidence of hilar lymphadenopathy. Aspiration pneumonia would cause an alveolar infiltrated centered in the cranioventral lung region, and penetrating trauma would likely cause pneumothorax. There is no evidence of pneumothorax in this study.
A 9yr old, MN, Rottweiler presents with a one month history of lameness of the right forelimb. The dog is painful on palpation of the proximal humerus. Which is the most likely differential diagnosis to discuss with the owner?
a. Primary bone tumor
b. Osteomyelitis
c. Hypertropic osteopathy
d. Old healed fracture
Primary bone tumor; the signalment of a large breed, older dog and radiographically aggressive bone lesion in the proximal humerus are most suggestive of primary bone neoplasia. The destructive element of the lesion indicates its aggression, and the location in one bone, in a site of predisposition for cancer, make fungal osteomyelitis less likely.
A 6 yr old, M cryptorchid, Schnauzer presents for weakness, lethargy, intermittent epistaxis, and melena for 1 week. PE include gynecomastia, a pendulous prepuce, symmetrical truncal alopecia, a palpable abdominal mass, pale MM, and a fever. The dog’s HCT is 14% (35-57%) with a total protein of 7.0 g/dL (5.4-7.5 g/dL). A blood smear reveals normocytic normochromic anemia with a platelet count of 34,000/microliter (211,000-621,000/ul). The WBC is 2,500/ul (5,000-14,100.ul) What is most likely responsible for the dogs signs?
a. testosterone excess
b. thyroid hormone deficiency
c. estrogen excess
d. cortisone deficiency
e. cortisone excess
Estrogen excess; this dog’s presentation should lead you to the presumptive diagnosis of an estrogen secreting tumor; likely a sertoli cell tumor or seminoma. The dog was described as cryptorchid; dogs with cryptorchidism are prone to testicular tumors. The signs of male feminization such as gynecomastia and the signs of bone marrow suppression are most suggestive of estrogen toxicity.
Rufus, a 10 yr old, MN, Lab presents for acute abdominal pain, vomiting and distended abdomen. Pancreatitis is suspected due to table scrap consumption history. His PLI snap test is a strong positive, and his CBC and Chem are below. Based on the results there is one value that is very concerning for Rufus’s prognosis. What test is recommended?
a. Abdominal US
b. bone marrow biopsy
c. chest rads
d. toxicology screen
e. PT, PTT, FDP
PT, PTT, and FDP; diseases that cause severe inflammation can induce disseminated intravascular coagulation (DIC) complex. The severe inflammation from pancreatitis can cause massive endothelial injury, resulting in vasculitis. This starts the coagulation cascade, which can be so severe that it uses up all the clotting factors; the patient then becomes susceptible to bleeding disorders. DIC can be difficult to diagnose especially in the early stages of the disease, when the clinician would most like to discover it. Patients with clinical signs and the 3 of the following 4 laboratory findings have DIC (increased PT, increased PTT, increased FDP and decreased PLT)
A 7yr old, FS, spaniel presents to ER for several day history of progressive weakness and lethargy. She has no recent history of travel or tick exposure. On PE her temp is 104.7F, HR 128bpm, RR 42brpm, MM = pale pink, CRT = 1.5sec. A blood smear is below. Based on the most likely diagnosis, which of the following treatments is most appropriate?
a. plasma transfusion, vitamin K supplementation
b. erythropoietin injections and iron supplementation
c. packed RBC transfusion, immunosuppressive doses of corticosteroids
d. platelet rich plasma transfusion and anti-inflammatory doses of corticosteroids
e. fresh whole blood transfusion, ampicillin
Packed RBC transfusion, immunosuppressive doses of corticosteroids; this description is most compatible with IMHA. On the blood smear there are small numbers of erythrocytes compared to the numbers of platelets and leukocytes. There is also polychromasia with some red blood cells appearing very pale and others appearing a more purple color, consistent with regenerative response from the bone marrow. It may be difficult to appreciate spherocytes on this blood smear, but that is another classic finding of IMHA.
A patient presents after being found wandering along the middle of the road. On PE, RR = 54bpm, decreased lung sounds in the left dorsal quadrant and several abrasions are noted on the forelimbs. Pulse oximetry on the gingiva was 94%. What is the best treatment option?
a. perform a left sided thoracocentesis on the ventral aspect of the chest
b. perform a left sided thoracocentesis on the dorsal aspect of the chest
c. perform a right sided thoracocentesis on the ventral aspect of the chest
d. perform a right sided thoracocentesis on the dorsal aspect of the chest
e. place a thoracotomy tube on the right side
Perform a left sided thoracocentesis on the dorsal aspect of the chest; the radiograph shows a pneumothorax. Notice the lungs are collapsed on the left and no vasculature or airways can be appreciated on the left as compared to the right. In a standing patient it is best to perform a thoracocentesis dorsally since air rises. This will yield the most amount of air to aspirate. In most cases with a pneumothorax secondary to trauma it is not necessary to place a chest tube as the leak seals over quikly, making a chest tube excessive; however patients that are tapped must be monitored closing for recurrence of pneumothorax. If air builds up persists more aggressive treatment such as a chest tube with or without continuous suction should be considered.
What breed of dog has a congenital ocular anomaly characterized by choroidal hypoplasia, manifested by varying degrees of visual dysfunction with signs of large bizarre choroidal vessels visible on fundic exam as depicted here?
a. Boston Terrier
b. West Highland White Terrier
c. Collie
d. GSD
e. Toy Poodle
Collie; collie eye anomaly is seen in up to 80% of the breed. Some are completely blind and others show no visual deficits. Other signs include optic disc coloboma, retinal hemorrhage and retinal seperation.
