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ACVIM SAIM Specialty 2023 > Endocrine/Metabolic/Nutrition > Flashcards

Endocrine/Metabolic/Nutrition Flashcards

1
Q

The most common cause of DI is what category polyuric disorder?

A

secondary nephrogenic DI

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2
Q

How does hypokalemia cause Pu/Pd?

A

Causes downregulation of AQ-2 and may alter medullary interstitial gradient by downregulating urea transporters. Also might interfere with AVP release from pituitary

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3
Q

How does polycythemia cause pu/pd?

A

Abnormal AVP response due to increased blood volume/hyperviscosity stimulating ANP from baroreceptors, thus inhibits AVP release

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4
Q

Dogs can still have Pu/pd despite having the ability to concentrate urine. T/F?

A

True - consider osmotic diuresis, psychogenic polydipsia, and disorders in AVP secretion (note - this generally would still result in non concentrated urine however)

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5
Q

Serum Na concentrations in the higher range and a USG of 1.003 is more consistent with DI or psychogenic polydipsia?

A

DI

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6
Q

Hypophysectomy always results in permanent CDI. T/F?

A

False - sufficient hormone can be released from fibers ending in median eminence and pituitary stalk (unless that’s removed too). Most dogs can be weaned off DDAVP.

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7
Q

Why could primary nephrogenic DI dogs be responsive to DDAVP?

A

The V2 receptors may have an extremely low binding affinity for AVP, requiring higher doses than physiologically produced

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8
Q

Giving DDAVP to a dog with pituitary dependent HAC will result in no improvement, transient improvement, or complete improvement?

A

Transient improvement. (Dogs with pituitary dependent HAC can respond similar to dogs with partial CDI or psychogenic polydipsia)

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9
Q

When is the earliest one can evaluate response to DDAVP?

A

5-7d, because renal medullary wash out may complicate concentration

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10
Q

What % change in USG indicates response to DDAVP consistent with CDI?

A

50% change. Or USG > 1.030

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11
Q

When to end a modified water deprivation test?

A

Lost 3% of body weight, USG > 1.030, clinical dehydration, behavior/mentation change (due to dehydration), azotemia, hypernatremia. Can do plateau of urine concentration (change of less than 5% or 30 mOsm/kg of water over 3h) but this can have a false plateau

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12
Q

Giving DDAVP to a dog without DI will result in what change to USG during water deprivation test?

A

Little effect.< 10 % change.

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13
Q

Diagnosis for complete central DI with a modified water deprivation test?

A

Minimal (<10%) change in USG at 5% dehydration. Increase in 50% of USG or urine osmolality with DDAVP.

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14
Q

A dog that is clinically dehydrated with a USG <1.030 does not have psychogenic polydipsia. T/F?

A

False - can still be <1.030 due to medullary solute washout

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15
Q

Detecting hypertonic dehydration is soonest detected with what hydration parameter?

A

Body weight.

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16
Q

Free water deficit formula

A

(([Current Na] / [normal Na]) - 1 ) * (.6 * kg)

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17
Q

In differentiating DI between psychogenic polydipsia, a low plasma osmolality is consistent with which process?

A

Psychogenic polydipsia

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18
Q

Diagnosis of syndrome of inappropriate ADH?

A

hyponatremia with plasma hypoosmolality; inappropriately high urine osmolality with plasma hypo-osmolality; normal renal and adrenal function; presence of natriuresis with hyponatremia; inappropriately AVP with plasma osmolality; no hypovolemia/edema/ascites; correction of hyponatremia with fluid restriction

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19
Q

Popular breed in which pituitary dwarfism is known?

A

German Shepherd

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20
Q

Difference in growth for pituitary dwarfism vs congenital hypothyroidism?

A

Pituitary dwarf - proportionate
Hypothyroid - disproportionate (short limbs, broad head)

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21
Q

Basal growth hormone assays are not useful to distinguish pituitary dwarfs from normal dogs. T/F?

A

True

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22
Q

What is the gene mutation present in GSDs responsible for pituitary dwarfism? (And can be screened for)
- ABCD1
- LHX3
- MCH3
- SLC2A9

A

LHX3 gene mutation

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23
Q

Measurement of what hormone is used to dose adjustments of porcine GH to pituitary dwarfs?

A

IGF-1

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24
Q

What other congenital abnormality accompanies pituitary dwarfs and should also be treated?

A

Hypothyroidism

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25
Q

Prognosis if pituitary dwarf left untreated?

A

Severe hair coat and skin abnormalities; become progressively thin, lethargic, dull. Die or euthanized between 3-5 years of age.
If treated- live several years with good QOL but still do not have normal life expectancy

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26
Q

What is cause of acromegaly in most cats?

A

GH-producing pituitary adenoma

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27
Q

IGF-1 can be falsely low in an acromegalic cat in what scenarios?

A

serious other concurrent disease, untreated diabetic cat, grey zone IGF, starvation, early acromegaly

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28
Q

IGF-1 can be falsely high in a normal cat in what scenarios?

A

Vigorous or long-term insulin treatments, problems with assay

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29
Q

What is generally used for medical management for acromegaly?

A

Pasireotide (somatostatin)
Cabergoline (dopamine agonist)

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30
Q

what are differentials for acromegaly in a dog?

A

Excess progesterone production or administration (intact females), pituitary tumor is very rare

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31
Q

Which body system is most commonly affected in dogs with diagnosed with hypothyroidism?

A

Skin (60-80%)

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32
Q

Why is T4 measured instead of T3?

A

T4 is produced only by thyroid, while T3 can also come from extrathyroidal sites through the deiodination of T4.

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33
Q

What dog type has a lower tT4 and fT4 than other breeds?

A

Sighthounds (Greyhound, Whippet, Saluki, Sloughi)

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34
Q

What percentage of hypothyroid dogs have TSH within the reference range?

A

20-40%

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35
Q

A more useful test of thyroid function in Greyhounds would be

A

total T3 - generally within normal reference range and thyroiditis is not common

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36
Q

If you are suspicious that a dog is not hypothyroid but is receiving supplementation, how soon should you recheck thyroid levels after stopping supplementation?

A

Recheck in 6-8w ideally. Earliest re-evaluation in 4w. (however JVIM 2017 said that in dogs receiving levothyroxine SID for 16w you can recheck as early as 1 week)

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37
Q

If you receive a post-pill T4 taken 5 hours after medication that is in lower half of reference range in a hypothyroid dog whose clinical signs are well-controlled, what is the the gold standard next step?

A

Measure serum TSH - if normal - maintain dose.

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38
Q

Starting thyroid doses in dogs with cardiomyoopathy should be what % of the normal dose?

A

25-50%

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39
Q

Dogs with severe malabsorptive disease may benefit from what medication instead of levothyroxine? What are disadvantages of this medication?

A

Liothyronine. Has to be dosed three times a day and must measure T3. (2-4h post). Higher risk of toxicosis.

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40
Q

95% of cats that are hyperthyroid are diagnosed over what age?

A

8 years

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41
Q

fT4 is more sensitive/specific than tT4 but is less sensitive/specific in cats for detection of hyperthyroidism.

A

Sensitive, specific

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42
Q

What is the significance of measuring T3 in a T3 suppression test in measurement of feline hyperthyroidism?

A

T3 should ALWAYS reliably increase if done correctly. If T3 is not increased, then owner was not compliant and test results may not be reliable.

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43
Q

Where else does can pertechnetate accumulate besides thyroid glands during thyroid scintigraphy (if any)?

A

Salivary glands and gastric mucosa

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44
Q

The majority of hyperthyroid cats have bilateral or unilateral disease?

A

Bilateral (70%) according to Nelson/Feldman

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45
Q

Advantage of thyroid scintigraphy over CT scan?

A

Can distinguish unilateral vs bilateral dysfunction and can identify ectopic tissue

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46
Q

Why is medical management recommended prior to definitive treatment for hyperthyroidism?

A

Assess for development of azotemia

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47
Q

Prescription y/d may be acceptable for cats with what other concurrent disease process?

A

Early renal disease (at least…as of time of Nelson Feldman 4th edition)

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48
Q

Thyroid carcinomas most frequently metastasize to which site in the dog?

A

Lungs (77% of metastasized tumors)

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49
Q

What % of dogs had had evidence of metastasis with thyroid carcinomas with tumor volume of > 100 cm^3?

A

100%

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50
Q

Describe a clinical case of thyroid carcinoma in a dog for which surgery would be treatment of choice.

A

Freely moveable, non-invasive thyroid tumors (25-50% of dogs)

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51
Q

PTH encourages Ca reabsorption from which part of the tubule?

A

Distal tubule

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52
Q

Adult onset hyperparathyroidism is most well known noted as an inheritable condition in what breed of dog?

A

Keeshond

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53
Q

How does acid-base affect ionized calcium concentrations?

A

Acidosis decreases plasma protein-binding affinity for calcium > ionized hypercalcemia Alkalosis has the opposite effect

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54
Q

Ca x P product over what number is concerning for nephrotoxicity.

A

Depends on source, but around 60-80

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55
Q

Hypocalcemia will cause increase nerve cell membrane permeability to sodium. This will result in increased or decreased excitability?

A

Increased. (Hence why tetany and seizures can be caused by hypocalcemia)

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56
Q

Why is magnesium a cofactor for PTH secretion?

A

Required for release of stored hormone from secretory granules

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57
Q

What are adverse effects of methimazole in cats?

A

Anorexia, vomiting, lethargy, ulcerative pinnal lesions, blood dyscrasias, hepatopathy, rarely myasthenia

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58
Q

Calcium levels for supplementation for dogs with hypoparathyroidism should: a. just below reference range b. lower half of reference range c. upper half of reference range d. just over reference range

A

a. just below (according to nelson/feldman) as this should not induce clinical signs, maximize PTH secretion (if present), and avoid the possibility of excess calcium (and causing nephrotoxicity or cystoliths through calciuria)

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59
Q

Stress-induced hyperglycemia can take several days to resolve in a diabetic animal. T/F?

A

True

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60
Q

Human portable glucometer will generally underestimate/overestimate blood glucose in dogs.

A

Underestimate

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61
Q

Anti-insulin antibodies in dogs can develop if insulin is developed from which sources?

A

Canine or beef

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62
Q

Mechanism of action of glipizide? (oral hypoglycemic most often used in cats and studied the most)

A

Sulfonylurea- stimulate insulin secretion

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63
Q

If used, acarbose seems to have its best effects in cats that have to remain on a high carbohydrate diet.T/F?

A

True

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64
Q

Mechanism of action of exenatide.

A

GLP-1 agonist. (enhance insulin secretion, reduce glucagon secretion, reduce post-prandial hyperglycemia, slows gastric emptying, enhances satiation). Can be given once a week in XR models

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65
Q

Fructosamine can be falsely low under what pathological situations in cats? (and dogs)

A

Hyperthyroidism, hypoalbuminemia

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66
Q

What does Nelson/Feldman recommend for diabetic ketosis patients (with no acidosis)?

A

Short acting insulin TID (with feedings at each meal) until ketosis resolves, then long-acting insulin…

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67
Q

Concurrent causes for dogs/cats in HHS?

A

Sepsis, hemorrhage, anemia, pulmonary disease, liver disease, kidney disease!, panc, CHF

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68
Q

Differences in treatment for HHS vs DKA?

A

Heavier emphasis on fluid therapy for HHS. Insulin doses are started lower (Nelson/Feldman recommends 50% lower) to also avoid rapid changes in glucose affecting osmolality and neurologic status

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69
Q

Most common sites of beta cell metastasis?

A

regional lymphatics and lymph nodes of liver and peripancreatic omentum (pulmonary is not until late in disease)

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70
Q

Glucose enters beta cell by what transporter?

A

GLUT-2

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71
Q

Hepatic glucose production is inversely related to what concentration?

A

Blood glucose

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72
Q

What can set off clinical signs in dogs with insulinoma?

A

Increased exercise, fasting, excitement, eating (especially highly digestible food)

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73
Q

A Maltese that presents for weakness has hypoglycemia, increased liver enzymes, and hepatomegaly with severe vacuolation noted on liver aspirate. What is your top differential?

A

Glycogen storage disease (Type Ia). Other types - Type II - Lapland dogs; Type III - GSD and Curly Coated Retrievers, Type IV - Norwegian Forest Cats.

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74
Q

Insulin levels in the lower half to below the refence range rule out insulinoma. T/F?

A

False - only if insulin is below the reference range

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75
Q

Mechanism of action of diazoxide? What else can be given with it to potentiate its effects?

A

Benzothiadiazide diuretic that inhibits insulin secretion, stimulates hepatic gluconeogenesis and glycogenolysis, and inhibits tissue use of glucose. No anti-neoplastic effects. Can be used with thiazide diuretic (hydrochlorothiazide).

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76
Q

Side effects of streptozocin?

A

Many. Nephrotoxicity, hepatopathy, diabetes mellitus, GI signs.

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77
Q

The stepwise medical recommendation for insulinoma?

A

Small frequent feedings (ideally higher fiber/carb) > steroids > diazoxide > somatostastin/streptozotocin

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78
Q

the ACTH stim is more sensitive to detect PDH or adrenal tumor?

A

PDH

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79
Q

You receive results of a LDDST from a dog you are concerned has Cushing’s. The 8 hour result is below the lab cut off, but the 4 hour is over the lab cut-off. What is your interpretation?

A

“Inverse” pattern which can occur in dogs with PDH. not diagnostic, but further testing indicated.

80
Q

Suppression on HDDST at any time point is consistent with PDH or adrenal tumor?

A

PDH

81
Q

Lack of suppression of HDDST at any time point is diagnostic for adrenal tumor. T/F?

A

False - PDH is still possible.

82
Q

When to stop loading dose of mitotane and perform ACTH stim in dog with PDH?

A

Any GI signs or listlessness, water intake <60 ml/kg/d, or maximum of 8 days

83
Q

How is an ablative loading regimen of mitotane different in adrenal tumor dog vs PDH

A

Higher dose, add physiologic dose of steroid, max of 14d as long as dog is doing well, otherwise similar monitoring in terms of GI signs or water intake

84
Q

Ideal post ACTH cortisol concentrations for a dog on trilostane?

A

1-5, up to 9 is ok

85
Q

Dopamine agonist can be considered for which form of HAC?

A

PDH only (dopamine inhibits ACTH)

86
Q

Increased concentrations of which types of hormones on an adrenal panel lie BEFORE trilostane’s mechanism of action?

A

pregnenolone, 17a-pregnenolone, DHEA, DHEA sulfate

87
Q

Cats with hyperadrenocorticism generally lack stress leukograms and liver enzyme elevations. T/F?

A

True

88
Q

The dose used for cats in the LDDST is higher/lower/the same as the dose used for dogs.

A

Higher (10x).

89
Q

The ACTH stimulation test is not a sensitive test to use to diagnose feline hyperadrenocorticism. T/F?

A

True

90
Q

What are the two tests recommended by Nelson/Feldman monitoring cats on trilostane?

A

Morning UCCR+ ACTH stim

91
Q

Most common owner concerns in cats diagnosed with primary hyperaldosteronism?

A

Weakness (hypokalemia) and signs from hypertension

92
Q

Common concurrent diseases or signs in cats with hyperadrenocorticism?

A

Insulin resistant diabetes, PU/PD, skin fragility, poor hair growth/alopecia

93
Q

Hypophysectomy will result in mineralicorticoid deficiency.T/F?

A

False. While ACTH has some effect on decreased aldosterone secretion, removing pituitary does not result in clinical mineralicorticoid deficiency

94
Q

Breeds known to develop hypoadrenocorticism?

A

There are many - but main ones are Standard poodle, Bearded Collie, Portuguese Water dog (these also found in JVIM 2016 study!), Nova Scotia Duck Tolling Retriever, Cairn terriers and Cockers also found in JVIM 2016 Swedish study

95
Q

What acid/base abnormality generally develops in Addisonian dogs?

A

Metabolic acidosis due to lack of aldosterone (impairment of hydrogen secretion)

96
Q

How can an Addisonian patient have a low USG without true renal dysfunction?

A

Loss of Na > loss of normal medullary concentration gradient > impaired ability to resorb water; low Na also interferes with vasopressin release by reducing plasma osmolality.

97
Q

Dogs with glucocorticoid-deficient hypoadrenocorticism (atypical addison’s) - if they progress to complete adrenocorticial insufficiency - generally do so within what amount of time?

A

1 year

98
Q

Potency of epinephrine and norepinephrine compared to alpha and beta receptors?

A

Similar potency for alpha and beta1 receptors. Epinephrine more potent for b2 (low dose - vasodilation in skeletal muscles for b2, high doses the a1 receptor predominants = vasoconstriciton), norepi more potent for b3.
b2 - does a lot (inc lipolysis, decrease bronchial contraction, decrease intestinal motility, increase insulin and glucagon release, decrease vasoconstriction, etc)
b3 - increase lipolysis and increases intestinal motility

99
Q

Which hormone best correlates with pheochromocytoma and in urinary or plasma?

A

Urinary normetanephrine

100
Q

What could be the consequence of adding a beta blocker to a dog with secretory pheochromocytoma before alpha blockade?

A

Severe hypertension due to vasoconstriction from a receptor agonism

101
Q

Paragangliomas in dogs and cats (chemodectomas) generally are considered nonfunctional. T/F?

A

True

102
Q

Step-wise work-up in incidentaloma?

A
  1. rule out adrenal metastasis
  2. rule out hormonally active tumor (blood pressure, review case, hormonal tests)
  3. discuss treatment options (sx, medical management if indicated, monitoring with imaging)
103
Q

Name the hormones secreted from pituitary.

A

Posterior - oxytocin, vasopressin
Anterior- TSH, ACTH, GH, prolactin, sex hormones

104
Q

What % of cats achieved diabetic remission in cats that underwent radiation for pituitary adenoma with acromegaly?

A

34% (roughly 1/3 was temporary, 2/3 was permanent). Rare side effects - hypot4, blindness, progression
Most achieved reduction insulin, MST 3y - JVIM 2018

105
Q

What was rate of diabetic remission in cats that underwent hypophysectomy for acromegaly?

A

71% of surviving cats (60% of all cats) in hypophysectomy.
85% survival rate, MST 853 days of all cats. JVIM 2021

106
Q

What is % of cats that entered remission for acromegaly for those that received hypophysectomy? What was definition of remission?

A

23/24; remission was normalization of IGF-1 concentration, JVIM 2021

107
Q

Mortality rate for hypophysectomy in cats?

A

Ranges from 8-15% (JVIM 2018, JFMS 2019)

108
Q

Was cabergoline effective in normalizing IGF-1 or insulin doses in cats with DM with acromegaly?

A

No - JFMS 2021

109
Q

Serum N-terminal type III procollagen propeptide above 10.5 was highly specific (100%) for cats with acromegaly. T/F?

A

True - JVIM 2016

110
Q

Why might pasireotide be more effective than octreotide at addressing acromegaly in cats?

A

Binds more somatostatin receptors (up to 4) than octreotide (2). JVIM 2017

111
Q

Homocysteine levels are higher in hypothyroid dogs. T/F?

A

True - JVIM 2017 (median 22 to median 11)

112
Q

What are typical changes in GH and TSH in hypothyroid dogs with TRH stimulation test compared to dogs with nonthyroidal illness?

A

No change in TSH response between the two. GH increases and is in general higher in hypoT4 dogs. JVIM 2017

113
Q

Most sensitive test for feline hypoT4?

A

Elevated TSH JVIM 2018

114
Q

Diagnosis for central hypoT4 (in Miniature Schnauzers)?

A

T4 increase with repeated TSH as TSH may not fully activate T4 the first time due to thyroid atrophy.
TRH is not always test of choice because TSH does not always increase in dogs with primary T4 JVIM 2016

115
Q

When is the earliest that you can assess hypothalamic-pituitary-thyroid axis in dogs receiving once daily levothyroxine for up to 16 weeks?

A

1 week JVIM 2017

116
Q

Feline breeds at decreased risk of hyperT4? Increased risk?

A

Burmese, Tonkinese, Persian, Siamese, Abyssinian, British shorthair (Burmese most protected!)
Long-haired, non-purebred at increased risk. Color or coat pattern not a risk factor. JVIM 2017

117
Q

A variable dosing method of radioiodine based on percent dose uptake using 99mTc-pertechnetate on thyroid scintigraphy (primarily) and thyroid gland size (secondarily) based on thyroid:salivary size ratio did not improve outcome compared to a standard fixed dose method. T/F?

A

True - JVIM 2018

118
Q

One-time administration of rh-TSH, even at high doses, does not lower radioactive iodine doses needed for treatment of hyperthyroidism in cats. T/F?

A

True - jVIM 2018

119
Q

What % of cats became hyperthyroid again after bilateral thyroidectomy?

A

44% on long term (22% over 6 mo) JVIM 2019

120
Q

What was proportion of hypoT4 cats that actually had a tT4 below reference range?

A

81% - JVIM 2020

121
Q

Of tT4, fT4, tT3, and TSH - which value(s) was NOT different between ill and healthy cats? Which values were predictive survival in ill cats?

A

TSH and fT4. Lower tT4 and TSH predictive of survival -JVIM 2020

122
Q

TT4 over what value at discharge is 100% predictive of treatment failure in I-131 cats?

A

150 nmol/L JVIM 2021

123
Q

An individualized model of I-131 in cats lowered prevalences of which two conditions compared to historic standard doses? [Ultimately individualized models gave lower doses]

A

Hypot4 and azotemia JVIM 2021
SAME thing happened with lower radio-iodine dose in JVIM 2017

124
Q

Is serum T4 a predictor of hypercoagulable state in hypert4 cats?

A

No - JVIM 2021

125
Q

Renal function and T4 should be monitored at least how long after finishing I-131 to screen for hypoT4 in cats?

A

6-9 mo JFMS 2016, 2019

126
Q

What are AAFP recommendations for a cat with elevated tT4 but no clinical signs on PE or history?

A

First confirm tT4. If still elevated (with no clinical signs) in 6 mo - treat.

127
Q

The more severe hyperT4 is in a cat, the lower IGF-1 will be. T/F?

A

True - JFMS 2018

128
Q

Limited iodine diet (y/d) fed to healthy cats did not have impact on UA, chemistry, tT4, TSH, or thyroid gland height for up to 2 years. T/F?

A

True - JFMS 2018

129
Q

SDMA generally increases after I131 treatment in hypert4 cats. T/F?

A

True - JFMS 2020, JVIM 2020

130
Q

What percent of cats had thoracic abnormalities in hyperT4 cats referred for I-131 therapy?

A

77% (43% - cardiac, 59% - resp) - JFMS 2020

131
Q

fT4 via chemiluminescence is recommended alongside ED in cats post I-131 cats. T/F?

A

False - good correlation but chemiluminscence was consistently lower than ED (in cats that were not hypoT4 based on TSH and tT4) - JFMS 2020

132
Q

Low cobalamin levels in hyperT4 cats should be supplemented. T/F

A

False - JVIM 2016

133
Q

What % of cats diagnosed with hyperT4 were microcytic?

A

29.5% - JFMS 2021

134
Q

Diabetic dogs had highest increases in which lipoproteins?

A

low density lipoprotein cholesterol and nonHDL cholesterol - JVIM 2018

135
Q

Flash glucose monitoring systems were more effective at detecting hypoglycemia than blood glucose curves. T/F?

A

True - Flash glucose detected 60% of episodes to portable detecting 9% - JVIM 2020

136
Q

Beta-hydroxybutyrate is higher in dogs with acute pancreatitis and can confound diagnosis of DKA. T/F?

A

False - it is higher but unlikely to confound JVIM 2016

137
Q

Elevated cPLI can be found in what % of dogs with DKA?

A

73% JVIM 2016

138
Q

Insulin-induced hypoglycemia (aka somogyi) was found to occur in what % of diabetic cats?

A

25% JVIM 2018 (also found in JFMS 2016 study with glargine) - unsurpisingly these cats had higher insulin dose, higher fructosamine, and higher glucose variability in JVIM 2018 study

139
Q

What % of new diabetic cats had IGF-1 > 1000 2-4w after starting insulin?

A

33%. Not all these cats were acromegalic! JVIM 2018

140
Q

Diabetes mellitus is significantly associated with CKD in cats. T/F?

A

T - JVIM 2019

141
Q

Exenatide is shown to improve glycemic variability compared to placebo in cats also receiving glargine and low carb diet. T/F?

A

True - JVIM 2020

142
Q

Rate of flash glucose monitoring sensor failure and median time of sensor activity in outpatient diabetic cats?

A

30-80% (failure meaning before they stopped working or fell off or something) - depending on JFMS 2021 vs JVIM 2021, median time 7 days JVIM 2021
JFMS 2021 - 2/3 of sensors placed lasted full 14d…

143
Q

Clinical signs associated with what body system were associated with feline hypoglycemia in diabetics

A

Inappropriate neurologic signs (JFMS 2018)

144
Q

What is alternative to regular insulin CRI for DKA in cats?

A

Lispro (JFMS 2019 and JVIM 2019); or IM/SC glargine - JVECC 2021

145
Q

What % of cats became diabetic after 3 mo of 2 mg/kg/d prednisolone?

A

85% - JFMS 2021

146
Q

Cats with hyperadrenocortocism and concurrent diabetes are not always insulin resistant. T/F?

A

True - JFMS 2021

147
Q

Cat breeds at higher risk for DM in the UK?

A

Tonkinese, Norwegian Forest and Burmese cats - JVIM 2016

148
Q

What were increased risks of diabetes in cats?

A

Indoor, being male (not found in JVIM 2016), greedy eater, overweight, or eating dry food while normal weight; confirmed Burmese and Norwegian Forest cat risk - JVIM 2017

149
Q

Complication rate in adrenal FNA?

A

4/50 - 1/50 died (from resp distress?) JVIM 2020

150
Q

Normal adrenal gland thickness in dogs < 12kg? > 12kg?

A

0.62 cm, 0.72 cm

151
Q

Expression of what enzyme is higher in zona fasciculata, resulting in higher cortisol formation?

A

17a hydroxylase (CYP17). (aldosterone synthase - CYP11B2 is found in both ZF and ZG in equal amounts) - JVIM 2016

152
Q

Which pattern provides the highest support for HAC on LDDST? (complete lack of suppression; partial suppression; escape pattern; inverse pattern)

A

Complete lack (duh) - 93% PPV - JVIM 2018

153
Q

The baseline cortisol in ACTH stim is needed to diagnose what conditions?

A

Iatrogenic HAC and CIRCI - JVIM 2018 (not needed for PDH)

154
Q

Concurrent pituitary and adrenal lesions were present in what % of dogs with hypercortisolism?

A

5% (10% in dogs that did not suppress with dexamethasone) - JVIM 2019

155
Q

Pre- and post-trilostane cortisol, ACTH stim, USG, and UCCR did not reliably distinguish adequate dosing from underdosed dogs. T/F?

A

True JVIM 2020, 2021

156
Q

Which of the following was lower in Cushingoid dogs vs controls?
mean serum phosphate concentrations, median fractional excretion of Ca, median serum wPTH, FGF-23

A

FGF-23 - which is weird because Cushing’s dogs had higher phosphorus (which generally should increase FGF-23) - JVIM 2021

157
Q

Dogs with HAC can develop hypertension even with disease control. T/F?

A

True - JVIM 2021(ultimately needed in 31/51 dogs - so like 60%)

158
Q

Cats with hyperaldosteronism frequently have multiple corticosteroid abnormalities in addition. T/F?

A

True - particularly progesterone and corticosterone (JVIM 2021)

159
Q

Serum haptoglobin identified what % of undercontrolled dogs on trilostane for HAC?

A

65% - JVIM 2021

160
Q

Most common primary adrenal neoplasia in the cat?

A

Adrenocortical carcinoma JFMS 2016

161
Q

A pituitary height: brain ratio over 0.31 was associated with what in dogs?

A

2x earlier chance of death and higher recurrence after transphenoidal hypophysectomy (JVIM 2016)

162
Q

What was MST of dogs that were not treated for PDH?

A

1.4 years (JVIM 2017) - compared to unreached MST if on trilostane

163
Q

Prevalence of gall bladder mucocele was how much higher in dogs with HAC?

A

29x - JVIM 2017

164
Q

TSH levels are generally normal in dogs with hypoadrenocorticism and normal dogs. T/F?

A

False -they can be increased JVIM 2017. Should normalize with treatment for hypoA

165
Q

DOCP doses of up to 2.2 mg/kg can last for a median time of how long?

A

~60d JVIM 2017

166
Q

Dogs under what age needed significantly higher starting dose for DOCP for hypoadrenocorticism?

A

3 years (JVIM 2019). However none still needed dose of 2.2 mg/kg. Most were okay with 1.5 mg/kg dose. Another JVIM 2021 study also looked at 1.1mg/kg and found it to be fine

167
Q

What was prevalence of hypoadrenocorticism in multi-center study of dogs with chronic GI disease? What sign was more common in these dogs?

A

4%; melena /hematochezia more common (JVIM 2020)

168
Q

Administering calcitriol the day of parathyroidectomy for primary hyperparathyroidism was associated with improved calcium immediately following surgery. T/F?

A

False - JVIM 2018

169
Q

Vitamin D receptors are more highly expressed in duodenum of CE dogs than in normal dogs. T/F?

A

False - JVIM 2018

170
Q

1-alpha-hydroxylase is found where? What does it do?

A

Kidney; changes calcidiol > calcitriol

171
Q

Name some diseases associated with decreased Vitamin D (and metabolites)

A

CKD, proteinuria, PLE, MCT, rickets (type 1), CHF or progressive CVD, FIV, spirocherca, blastomycosis, immune mediated diseases (immune mediated disease - JVIM 2017 -92% had decreased VD receptors regardless of control)

172
Q

What are the mechanism of action of fibrates?

A

exert their effects mainly by activating the peroxisome proliferator -activated receptor-alpha (PPAR-alpha) =induction of hepatic fatty acid uptake, decrease in hepatic TG and VLDL synthesis, increased activity of lipoprotein lipase, increased GB excretion of hepatic CHO, increased production of HDL

173
Q

What inflammatory biomarker was increased in Miniature Schnauzers with hyperlipidemia but was unchanged with treatment?

A

Serum calprotectin (JVIM 2019)

174
Q

Lifespan was shortest in overweight dogs specifically in which breed?

A

Yorkshire Terrier (JVIM 2019)

175
Q

Higher protein over the counter feline diets were associated with having higher amounts of which element? (Ca, P, or Mg)

A

Phosphorus (JVIM 2020)

176
Q

Higher serum spexin concentrations were associated with increased or decreased BCS in dogs?

A

Decreased (JVIM 2021)

177
Q

Omega-3 and Omega-6 fatty acid concentrations were significantly lower in dogs with higher Cr. T/F?

A

True (JVIM 2021)

178
Q

IGF-1 was not shown to be associated with weight changes in healthy cats. T/F?

A

True (JVIM 2021)

179
Q

What nutrients are specifically derived from animal-based ingredients in dogs?

A

total protein, methionine, taurine, DHA, and vitamins A, B12, and D (JAVMA 2016)

180
Q

What nutrient was most frequently under-supplemented even in veterinarian prepared home-made recipes for cats?

A

Choline (JAVMA 2019) [other nutrients decreased in non-veterinarian diets included iron, thiamine, zinc, manganese, vitamin E, and copper]

181
Q

What enzyme (or enzymes) help facilitate the first rate-limiting step in glycolysis ?

A

Glucokinase, hexokinase (Glucose > G6P)

182
Q

Clinical signs of thiamine deficiency in cats?

A

non-specific signs (anorexia, lethargy, vomiting) followed by NEUROLOGICAL signs (most commonly vestibular) - JFMS 2017

183
Q

In what breed were all healthy dogs found to have high levels of homocysteine?

A

Greyhounds (JVIM 2017) (40% also have low folate)

184
Q

What is risk of developing diabetes after surgery for insulinoma?

A

1/3 of dogs became hyperglycemic, 20% of those became diabetic. (JVIM 2020). MST about a year, 2 years if stage 1

185
Q

Flash glucose monitoring systems are NOT as accurate with sudden increases or decreases in blood glucose. T/F?

A

True - JVIM 2021

186
Q

Which of the following was not associated with decreased survival in survivors vs nonsurvivors in critically ill dogs? Increased serum cortisol, lower tT4, lower cholesterol, lower triglycerides

A

Lower tT4 (JAVMA 2019, 2020)

187
Q

What % of cats with thyroid cysts were also hyperthyroid? What % of cyst resolved with radio-iodine treatment?

A

93% hyperthyroid; only 50% resolved with radio-iodine (therefore surgery may be needed) - JVIM 2017

188
Q

Perivascular administration of ACTH was acceptable for both healthy and cushinoid dogs. T/F?

A

True JVIM 2017

189
Q

What is the sensitivity for a low total calcium in a dog with hypoalbuminemia to detect true ionized hypocalcemia?

A

100% (but specificity was 60%) - JVIM 2021

190
Q

A dog with hypoalbuminemia and a normal corrected calcium is how likely to be truly normocalcemic?

A

Extremely likely (NPV of 100%) - JVIM 2021
Equation - tCa (mg/dL) - serum albumin concentration (g/dL) + 3.5 (g/dL).

191
Q

Ideally, Ca:P ratios should be kept over what?

A

1:1 (Phosphate review JVIM 2020)

192
Q

A dog with an adrenal mass and a low serum inhibin would be consistent with what diagnosis for the adrenal mass?

A

Pheochromocytoma

193
Q

CRH, TRH, and some ADH is released from what part of the brain?

A

Paraventricular nucleus within hypothalamus

194
Q

What is rate-limiting step of cholesterol synthesis? What drug class works to inhibit step?

A

HMGCoA reductase, statins

195
Q

Which of the following insulins was associated with the most day to day variability when administered q12?
-Porcine lente
-Glargine 300
-Degludec

A

Lente (at q24 - day to day variability between all 3 were similar) - JVIM 2021

196
Q

What % of dogs had over-suppressed renin activity on conventional doses of DOCP compared to 1.1 mg/kg dose?

A

80% (84/104) compared to 20% (23/112) - JVIM 2021

ACVIM SAIM Specialty 2023 (12 decks)

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