Final Exam--SA material

Question 1

In most cases, feline hyperthyroidism is due to?

Answer 1

adenoma of thyroid gland

*usually bilateral

Question 2

The most common physical exam finding in cats with hyperthyroid?

Answer 2

palpable goiter

Question 3

T/F: Feline hyperthyroidism can cause marked elevations in liver enzymes

Answer 3

False

*MILD increases (up to 400s)

Question 4

How can you determine if feline thyroid nodules are malignant?

Answer 4

histopath is ONLY definitive way

*radionuclide scan can only be suggestive

Question 5

Which treatment options for feline hyperthyroidism are reversible if hypothyroidism develops?

Answer 5

Medical (Methimazole) & dietary

Question 6

If ectopic thyroid tissue is present, what would be your best treatment choice?

Answer 6

radioiodine

Question 7

Regardless of therapy choice, ~25% of cats will develop what after being treated for hyperthyroidism? why?

Answer 7

25% develop azotemia

hyperthyroidism masks renal disease by increasing GFR–so when you stop the disease, GFR decreases and azotemia develops

Question 8

Methimazole:

1) MOA
2) most common side effect

Answer 8

inhibits formations of T4

GI side effects most common (anorexia, vomiting)

Question 9

What clinical side effects (4), if they develop, would mean permanent d/c of methimazole as a method of treatment?

Answer 9

1) severe facial pruritus
2) thrombocytopenia (bleeding)
3) icertus
4) agranulocytosis (low neutrophil #)

Question 10

When regulating T4 levels in hyperthyroid cat, where do we want the levels to be?

Answer 10

in lower half of RR

Question 11

You must give radioactive iodine ___months to work before assuming cat is still hyperthyroid or has developed hypothyroidism

Answer 11

3 months

*transient hypothyroidism is normal

Question 12

When would surgery or radioactive iodine be contraindicated in treating feline hyperthyroidism?

Answer 12

If the cat is azotemic prior to receiving any treatment AND fails trial medical therapy

*failing= azotemia worsens and clinical signs of renal failure develop

Question 13

The best marker of hypothyroidism in a cat?

Answer 13

Elevated TSH

Question 14

When do clinical signs of DM develop?

Answer 14

when glucosuria develops

Question 15

What is the renal threshold for glucose in

1) dogs
2) cats

Answer 15

1) 200mg/dL

2) 300mg/dL

Question 16

How does sex predilection for DM differ btwn dogs and cats?

Answer 16

dogs–females are 2x as likely to be affected

cats–neutered males are more likely

Question 17

3 most common clinical signs assoc. with DM?

Answer 17

polyphagia
PU/PD
weight loss

Question 18

A clinical sign of DM unique to

1) dogs
2) cats

Answer 18

1) cataracts

2) diabetic neuropathy

Question 19

What 3 criteria must be met to make the dx of DM?

Answer 19

1) appropriate clinical signs
2) persistent fasting hyperglycemia
3) persistent glucosuria

Question 20

Why are UTIs so important to r/o before starting therapy for DM? How can we rule out a UTI in a diabetic?

Answer 20

only way to rule out is to do a culture

infection can cause insulin resistance!!

Question 21

As far as dietary recommendations for diabetics go, the most important thing to avoid feeding is?

Answer 21

simple carbs–are absorbed too quickly and cause severe post-prandial hyperglycemia

Question 22

Which types of insulin:

1) are veterinary products
2) are used for emergency situations

Answer 22

1) Vetsulin (lente) & PZI

2) Regular & Lispro

Question 23

Considering handling of insulin, most should be ______ to be mixed; the exception is ?

Answer 23

rolled;

exception= vetsulin (shake this one)

Question 24

Which insulin, due to higher potency, requires a lower initial dose?

Answer 24

Detemir

Question 25

What 4 components do we use to monitor diabetics?

*4 pieces of the puzzle

Answer 25

1) clinical signs
2) BG curves
3) glycosylated proteins
4) urine glucose

Question 26

What is the ideal nadir for both dogs and cats?

What do you do if it’s too high? Too low?

Answer 26

80-150

If too high–increase dose 10-25%

if too low–decrease dose (50% if clinical signs of hypoglycemia)

Question 27

What are your two options if duration of insulin activity isn’t appropriate?

Answer 27

change insulin

change frequency of administration

Question 28

Which oral hypoglycemic agent can replace insulin in cats? What’s its MOA?

Answer 28

Glipizide;

binds sulfonylurea receptor to cause insulin release

Question 29

Which oral hypoglycemic agent can only be used IN COMBINATION with insulin (not alone) in both dogs and cats

Answer 29

Acarbose

**prevents breakdown of maltose and sucrose to decrease carb/glucose absorption from GI tract

Question 30

What two situations (if present) should make you SUSPECT insulin resistance

Answer 30

1) if patient remains markedly hyperglycemic on dose >1.0 U/kg
2) if patient requires a dose >1.5U/kg to

Question 31

If a dog is on a low dose of insulin but still becoming hypoglycemic, you should suspect?

Answer 31

maldigestion/malabsorption (EPI or other dz)

Question 32

The predominant ketone in dogs and cats?

Answer 32

beta-hydroxybutyrate

also acetone and acetoacetic acid

Question 33

When treating DKA, what are your top 3 goals?

Answer 33

1) achieve and maintain hydration
2) correct electrolyte abnormalities
3) reduce BG

Question 34

A patient presents with DKA–when you spin the blood down, the serum is red. What is your ain concern?

Answer 34

Hypophosphatemia

**causes hemolysis

Question 35

In DKA patients, by which route should you NOT administer insulin?

Answer 35

SQ–dehydration alters absorption

Question 36

1 presenting clinical sign of dogs with insulinoma?

Answer 36

seizures

Question 37

If BG is low (<60) what two insulin level findings would be indicative of insulinoma

Answer 37

1) if inuslin is above normal

2) if insulin in upper 50% of RR

Question 38

Why is prednisone indicated for tx of insulinomas?

Answer 38

it causes insulin resistance

Question 39

What are the chances of a cure with surgical removal in insulinoma?

Answer 39

0%!!

only diagnostic and therapeutic–WILL NOT CURE

Question 40

Compared to feline thyroid tumors, canine thyroid tumors tend to be _____ and _______

Answer 40

malignant and non-functional

Question 41

A dog presents for a cervical mass. When you got to aspirate it, the contents appears to be straight blood… you’re suspicious the mass is a?

Answer 41

thyroid tumor (most likely carcinoma)

Question 42

What characteristics of mass must be present for sx to potentially be curative?

Answer 42

Mass must be small, freely movable

**if invasive, can’t cure with sx

Question 43

Pheochromocytomas are tumors of the _____ and secrete what?

Answer 43

adrenal medulla

Epi and norepi

Question 44

Prior to sx on adrenal glands, you can administer which drug? Why?

Answer 44

Phenoxybenzamine–blocks effects of any epi that gets released

Question 45

Gastrinomas are tumors of the _____ cells; what do they secrete?

Answer 45

pancreatic delta cells

*secrete gastrin

Question 46

2 effects of hypergastrinemia

Answer 46

1) increased gastric acid secretion (ulcerations)

2) hypertrophy of stomach rugal folds (can affect motility and cause outflow tract obstruction)

Question 47

The biggest stimulus for secretion of ADH is?

Answer 47

plasma osmolality

Question 48

Define polydipsia in:

1) dogs

2) cats

Answer 48

1) > 100ml/kg/day

2) >45ml/kg/day

Question 49

3 most common causes of PU/PD in

1) dogs
2) cats

Answer 49

1) renal failure, HAC, DM

2) renal failure, DM, hyperthryoid

Question 50

Only do a modified water deprivation test if what 3 things are left on your ddx list?

Answer 50

1) central DI
2) psychogenic polydipsia
3) primary nephrogenic DI

Question 51

What are the 3 major endpoints for water deprivation test?

Answer 51

1) Azotemia (if present before test, don’t start it)
2) plasma osmolality >320 mOsm/kg

3) USG concentrates
(>1.030 dog, >1.035 cat)

Question 52

Why might some animals with DI show neuro signs?

Answer 52

~40% have a tumor in area of pituitary destroying ability to secrete ADH

Question 53

For which cause of PU/PD is water restriction the recommended tx?

Answer 53

Psychogenic polydipsia

Question 54

What type of treatment is used for nephrogenic DI?

Answer 54

Thiazide diurectics

**dehydrates patient and forces them to save Na and water follows