Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACVIM Specialty 2023 > General infectious disease > Flashcards

General infectious disease Flashcards

1
Q

Name 4 core canine vaccines. What form do the vaccines come in?

A
  1. Canine parvovirus - attenuated live
  2. Canine distemper virus - attenuated live or recombinant
  3. Canine adenovirus 2 - attenuated live
  4. Rabies - inactivated whole organism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Name 4 core feline vaccines. What form do the vaccines come in?

A
  1. Feline panleukopenia virus - attenuated live or inactivated whole vaccine
  2. Feline herpes virus 1 - attenuated live or inactivated whole vaccine
  3. Feline calicivirus - attenuated live or inactivated whole vaccine
  4. Rabies - inactivated whole organism or recombinant canarypox
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What complication can occur if the intranasal, avirulent live Bordetella vaccine is injected subcutaneously?

A

Fatal hepatic necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are depot adjuvants in vaccines? Give an example of one

A
  • Protect antigens from degradation - prolong the immune response by causing sustained release of antigen over a period of time
  • Oil in water emulsions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are particle adjuvants in vaccine? Give an example of one

A
  • Particles that effectively deliver antigens to DCs and enhance antigen presentation (soluble antigens alone are not trapped/processed very efficiently)
  • Microparticles, liposomes, immune-stimulating complexes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How do aluminum based adjuvants work?

A

Cause the release of inflammatory molecules and cytokines, trigger innate immunity by causing tissue damage/inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do saponin based adjuvants work?

A

Detergent like molecules that cause local tissue damage and stimulate Th1 activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why are microbial products effective as adjuvants in vaccines?

A

Represent PAMPs that trigger innate immunity through TLRs => release of cytokines and Th1 or Th2 responses
- Ex. LPS, killed anaerobic Corynebacteria, killed Mycobacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the mechanism of action of acyclovir and peniciclovir?

A

Guanosine analogs - activated by viral thymidine kinase, interfere with viral replication by inhibiting viral DNA polymerase and DNA synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the prodrugs of acyclovir and peniciclovir?

A

Valacyclovir and famciclovir, respectively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the side effects of acyclovir/valacyclovir in cats and why are they not recommended for treatment of herpes virus?

A
  • Myelosuppression, renal tubular necrosis, hepatic necrosis
  • These side effects can occur without effective suppression of viral replication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the mechanism of action for idoxuridine, trifluridine, and zidovudine?

A

All thymidine analogues that interfere with DNA synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the mechanism of action of oseltamivir (Tamiflu)?

A

Inhibitor of influenza virus neuraminidase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the mechanism of action of pentoxifylline?

A

Phosphodiesterase inhibitor - inhibits cytokine production, activation of T and B cells, neutrophil chemotaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Beta lactam antibiotics are named because they contain a beta lactam ring in their chemical structure. Name 4 antibiotic classes that are beta lactams

A
  1. Penicillins
  2. Cephalosporines
  3. Carbapenems
  4. Clavulanate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Are beta lactam antibiotics bacteristatic or cidal?

A

Bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the mechanism of action of beta lactam antibiotics?

A

Covalently bind to and inhibit penicillin binding proteins - needed to catalyze the cross linking of the peptidoglycan layer of the bacterial cell wall (see photo on desktop)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What bacteria are susceptible to beta lactam antibiotics?

A

Gram positive&raquo_space;»> gram negative
Gram positive bacteria are more reliant on peptidoglycan cell walls (50-100x thicker than in gram negatives)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What mediates resistance to beta lactam antibiotics?

A
  • Primarily beta lactamases - gram negatives express just under the LPS layer, gram positives excrete into the environment
  • Can also alter the structure of peptidoglycan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Are beta lactam antibiotics time or concentration dependent?

A

Time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are clavulanic acid, sulbactam, and tazobactam?

A
  • Beta lactamase inhibitors - can be administered in conjunction with penicillins to overcome resistance
  • Have weak intrinsic antibacterial activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

In an animal with renal failure, how should you adjust the dose of penicillins?

A

Time dependent and renal excretion - increase the length of the dosing interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What class of beta lactam antibiotics are highly resistant to all beta lactamases and lead to rapid lysis of bacteria?

A

Carbapenams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the mechanism of action of glycopeptide antibiotics?

A

Inhibit synthesis of peptidoglycan by binding to amino acids in the cell wall, thus preventing addition of new units

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is an example of a glycopeptide antibiotic?

A

Vancomycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the mechanism of action of fluoroquinolones?

A

Bind to DNA gyrase (aka topoisomerase II) and topoisomerase IV, which are the enzymes that cleave DNA during replication => disruption of DNA and protein synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why are fluoroquinolones more effective in gram negative bacteria?

A
  • Gram negative primarily use DNA gyrase, while gram positives primarily use topoisomerase IV
  • Fluoroquinolones usually have a lower affinity for topoisomerase IV => higher MICs for gram positives
  • Newer generations inhibit BOTH more equally
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What fluoroquinolones have greater efficacy against anaerobes?

A

Pradofloxacin&raquo_space;> marbofloxacin > enrofloxacin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Are fluoroquinolones time or concentration dependent?

A

Concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why does enrofloxacin result in blindness in cats? What are the physical exam findings?

A
  • Causes acute retinal degeneration
  • Bilateral mydriasis and tapetal hyperreflectivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What effect can fluoroquinolones have on young animals?

A
  • Can cause cartilage and joint toxicity by inhibiting proteoglycan synthesis
  • Avoid prolonged (>7 day) use in rapidly growing dogs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the mechanism of action of metronidazole?

A

Accepts electrons from the electron transport chain, thus forming a nitroso free radical that damages DNA => bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What dose of metronidazole can cause neurotoxicity?

A

> 30mg/kg/day (lower if hepatic dysfunction exists)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the mechanism of action of rifampin?

A

Inhibits the beta subunit of DNA-dependent RNA polymerase => impaired RNA synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Are fluoroquinolones bacteriostatic or bactericidal?

A

Bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is an adverse effect of rifampin?

A

Can cause the tears or urine to be red-orange colored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is the mechanism of action of TMS?

A

Inhibit folic acid metabolism by bacteria => interferes with purine and DNA synthesis

  • Trimethoprim: inhibits dihydrofolate reductase
  • Sulfonamides: analogs of PABA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Is TMS bacteriostatic or bactericidal?

A

Trimethoprim and sulfonamides separately are bacteriostatic. Together, they are bactericidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What bacteria can be treated with TMS?

A

Gram positive and negative
- Enterococci are intrinsically resistant though

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the mechanism of action of aminoglycosides?

A
  • Bind electrostatically to the bacteria outer membrane and displace Mg and Ca, which link adjacent LPS molecules => increased cell permeability
  • Once in the cell, bind to the 30S subunit of ribosomes => decreased protein synthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What bacteria are resistant to aminoglycosides?

A

Anaerobes - oxygen is required for movement into the cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Aminoglycosides are water soluble and poorly lipid soluble. What tissues do they not penetrate well?

A

Prostate, brain, eye, CNS, bile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Are aminoglycosides bacteriostatic or bactericidal? Time or concentration dependent?

A

Bactericidal, concentration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the side effects of aminoglycosides?

A

Nephrotoxicity, ototoxicity, neuromuscular blockade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the mechanism of action of chloramphenicol?

A

Binds to the 50S unit of ribosomes and inhibits protein synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Why do owners need to wear gloves when handling chloramphenicol?

A

In humans, even small amounts lead to irreversible aplastic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the mechanism of action of macrolides (clindamycin)?

A

Binds to the 50S unit of ribosomes and inhibits protein synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Are macrolides bacteriostatic or cidal? What bacteria do they treat?

A

Gram positives, bacteriostatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the mechanism of action of tetracyclines?

A

Binds to the 30S unit of ribosomes and inhibits protein synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Are tetracyclines bacteriostatic or cidal? Time or concentration dependent?

A

Bacteriostatic, time dependent

51
Q

Name two slow growing mycobacterial species

A

Mycobacterium tuberculosis, bovis, microti, avium

52
Q

What are the clinical signs of infection with slow growing mycobacterial species in cats?

A
  • Cutaneous lesions most common: dermal nodules +/- ulceration +/- lymphadenopathy
  • Can also affect the respiratory or GI tract
53
Q

What are the clinical signs of infection with rapid growing mycobacterial species in cats?

A

Panniculitis - usually of the inguinal fat pad, but also described on the flanks and base of the tail. SubQ tissue becomes thickened, adherent to the dermis, nodules and draining tracts

54
Q

What are the characteristics of Nocardia species?

A

Aerobic, branching, filamentous, gram positive, partially acid-fast bacteria

55
Q

What are the characteristics of Actinomyces species?

A

Anaerobic or microaerophilic, filamentous, gram positive,
non-acid-fast bacteria

56
Q

What are the typical clinical signs of infection with either Nocardia or Actinomyces?

A
  • Typically form cutaneous, non-healing wounds, abscesses, or cellulitis (75% of cases); can become disseminated or cause intra-cavitary infections but it’s more rare
  • Most common on the head, neck, and inguinal region
57
Q

Sulfur granules (small, yellow, firm tissue grains) can be seen with what infection?

A

Actinomyces usually
Rarely Nocardia

58
Q

How is Brucella canis transmitted? What is the most common route of infection?

A
  • Penetrates the mucosal membranes of the conjunctiva, oral cavity, and vagina
  • Oronasal contact with aborted fetal material or venereal are the most common routes of transmission
59
Q

If a bitch is exposed to Brucella up to 20 days after conception, what occurs? If she’s exposed later in gestation?

A

Up to 20 days: Early embryonic death and resorption
Later: abortion around day 45-59

60
Q

In problem kennels, how often should all dogs be tested by serology for Brucella? What is done if there is a positive test?

A
  • Test every 3 months
  • Positive dog is removed and the kennel is placed under quarantine until all dogs test negative by serology every 90 days for 3 tests
61
Q

Before adding a new dog to the kennel, how should they be tested for Brucella?

A
  • Tested using serology every 30 days for 3 tests before introduction
62
Q

Brucella should be on your differential list in any dog presenting with what clinical signs, especially if intact?

A
  • Uveitis
  • Lameness, muscle weakness
  • Spinal pain - vertebral osteomyelitis and disko
  • Acute epididymitis and prostatitis
63
Q

Why is spinal disease more common in male dogs with Brucella?

A

Prostate acts as a reservoir for the bacteria, leading to intermittent bacteremia

64
Q

When will dogs test positive for Brucella on a rapid slide agglutination test?

A

As early as 2-4 weeks after infection BUT don’t trust a negative until 12 weeks after infection

65
Q

Is the RSAT sensitive or specific for Brucella?

A

Highly sensitive but not overly specific - confirm all positives

66
Q

What confirmatory tests are available for Brucella?

A

Agar gel immunodiffusion, tube agglutination, PCR

67
Q

Is medical treatment of Brucella effective? Why or why not?

A

No - bacteria can live inside cells for extended periods of time, where they are protected from antimicrobials and the host immune response; bacteremia can be episodic and recrudescence is common

68
Q

In IV catheters removed for clinical complications, what was the bacterial colonization rate? What was the most frequently isolated bacteria?

A

40%
Acinetobacter

69
Q

How are dogs/cats infected with Francisella tularensis?

A

Contact with tissues of infected animals (rabbits, voles, ground squirrels, muskrats), tick or deerfly bites, rarely inhalation or ingestion

70
Q

What are the clinical signs of F. tularensis infection in dogs and cats?

A

Pyrexia, lethargy, lymphadenopathy, mucopurulent oculonasal discharge, skin lesions/subQ abscesses, hepatomegaly, splenomegaly

Often self-limiting in dogs

71
Q

Is hyperbilirubinemia +/- icterus more common with plague or tularemia in cats?

A

Tularemia

72
Q

What is the treatment of choice for tularemia?

A

Aminoglycosides
Doxy, fluoroquinolones can be used but relapses may occur

73
Q

How long should cats with Tularemia be housed in isolation?

A

First 72 hours of antibiotic treatment

74
Q

What is “Alabama rot”?

A

Cutaneous and renal glomerular vasculopathy - thrombotic microangiopathy that begins as ulcerated skin lesions (often on the distal limb) and progresses to oligoanuric renal failure ~4 days later

75
Q

What cardiac biomarker was higher in dogs with infectious endocarditis than in dogs with MMVD or immune mediated disease? What level predicted endocarditis?

A

Cardiac troponin I - serum >0.625 ng/dL had a 100% specificity and 52% sensitivity for diagnosis

76
Q

Name 4 complications that can occur with infectious endocarditis

A
  1. Congestive heart failure from damage to cardiac valves
  2. Arrhythmias
  3. Thromboembolic disease
  4. Immune complex disease
77
Q

What are the 2 major Duke criteria for the diagnosis of endocarditis?

A
  1. Echocardiogram findings: vegetative lesions, new valvular insufficiency, erosive lesions
  2. Positive blood cultures with a typical organism: 2 cultures taken >12 hours apart
78
Q

What are the minor Duke criteria for the diagnosis of endocarditis?

A
  1. Fever
  2. Predisposing cardiac disease (sub aortic stenosis)
  3. Evidence of thromboembolic disease
  4. Evidence of secondary immune complex disease
  5. Microbiologic findings not meeting major criteria
79
Q

What criteria must be met for a diagnosis of endocarditis?

A

2 major criteria OR 1 major and 3 minor

80
Q

What was the survival rate of dogs with endocarditis in the 2021 JVIM paper?

A

Survival to discharge: 70%
1 month survival: 54%

81
Q

What risk factors were associated with mortality in endocarditis cases?

A

CHF (OR 12), thromboembolic events (6), AKI (6.2)

82
Q

What factor was associated with survival in dogs with endocarditis?

A

Administration of antithrombotics- MST not reached vs 92 days

83
Q

Infection of what heart valve has historically been associated with a poorer outcome in endocarditis?

A

Aortic - not shown in the 2021 JVIM study though

84
Q

What rare disease was found to be the cause of mesenteric lymphadenopathy in 3 young to middle aged cats?

A

Listeria - 2 were fed a raw meat diet

85
Q

What antibiotic is used to treat Actinomyces? Nocardia?

A

Actinomyces - penicillins (amoxicillin)
Nocardia - TMS

86
Q

In 106 cats presenting with pyrexia, what was the most common disease category and specific disease?

A

Infectious disease most common - 40%
Of those FIP was the most common - 20%

87
Q

Describe the changes in vitamin D status in dogs with blastomycosis?

A
  • Lower 25(OH)D, lower PTH
  • Higher ionized calcium
88
Q

Was vitamin D concentration associated with survival in dogs with blastomycosis? What other factors were associated with survival?

A
  • Vit D was not
    The following were:
  • Lactate concentration
  • Bone, skin, and LN involvement/number of affected sites
  • Presence of respiratory signs
89
Q

What are the most common clinical signs of coccidioidomycosis in dogs and cats?

A
  • Dogs: lameness from osteomyelitis, 80% with disseminated disease have respiratory signs
  • Cats: dermatologic disease
90
Q

How is coccidioidomycosis diagnosed?

A

Serology by AGID or ELISA - BUT there is overlap in low positive titers between clinical and subclinical infections and clinical disease can occur without seroconversion

91
Q

In dogs with intracranial coccidioidomycosis, what are the most common clinical signs?

A

Generalized tonic-clonic seizures

92
Q

What two forms of intracranial coccidioidomycosis are seen on MRI in dogs?

A
  • Granulomatous form - 1 or more distinct, contrast enhancing foci
  • Diffuse, bilateral, symmetric lesions of the caudate nuclei and frontal lobes
93
Q

What is intracranial coccidioidomycosis treated with and what is the 1 year survival rate?

A
  • Treatment of cerebral edema (mannitol, hypertonic saline, dexamethasone)
  • Fluconazole for 6-18 months, anti-inflammatory prednisone (tapered after 7-10 days)
  • 82% alive at one year (what?? wild)
94
Q

What effect can coccidioidomycosis have on the kidneys?

A

Can induce ICGN - 54% of dogs had histopathologic evidence of ICGN

95
Q

What is the most common systemic fungal disease in the cat?

A

Cryptococcus

96
Q

Inflammatory arthritis with lameness as the presenting complaint has been described in cats with what fungal disease?

A

Histoplasmosis - organisms often found in joint fluid

97
Q

Renal function may influence what fungal diagnostic test in cats?

A

Urine histoplasmosis EIA - decreased in cats with renal compromise, kidney disease may impact sensitivity

98
Q

What dogs more commonly had disseminated histoplasmosis? What dogs more commonly had histoplasmosis confined to the GI tract?

A
  • Disseminated: working and herding breeds
  • GI: toy breeds
99
Q

What are the clinical signs of Sporothrix infection in cats?

A
  • Usually infects the subcutaneous space => multiple skin lesions, subcutaneous ulcers and nodules
  • Respiratory or systemic involvement is more rare
100
Q

What may be an effective treatment for Sporothrix infection in cats?

A

Combination cryosurgery and itraconazole cured 11/13 cats

101
Q

What compounded anti-fungal drug should not be used in cats due to poor absorption?

A

Compounded oral itraconazole

102
Q

The blastomyces urine antigen concentration correlated with what other diagnostic?

A

Radiographic lung score

103
Q

What diagnostics provided prognostic information in dogs with pulmonary blastomycosis?

A

Urine antigen concentration <5ng/dL and mild (0-1) radiographic lung score = greater survival

104
Q

What protocols have been described for managing GI pythiosis?

A
  • Itraconazole, terbinafine, prednisone (0.5mg/kg/day)
  • Itraconazole, terbinafine, mefenoxam
105
Q

During the initial phase of infection, how does Leptospirosis avoid the immune response?

A

Binds inhibitors of complement on the surface of the organisms

106
Q

What renal lesions are seen in the acute phase of leptospirosis?

A

Acute interstitial nephritis with tubular cell necrosis

107
Q

In dogs with leptospirosis, what endothelial makers were correlated with survival?

A

VEGF and sICAM-1 - both higher in non survivors

108
Q

In dogs with leptospirosis, what endothelial marker predicted the development of pulmonary hemorrhage?

A

s-ICAM1

109
Q

Dogs with leptospirosis may display a hypercoagulable or hypocoagulable profile. Hypocoagulation was associated with what?

A
  • Hemorrhagic diathesis
  • Higher mortality rate
110
Q

What percent of dogs had a positive urine PCR after doxycycline treatment?

A

38% - lasted as long as 18 days

111
Q

What recommendation did the JVIM paper make regarding repeated urine PCR testing?

A
  • Repeat urine PCR testing after 7 days of appropriate antibiotic therapy
112
Q

What leptospirosis serovar has been shown to cause hepatic involvement (ELE) without clinically relevant renal involvement? What are the histopathologic findings on liver biopsy?

A
  • L. interrogans/kirschneri
  • Chronic granulomatous hepatitis
113
Q

Dogs with leptospirosis and AKI may develop what electrolyte abnormality?

A

Hypokalemia - due to proximal tubular damage, may be severe

114
Q

Vaccine against Leptospirosis typically target what serovars?

A
  • Bivalent vaccine: Canicola, Icterohemorrhagiae
  • Quadrivalent: Canicola, Icterohemorrhagiae, Pomona, Grippotyphosa
115
Q

In dogs in the US, what was the most common leptospirosis serovar?

A

Grippotyphosa

116
Q

After exposure to Leptospirosis, how long does seroconversion take?

A

Occurs by day 10 with the WITNESS test and day 14 with the MAR - same for all 4 serovars tested

SNAP Lepto was terrible

117
Q

Cuterebra infection in small breed dogs can lead to SIRS and DIC. What breed is most susceptible?

A

Yorkies

118
Q

What is the treatment of choice for Trypanosoma cruzi in dogs?

A

Benznidazole

If not available, can try amiodarone, hydrochloride, and itraconzole

119
Q

How is Heterobilharzia treated?

A

Fenbendazole, praziquantel

120
Q

Kittens infected with congenital toxoplasmosis typically display what clinical signs?

A

Chorioretinitis or uveitis

121
Q

What is the mechanism of action of the anti-FIP drug GS-441524?

A

Adenosine nucleoside analogue

122
Q

What are the MRI findings in cats with FIP?

A

Meningeal and ependymal contrast enhancement, ventriculomegaly, syringomyelia, foramen magnum herniation

123
Q

How do you perform the Rivalta’s test?

A

8mL of distilled water, 1 drop of 98% acetic acid, one drop of effusion
- If the drop of effusion stays attached to the surface of the liquid, retains its shape with a connection to the liquid, or floats to the bottom = positive for an exudate
- If the drop disappears and the solution is clear = negative

ACVIM Specialty 2023 (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions