MCQ questions and answers

Question 1

In veterinary patients with thyrotoxicosis:

A. the absolute T4 values is the primary determinant of the clinical signs and severity of these signs.

B. there is rarely an inciting event that can be identified.

C. the degree and rate of change in the thyroid hormone is more important that the actual value itself.

D. there is a difference in total T4 and free T4 compared to patients with stable hyperthyroidism.

Answer 1

C. the degree and rate of change in the thyroid hormone is more important that the actual value itself.

Question 2

In a recent study investigating urine sodium concentrations to distinguish between hypoadrenocorticism and nonadrenal causes of hyponatremia, a urine sodium value less than _________ suggests that hypoadrenocorticism is unlikely the cause.

A. 40 mmol/L
B. 20 mmol/L
C. 55 mmol/L
D. 30 mmol/L

Answer 2

D. 30 mmol/L

Question 3

Cardiovascular manifestations of thyrotoxicosis include
A. a 50% decline in systemic vascular resistance through dilation of the resistance arterioles.
B. a decrease in cardiac output due to concentric hypertrophy of the myocardium.
C. increased concentrations of plasma and urine catecholamines.
D. increased mean arterial blood pressure due to an increased diastolic pressure.

Answer 3

A. a 50% decline in systemic vascular resistance through dilation of the resistance arterioles.

Question 4

Which of the following may be indicated as part of perioperative treatment for a patient with a suspected pheochromocytoma?
A. Patient ideally receives two weeks of beta blockade prior to alpha-adrenergic blockade.
B. Anesthetic protocol to include premedication with an anticholinergic drug and acepromazine.
C. Post-operative anticoagulant therapy with heparin to reduce risk of thromboembolic complications.
D. Administration of calcium gluconate to promote vasodilation and to control ventricular arrhythmias.

Answer 4

C. Post-operative anticoagulant therapy with heparin to reduce risk of thromboembolic complications.

Question 5

A prospective, observational study of 27 client-owned dogs with naturally occurring septic peritonitis was published in 2013. Investigators measured coagulation profiles including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer and fibrinogen concentrations, total protein C (PC) and antithrombin (AT) activities, and thromboelastography (TEG) pre-operatively and on days 1 and 3 post-operatively. The major findings of this study included:

A. PC and AT deficiencies were more common, and mean activities were lower, in nonsurvivors compared to survivors
B. The maximum amplitude, α angle and coagulation index from preoperative TEG were significantly greater in survivors compared to nonsurvivors
C. Both A and B.
D. None of the above

Answer 5

C. Both A and B.

Question 6

A prospective, observational study comparing 31 cats with naturally occurring sepsis to 33 healthy control cats was published in 2016. Investigators compared history; clinical signs; results of hematologic, serum biochemical, and hemostatic tests; diagnosis; and outcome between the two groups. The major findings of this study included:
A. Protein C and antithrombin were significantly lower in the septic group.
B. Disseminated intravascular coagulopathy was common in the septic group.
C. Median prothrombin time and activated partial thromboplastin time were both longer in the septic group.
D. On multivariate analysis, disseminated intravascular coagulopathy was associated with death in the septic group.

Answer 6

A. Protein C and antithrombin were significantly lower in the septic group.

Question 7

According to the cell-based model of coagulation, which is the sole relevant initiator of coagulation in vivo?
A. Tissue factor
B. von Willebrand factor
C. Thrombin
D. Factor VIIa

Answer 7

A. Tissue factor

Question 8

Which of the following does not control thrombin generation, according to the cell-based model of coagulation?
A. Activated protein C (aPC)
B. Tissue pathway factor inhibitor (TFPI)
C. Factor XIIIa (FXIIIa)
D. Thrombomodulin (TM)

Answer 8

C. Factor XIIIa (FXIIIa)

Question 9

QuikClot Combat Gauze is the primary hemostatic dressing used by all branches of the military, per Committee on Tactical Combat Casualty Care (CoTCCC) guidelines. What are its primary active ingredient and mechanism of action?
A. Chitosan; cross-links red blood cells and platelets to form a mucoadhesive physical barrier
B. Kaolin; activates factor XII (FXII)
C. Smectite; absorbs plasma water, forms a clay substance that adheres to site of injury
D. Microporous polysaccharide derived from potato starch; absorbs plasma water, thereby concentrating platelets and clotting factors at the site of injury

Answer 9

B. Kaolin; activates factor XII (FXII)

Question 10

A randomized cadaveric ex vivo study recently evaluated the mechanical strength of three regions of ventral abdominal wall in cats (preumbilical, umbilical and postumbilical) following full-thickness vs fascia-only closure. The major findings included which of the following?
A. Load to failure was lowest in the post-umbilical group.
B. Load to failure was similar in males and females.
C. There was no difference between fascia-only and full thickness closure.
D. Both A and C are correct.

Answer 10

D. Both A and C are correct.

Question 11

A retrospective study recently evaluated the influence of preoperative septic peritonitis (PSP) and stapled vs hand-sewn anastomoses on the incidence of intestinal resection and anastomosis (IRA). The major findings included which of the following?
A. Risk factors for dehiscence included stapled anastomoses in a PSP patient
B. Risk factors for dehiscence included hand-sewn technique in a PSP patient
C. PSP was a risk factor for dehiscence; there was no association between technique and risk for dehiscence in dogs with PSP.
D. Indication for IRA significantly influenced risk for dehiscence.

Answer 11

B. Risk factors for dehiscence included hand-sewn technique in a PSP patient

Question 12

A randomized nonblinded controlled crossover study of surgical personnel (veterinary students, technicians, interns, residents and faculty in a veterinary teaching hospital (n=21) recently evaluated the influence of nail characteristics on surface bacterial counts. Major findings included which of the following?

A. Duration of nail polish application was a risk factor for increased bacterial counts.
B. Chipped nail polish was a risk factor for increased bacterial counts.
C. Nail biting was a risk factor for increased bacterial counts.
D. Nail length was a risk factor for increased bacterial counts.

Answer 12

D. Nail length was a risk factor for increased bacterial counts.

Question 13

What type of surgical needle is designed to pierce tissue with a sharp tip and spread the tissue without cutting it and may be best used in the intestines?
A. Cutting
B. Reverse cutting
C. Taper
D. Blunt point

Answer 13

C. Taper

Question 14

In a 2018 study by Grimes et al of dogs with uroabdomen, what was the prognosis for dogs that had surgical intervention for a uroadomen?
A. Good, 79% of dogs with surgical intervention survived to hospital discharge
B. Fair, 58% of dogs with surgical intervention survived to hospital discharge
C. Excellent, 91% of dogs with surgical intervention survived to hospital discharge
D. Guarded, 49% of dogs with surgical intervention survived to hospital discharge

Answer 14

C. Excellent, 91% of dogs with surgical intervention survived to hospital discharge

Question 15

The security of a suture knot is determined by multiple factors. Which of the following is NOT one of those factors?
a. Tissue tension
b. Length of the cut ends
c. Structural conformation of the knot
D. Material coefficient

Answer 15

a. Tissue tension

Question 16

A 25 kg 3-year-old male neutered Golden Retriever presents 30 minutes following ingestion of 43 mg/kg of carprofen. Emesis is induced via administration of apomorphine, the dog is administered Toxiban (activated charcoal with Sorbitol) and started on Misoprostol, an H2 blocker and intravenous lactated Ringer’s solution at 100 ml/hr. A physical examination and complete blood work performed 6 hours following admission reveals a lactate of 5.4 mmol/l (< 2.5 mmol/l), pH 7.32 (7.35-7.45), HCO3 18 mmol/l (20-24 mmol/l), PvCO2 32 (35-40 mmHg), heart rate 96 BPM, respiratory rate 22 bpm, temperature 38.4o Celsius (101.1 o Fahrenheit) with all other parameters, including blood pressure, within reference limits. The most likely cause of hyperlactatemia in this patient is type…

B1 lactic acidosis
B2 lactic acidosis
B3 lactic acidosis
B4 lactic acidosis

Answer 16

B2 lactic acidosis

Question 17

In a recent (2015****) retrospective study of 67 critically ill dogs with hypotension hospitalized in the intensive care unit (JAVMA, Vol 246, No. 1, January 1, 2015), what were the odds of survival in dogs that did not have hyperlactatemia compared to dogs that did have hyperlactatemia?

2.41 times as likely to survive
4.16 times as likely to survive
3.23 times as likely to survive
5.52 times as likely to survive

Answer 17

3.23 times as likely to survive

Question 18

A 2-year-old mix breed female spayed dog weighing 20 kg presents for vomiting. The dog is diagnosed with a septic abdomen secondary to a foreign body causing GI perforation. Following initial resuscitation and therapy the dog is taken to surgery. While receiving positive pressure ventilation under anesthesia the dog’s mean arterial blood pressure falls to 45 mmHg, heart rate is 156 BPM, and the pulse pressure variation (PPV) is calculated at 8%. Based on these findings and recent veterinary literature, what can you conclude about this patient’s intravascular volume status? The patient is most likely…

A fluid non-responder
A fluid responder
Difficult to ascertain based on the information given
Both A and B

Answer 18

A fluid non-responder

Question 19

The 3 causes of death commonly reported in cats with hypertrophic cardiomyopathy are congestive heart failure, arterial thromboembolism and sudden death. What are two risk factors associated with increased risk of death for all three causes?

left atrial fractional shortening and left ventricular septal wall thickness
spontaneous echo-contrast and an auscultable gallop rhythm
left atrial to aortic root diameter and left atrial emptying fraction
systolic anterior motion of the mitral valve and regional wall hypokinesis

Answer 19

left atrial to aortic root diameter and left atrial emptying fraction

Question 20

To minimize the adverse effects of reperfusion injury after achieving return of spontaneous circulation (ROSC) following cardiopulmonary arrest (CPA), supplemental oxygen should be titrated to what arterial partial pressure of oxygen (PaO2)?

200 – 300 mmHg
100-200 mmHg
80-100 mmHg
60-80 mmHg

Answer 20

80-100 mmHg

Question 21

Which of the following statements is MOST CORRECT in describing the mechanisms of microparticle formation?

A. When the cell becomes activated the enzyme complex, floppase, transports the negatively charge aminophospholipids from the outer membrane leaflet to the inner membrane leaflet.

B. Intracellular calcium increases as a consequence of cellular activation and this results in the increased activity of scramblase and floppase and reduction in the activity of flippase.

C. Increased intracellular cytosolic calcium originating uniquely from the endoplasmic reticulum results in reorganization of the cytoskeletal structures and membrane blebbing.

D. Cellular activation results in disruption of the phospholipid asymmetry, leading to membrane contracture and budding resulting in internalization of the biologically active aminophospholipids within the microparticle.

Answer 21

B. Intracellular calcium increases as a consequence of cellular activation and this results in the increased activity of scramblase and floppase and reduction in the activity of flippase.

Question 22

Which of the following statements MOST ACCURATELY describes the role microparticles have in the activation of the coagulation cascade.

A. Microparticles are derived from the plasma cell membranes of platelets which contain tissue-factor and activate the extrinsic coagulation pathway.
B. Microparticles are derived from the plasma membrane of multiple cell types and express negatively charged aminophospholipids, which support the enzymatic reactions involved in various hemostatic processes.
C. Microparticles are derived from the plasma membrane of endothelial cells and express endothelial protein C receptor (EPCR) which binds protein C , resulting in its inactivation.
D. Microparticles are not implicated in the pathophysiological state of coagulation.

Answer 22

B. Microparticles are derived from the plasma membrane of multiple cell types and express negatively charged aminophospholipids, which support the enzymatic reactions involved in various hemostatic processes.

Question 23

Which is the MOST CORRECT description of how the immune system response is initiated in a patient with a bacterial infection?

A. Toll-like receptors on innate immune system cells recognize the extracellular “Alarmins”, which are released due to tissue damage secondary to the invading microbes.
B. Pathogen-associated molecular patterns (PAMPS) are recognized by the innate immune system by pathogen recognition receptors (PRRS) which results in the activation of signal transduction cascade.
C. DAMPS (damage–associated molecular patterns) are released from damaged and apopotic cells and bind to the innate immune system cells via nuclear factor kappa beta (NF-Kβ).
D. RANTES (regulated upon activation, normal T cell expressed and secreted) is secreted by the innate immune system when a monocyte-antigen presenting cell binds to dendritic cells.

Answer 23

B. Pathogen-associated molecular patterns (PAMPS) are recognized by the innate immune system by pathogen recognition receptors (PRRS) which results in the activation of signal transduction cascade.

Question 24

What lung volume remains after a normal tidal volume breath?
A. Vital capacity
B. Functional Residual Capacity
C. Residual Volume
D. Physiologic dead space

Answer 24

B. Functional Residual Capacity

Question 25

Which of the following statements concerning the cytokine profile of this patient is the MOST ACCURATE? A. Tumor necrosis factor-alpha ( TNF-α) and Interleukin -1 (IL-1) are elevated in a stable manner for the first 24 hours leading to downstream activation of cytokine cascades. B. Interleukin-6 release is in response to TNF-α and IL-1 and has both proinflammatory and anti-inflammatory properties. C. Macrophage migration inhibitory factor (MIF) is acutely released (within 30 minutes) from monocytes/macrophages due to “Alarmins” binding to Toll-like membrane receptors. D. Soluble cytokine receptors and receptor antagonists, such as soluble tumor necrosis factor- receptor (sTNFR-) and interleukin-1 receptor (IL-1Ra, IL-1R2) are only present during the “compensatory anti-inflammatory response syndrome” (CARS).

Answer 25

B. Interleukin-6 release is in response to TNF-α and IL-1 and has both proinflammatory and anti-inflammatory properties.

Question 26

Fick’s law of diffusion states that the transfer of gas through a sheet of tissue is inversely proportional to which of the following variables? A. Area B. Diffusion constant C. Difference in gas partial pressure between the two sides D. Thickness of the tissue

Answer 26

D. Thickness of the tissue

Question 27

What is the volume of dissolved oxygen (represented as ml of O2 in 100 ml of blood) when the PaO2 is 100 mmHg? A. 100 B. 10 C. 3 D. 0.3

Answer 27

D. 0.3

Question 28

What is the total oxygen capacity of blood (ml of oxygen in 100 ml of blood) with the following parameters: Hb = 15 g/dl, SaO2= 100%, PaO2 = 100 mmHg? A. 15.55 B. 20.7 C. 11.05 D. 7.35

Answer 28

B. 20.7

Question 29

Peripheral chemoreceptors located in the carotid body at the bifurcation of the carotid arteries respond to changes in pH, PO2 and PCO2. Which of the following statements is true? The response to PCO2 is extremely important in control of respiration The peripheral chemoreceptors are maximally stimulated with a PaO2 of 500 mmHg The peripheral chemoreceptors are maximally stimulated with a PaO2 below 50 mmHg The response of peripheral chemoreceptors to an increase in pH causes increased respiration

Answer 29

The peripheral chemoreceptors are maximally stimulated with a PaO2 below 50 mmHg

Question 30

What of the following statements is INCORRECT regarding hyperbaric oxygen therapy (HBOT)? A. HBOT is provided by inhalation of 100% oxygen inside a treatment chamber with a pressure greater than pressure at sea level (> 1 atm) B. Common indications for HBOT include carbon monoxide toxicity, compartment syndrome, and necrotizing soft tissue infection C. HBOT pressures > 3 atm does not increase dissolved oxygen in blood enough such that tissue oxygenation can be maintained without hemoglobin D. HBOT at pressures > 3 atm can cause grand mal seizures secondary to neuotoxicity

Answer 30

C. HBOT pressures > 3 atm does not increase dissolved oxygen in blood enough such that tissue oxygenation can be maintained without hemoglobin

Question 31

Which clinical sign is MOST supportive of a primary (platelet associated) hemostatic disorder? A. Hemarthrosis B. Hematomas C. Melena D. Hemoperitoneuim

Answer 31

C. Melena

Question 32

Which of the following statements is true regarding the use of the buccal mucosal bleeding test (BMBT) to assess platelet function? A. BMBT measurements are well standardized, objective and generally correlate well with clinical outcomes B. The test is stopped 15 seconds after there is no further bleeding from the incision C. A 11 blade scalpel blade can be utilized to produce standardized superficial incisions for the test D. BMBT lacks sensitivity and specificity with variable results reported in animals and people

Answer 32

D. BMBT lacks sensitivity and specificity with variable results reported in animals and people

Question 33

All of the following are platelet alpha granule contents EXCEPT A. Adhesion molecules like P-selectin, fibrinogen, fibronectin B. Chemokines like PF4, CCL3, thromboglobulin C. Ions like calcium, magnesium and phosphate D. Fibrinolytic factors like A2 macroglobulin, plasminogen, PAI-1

Answer 33

C. Ions like calcium, magnesium and phosphate

Question 34

Type 1 Von Willebrand disease is typically as a result of A. Low VWF concentrations with preferential reduction in the high molecular weight multimers B. Low VWF concentrations with preferential reduction in the low molecular weight multimers C. Low level of all VWF multimer sizes with bleeding severity inversely correlated to VWF concentration D. Complete absence of VWF

Answer 34

C. Low level of all VWF multimer sizes with bleeding severity inversely correlated to VWF concentration

Question 35

A recent study by Cavanagh et al “Retrospective evaluation of fluid overload and relationship to outcome in critically ill dogs” concluded that A. Critically ill dogs didn’t have an increased risk of developing fluid overload during hospitalization and there was no association between fluid therapy and mortality B. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was a weak but significant association between fluid therapy and mortality. C. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was no association between fluid overload and mortality D. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was a strong association between fluid overload and mortality

Answer 35

B. Critically ill dogs had an increased risk of developing fluid overload during hospitalization and there was a weak but significant association between fluid therapy and mortality.

Question 36

Based on the 2018 ACVIM consensus statement regarding the diagnosis of immune-mediated hemolytic anemia, what is the recommend ratio of drops of blood: drops of saline to perform a saline agglutination test? a. 1:1 b. 1:2 c. 1:10 d. 1:4

Answer 36

d. 1:4

Question 37

Based on the same 2018 ACVIM consensus statement, which canine infectious disease has the highest chance of causing immune-mediated hemolytic anemia? a. Ehrlichia canis b. Dirofilaria immitis c. Leishmania infantum d. Babesia gibsoni

Answer 37

d. Babesia gibsoni

Question 38

Which organisms have been demonstrated to cause a Coombs positive anemia?

Answer 38

For some of these organisms, such as Leishmania spp., D. immitis, and Bartonella spp., Coombs' test-positive anemia is observed commonly

Question 39

Based on a review of immune thrombocytopenia by Levine, et al in 2019, what is the mechanism of thrombopoietin production? a. Constitutive production by the kidney b. Megakaryocyte “sensing” of the level of young, sialic acid-rich platelets c. Decreased binding levels of the myeloproliferative leukemia protein receptor d. Clearance of aged platelets via the Ashwell-Morrell receptor in the liver

Answer 39

d. Clearance of aged platelets via the Ashwell-Morrell receptor in the liver

Question 40

According to the 2019 ACVIM consensus statement regarding the treatment of immune-mediated hemolytic anemia, which of the following would be a reasonable choice as a secondary immunosuppressive agent? a. Intravenous immunoglobulin (IVIG) b. Cyclophosphamide c. Tacrolimus d. Mycophenolate mofetil

Answer 40

d. Mycophenolate mofetil

Question 41

Based on the recent consensus recommendations for the use of anti-thrombotic therapy in veterinary critical care, for which of the following disease states is routine prophylactic administration of antithrombotic agents recommended? a. Cats with sepsis b. Dogs with cancer c. Dogs with hyperadrenocorticism d. Cats with hypertrophic cardiomyopathy

Answer 41

d. Cats with hypertrophic cardiomyopathy

Question 42

With respect to the management of arterial thromboembolism, what guidelines were provided by the recent consensus statement on the rational use of antithrombotic in veterinary critical care? a. Antiplatelet drugs may be more effective than anticoagulants in dogs with venous thromboembolic disease. b. Anticoagulant drugs are more effective than antiplatelet drugs in dogs with venous thromboembolic disease. c. Antiplatelet drugs are equally effective as anticoagulant drugs in dogs with venous thromboembolic disease. d. No evidence based recommendation can be made on the use of antiplatelet drugs in dogs with venous thromboembolic disease.

Answer 42

b. Anticoagulant drugs are more effective than antiplatelet drugs in dogs with venous thromboembolic disease.

Question 43

In considering the discontinuation of anti-thrombotic therapy, based on the recent consensus statement on the rational use of antithrombotics in veterinary critical care… a. low-molecular-weight heparin can be stopped abruptly. b. unfractionated heparin administered as a CRI can be stopped abruptly. c. unfractionated heparin administered subcutaneously can be stopped abruptly. d. factor Xa inhibitors can be stopped abruptly.

Answer 43

a. low-molecular-weight heparin can be stopped abruptly.

Question 44

Based on a recent consensus statement on the rational use of antithrombotics in veterinary critical care, which of the following statements is correcting regarding oral aspirin administration? a. May be effective for the prevention of arterial thromboembolism (ATE) in dogs. b. May be used as a sole agent for prevention of ATE in cats 3. Is effective for the prevention of venous thromboembolism in dogs 4. Is associated with significant adverse effects when used at doses recommended to prevent ATE in dogs

Answer 44

a. May be effective for the prevention of arterial thromboembolism (ATE) in dogs.

Question 45

Which of the following statements correctly identifies the pathophysiological events associated with anaphylaxis? A. IgE mediated reactions occur when the antibody binds to high-affinity IgE receptors (FcεRI) in the plasma membrane of platelets and neutrophils. B. IgE independent events are mediated by IgG antibodies binding to FcγRIII receptors on macrophages. C. Non-immunological pathways occur when there is degranulation of platelets with the help of immunoglobulins. D. Nitric oxide production is markedly decreased during anaphylaxis in dogs and cats

Answer 45

IgE independent events are mediated by IgG antibodies binding to FcγRIII receptors on macrophages.

Question 46

Which of the following statements concerning the chemical mediators of anaphylaxis and any associated pathophysiological response time is correct? a. IgE antibodies bind to tissue mast cells and trigger the production of histamine, leukotrines and platelet activating factor within seconds to hours. b. Activation of the arachidonic acid cascade produces newly synthesized proinflammatory mediators within 5 to 30 minutes. c. A multitude of cytokines and chemokines are synthesized and released within 12 to 24 hours of the start of an anaphylactic event. d. The complement system produces the anaphylatoxins C3a, C4a and C5a within 24 hours of the start of an anaphylactic event.

Answer 46

a. IgE antibodies bind to tissue mast cells and trigger the production of histamine, leukotrines and platelet activating factor within seconds to hours.

Question 47

There are well recognized species differences in terms of the clinical manifestations that arise during an anaphylactic event. Which of the following statements concerning clinical manifestations is correct? A. The severity of shock in the dog is directly related to the degree of congestion in the liver and gall bladder. B. The clinical signs demonstrated by cats are related to the neurologic and hepatic systems. C. Clinical manifestations of an anaphylactic event, once resolved, often do not reoccur. D. Systemic anaphylactic reactions are a common manifestation in cats

Answer 47

A. The severity of shock in the dog is directly related to the degree of congestion in the liver and gall bladder.

Question 48

A 4-year-old 20 kg mixed breed male neutered dog presents to your clinic with acute collapse, hematemesis and hematochezia, and a bee stinger is located in the upper lip. Which of the following statements is most accurate with relation to this case? A. Histamine released into the portal system from the gastrointestinal tract likely resulted in portal hypertension, hepatic congestion, and a dramatic decrease in venous return. B. The best indicators of anaphylaxis in this dog is a dramatic increase in alkaline phosphatase (ALP) and an increased thickening (halo or double rim effect) of the gallbladder wall (greater than 10 mm). C. Bee envenomation is one of the best know triggers of anaphylaxis and is mediated solely through the IgE-dependent hypersensitivity pathway. D. The major components of bee venom: melittin, phospholipase A2 and hyaluronidase, cause alterations that have not been investigated in dogs.

Answer 48

A. Histamine released into the portal system from the gastrointestinal tract likely resulted in portal hypertension, hepatic congestion, and a dramatic decrease in venous return.

Question 49

What effects do angiotensin-converting enzyme inhibitors (e.g., enalapril, benazepril, lisinopril) have on the cardiovascular system? a. Arterial and venous vasodilation, increased preload, increased afterload b. Arterial and venous vasodilation, decreased preload, decreased afterload c. Arterial and venous vasodilation, increased preload, decreased afterload d. Arterial and venous vasodilation, decreased preload, increased afterload

Answer 49

b. Arterial and venous vasodilation, decreased preload, decreased afterload

Question 50

What is the mechanism of action of telmisartan? a. Blocks the effects of aldosterone in the distal convoluted tubule and collecting duct, decreasing sodium reabsorption and potassium excretion. b. Displaces angiotensin II from its receptor, antagonizing all effects, including vasoconstriction, sympathetic activation, aldosterone release and renal sodium reabsorption. c. Blocks the influx of calcium into vascular smooth muscle cells, thereby inhibiting contraction and ultimately decreasing systemic vascular resistance. d. Competitively inhibit conversion of angiotensin I to angiotensin II, ultimately resulting in systemic vasodilation.

Answer 50

b. Displaces angiotensin II from its receptor, antagonizing all effects, including vasoconstriction, sympathetic activation, aldosterone release and renal sodium reabsorption.

Question 51

Which of the following statements about hydralazine is TRUE? a. Hydralazine acts directly on arteriolar smooth muscle to increase peripheral vascular resistance b. Hydralazine may cause potassium and bicarbonate retention c. The most common adverse events in veterinary medicine are reflex tachycardia, weakness, GI upset and a lupus-like reaction d. Hydralazine acts directly on arteriolar smooth muscle and also has antioxidant effects

Answer 51

d. Hydralazine acts directly on arteriolar smooth muscle and also has antioxidant effects

Question 52

The most accepted methods to monitor response to unfractionated heparin administration includes: a. PT and/or aPTT measurement b. aPTT and/or BMBT measurement c. anti Xa assay and/or PT measurement d. aPTT measurement and/or anti Xa assay

Answer 52

c. anti Xa assay and/or PT measurement

Question 53

Clopidogrel’s mechanism of action is mediated through irreversible binding to which of the following receptors? a. ADP receptor P2Y12 b. Thrombin receptor PAR-4 c. Collagen receptor α2β1 d. αIIbβ3 receptor

Answer 53

a. ADP receptor P2Y12

Question 54

Evidence has suggested that low molecular weight heparins (LMWH) have a lower bleeding risk than unfractionated heparins (UFH). Mechanistically, why does this occur? a. UFH will bind to platelets causing inhibition of primary and secondary hemostasis. b. LMWH binds more specifically to thrombin than UFH. c. LMWH binds more specifically to factor Xa than UFH. d. There is no difference in the risk of bleeding between these two drugs.

Answer 54

c. LMWH binds more specifically to factor Xa than UFH.

Question 55

Your patient has received an overdose of heparin. What drug will you use to reverse the effects of heparin? a. Rivaroxaban b. Protamine sulfate c. Aminocaproic acid d. Phytonadione

Answer 55

b. Protamine sulfate

Question 56

Which of the following describes the correct mechanism of action of tissue plasminogen activator (tPA)? a. tPA binds to the ADP receptor on platelets, resulting in the cleavage of associated vonWillebrand factor bonds and thrombolysis. b. tPA binds to the Xa molecule, preventing it from binding to fibrin and resulting in thrombolysis. c. tPA binds to plasmin and causes cleavage of fibrin-plasmin bonds, resulting in thrombolysis. d. tPA binds to fibrin and subsequently activates plasminogen to plasmin, resulting in the cleavage of the fibrin molecule and thrombolysis.

Answer 56

d. tPA binds to fibrin and subsequently activates plasminogen to plasmin, resulting in the cleavage of the fibrin molecule and thrombolysis.

Question 57

What is the most commonly reported adverse effect in cats and dogs undergoing thrombolytic therapy utilizing tissue plasminogen activator (tPA)? a. Hepatic failure b. Tissue reperfusion injury c. Seizures d. Congestive heart failure

Answer 57

b. Tissue reperfusion injury

Question 58

Which of the following statements regarding antibiotic volume of distribution (Vd) is correct? a. In a non-critically ill patient with normal renal function being treated with a penicillin for a urinary tract infection, an increased volume of distribution results in decreased renal excretion of the antimicrobial agent. b. A patient with hypovolemic and distributive shock that is receiving large volumes of intravenous fluids to replenish their intravascular volume will have a decreased volume of distribution and therefore require a reduction in the dose and/or frequency of antibiotic administration. c. There is growing evidence to support that carbapenems and penicillins should be administered as extended infusions in critically ill patients due to the increased volume of distribution that occurs with critical illness. d. An increased volume of distribution prolongs the time to reach therapeutic tissue concentrations when concentration-dependent antibiotics are used. This does not occur with time-dependent antibiotics.

Answer 58

c. There is growing evidence to support that carbapenems and penicillins should be administered as extended infusions in critically ill patients due to the increased volume of distribution that occurs with critical illness.

Question 59

Which of the following statements regarding time-dependent antimicrobials is correct? a. When optimizing pathogen clearance in critically ill patients, the time above the MIC (minimum inhibitor concentration) is less important than peak tissue concentrations. b. Fluoroquinolones and aminoglycosides are time-dependent antibiotics that demonstrate a post-antibiotic effect (PAE). c. Time-dependent antibiotics prohibit bacterial growth through inhibition of DNA synthesis. d. Therapeutic drug monitoring and continuous rate infusions are two strategies to help achieve therapeutic tissue concentrations in critically ill patients.

Answer 59

d. Therapeutic drug monitoring and continuous rate infusions are two strategies to help achieve therapeutic tissue concentrations in critically ill patients.

Question 60

Based on the 2016 Surviving Sepsis Guidelines, what is the most appropriate strategy for early implementation of antimicrobial therapy? a. In a patient presenting with septic shock, a delay of antimicrobial therapy for several hours during fluid resuscitation and sample acquisition for cultures does not affect incidence of acute lung injury or acute kidney injury. b. In an effort to avoid antibiotic resistance, empiric regimens should err on the side of a narrower antimicrobial spectrum as there are been no documented decrease in survival if the empiric regimen does not cover the offending pathogen. c. In patients with inflammatory states such as severe pancreatitis or burns, broad spectrum antibiotic prophylaxis is still routinely recommended as secondary infections can complicate these disease states and affect outcome. d. When broad spectrum combination therapy is used in the initial management of septic shock, culture-based de-escalation of empiric therapy should occur within the first few days of a clinical response to therapy.

Answer 60

d. When broad spectrum combination therapy is used in the initial management of septic shock, culture-based de-escalation of empiric therapy should occur within the first few days of a clinical response to therapy.

Question 61

Which of the following combinations of antimicrobial class, mechanism of action, and method of clearance is correct? a. Fluoroquinolone, RNA synthesis inhibitor, renal/hepatic clearance b. Aminoglycoside, 30S ribosomal subunit inhibitor (protein synthesis inhibitor), renal clearance c. Penicillin, cell wall synthesis inhibitor, hepatic clearance d. Rifampin, 50S protein ribosomal subunit inhibitor (protein synthesis inhibitor), hepatic clearance

Answer 61

b. Aminoglycoside, 30S ribosomal subunit inhibitor (protein synthesis inhibitor), renal clearance

Question 62

Identification of which of the following clinical and laboratory findings would be consistent with the SIADH? a. Hypovolemic hyponatremia with elevated urine osmolality b. Euvolemic hyponatremia with elevated urine osmolality c. Hypovolemic hyponatremia with low urine osmolality d. Euvolemic hyponatremia with low urine osmolality

Answer 62

b. Euvolemic hyponatremia with elevated urine osmolality

Question 63

Which of the following has been associated with the development of the SIADH? a. Levetiracetam b. Traumatic brain injury c. Pneumonia d. All of the above

Answer 63

d. All of the above

Question 64

What is the mechanism by which euvolemia is maintained in SIADH? a. Over time, aquaporin expression is downregulated in the loop of Henle, decreasing the amount of water that is reabsorbed and preventing the development of hypervolemia. b. Pressure receptors are activated, leading to increased sodium and water excretion. c. An expanded extracellular fluid volume suppresses renin and aldosterone release and causes increased secretion of natriuretic peptides. d. There is a reset of the osmotic receptors in the hypothalamus, establishing a new equilibrium.

Answer 64

c. An expanded extracellular fluid volume suppresses renin and aldosterone release and causes increased secretion of natriuretic peptides.

Question 65

Which statement is true regarding SIADH? a. Hypoadrenocorticism is a primary differential diagnosis. b. Patients with SIADH will show signs of peripheral edema. c. Urine osmolality must exceed plasma osmolality in order to confirm the diagnosis. d. Hyperteonic saline should not be used to treat SIADH due to the risk of demyelination.

Answer 65

a. Hypoadrenocorticism is a primary differential diagnosis.

Question 66

Which of the following is correct regarding the 5 normal phases of a capnogram? a. No carbon dioxide should be measured during phase II. b. Inspiration begins during phase I. c. The steep incline in phase II reflects an increase in measured oxygen saturation. d. End tidal CO2 is measured at the end of the alveolar plateau.

Answer 66

d. End tidal CO2 is measured at the end of the alveolar plateau.

Question 67

Which of the following statements is true with relation to capnometry? a. The inspired CO2 concentration reflects PACO2 in most cases. b. A “curare cleft” occurs as a result of spontaneous expiratory effort during PPV. c. Cardiogenic oscillations can be seen during phase III. d. Embolic disease can lead to decreased ETCO2 levels with a normal capnograph waveform.

Answer 67

a. The inspired CO2 concentration reflects PACO2 in most cases.

Question 68

Part 3 of the RECOVER articles focused on basic life support (BLS). The BLS consensus statement recommends the utilization of 2-minute cycles of uninterrupted chest compressions. In addition, it is recommended that between these 2-minute cycles, interruptions in chest compression should only occur for the following reasons? a. Observation of spontaneous breaths b. Palpation of the femoral artery c. Checking for a palpebral or corneal reflex d. ECG rhythm diagnosis

Answer 68

d. ECG rhythm diagnosis

Question 69

Part 4 of the RECOVER articles focused on advanced life support (ALS). Which of the following statements is correct? a. The use of vasopressin is not recommended as an alternative to epinephrine during CPR. b. There is compelling evidence that the use of antiarrhythmic drugs improves outcome in dogs and cats suffering from cardiopulmonary arrest. c. There is supportive evidence that corticosteroids are beneficial and may improve outcome in dogs and cats suffering from cardiopulmonary arrest. d. In the patient that does not have a vagal-induced cause of cardiopulmonary arrest, evidence supporting the use of atropine is sparse

Answer 69

d. In the patient that does not have a vagal-induced cause of cardiopulmonary arrest, evidence supporting the use of atropine is sparse

Question 70

Part 5 of the RECOVER articles focused on monitoring. Which of the following statements is correct? a. Palpation for a lack of a femoral pulse is an acceptable means to identify cardiopulmonary arrest in dogs and cats. b. Doppler pulse sounds are a reliable tool to identify cardiopulmonary arrest in dogs but not in cats. c. Arterial blood pressure is a reliable indicator of cardiac output during CPR. d. In the continuously ventilated animal, a rapid decline of end-tidal carbon dioxide (ETCO2) strongly supports cardiopulmonary arrest.

Answer 70

d. In the continuously ventilated animal, a rapid decline of end-tidal carbon dioxide (ETCO2) strongly supports cardiopulmonary arrest.

Question 71

Part 7 of the RECOVER articles focused on clinical guideline. Which of the following statements is correct? a. Human studies have shown that the presence of a physician during CPR increases survival rates. b. Chest compressions can be effectively performed in either lateral or sternal recumbency in dogs and cats. c. Higher respiratory rates, longer inspiratory times and higher tidal volumes are preferred during CPR, as cardiac output will be maximized. d. Numerous studies have shown that rapid diagnosis of cardiopulmonary arrest is crucial ,as delays in CPR are deleterious.

Answer 71

d. Numerous studies have shown that rapid diagnosis of cardiopulmonary arrest is crucial ,as delays in CPR are deleterious.

Question 72

Which of the following is a physiologic change associated with acclimatization to extreme heat? a. Decreased aldosterone secretion b. Decreased plasma volume c. Decreased natriuresis d. Decreased cellular chemical heat production

Answer 72

c. Decreased natriuresis

Question 73

38. What proinflammatory cytokine is chiefly responsible for sepsis-associated pyrexia? a. Interleukin-4 b. Interleukin-10 c. Prostaglandin-E2 d. Interleukin-1

Answer 73

d. Interleukin-1

Question 74

According to 2012 RECOVER guidelines for post cardiac-arrest care, mild therapeutic hypothermia refers to a core temperature of: a. 28-30°C b. 30-32°C c. 32-34°C d. 34-36°C

Answer 74

c. 32-34°C

Question 75

Which of the following electrocardiography findings are associated with hypothermia? a. sinus bradycardia b. prolonged QRS duration c. presence of J waves d. biphasic T waves

Answer 75

c. presence of J waves

Question 76

According to a 2018 retrospective study of military working dogs published in the Journal of the American Veterinary Medical Association, which of the following was associated with an increased risk of mesenteric volvulus. a. History of endocrine diseases b. History of exercise after eating a meal c. History of GDV d. History of prophylactic gastropexy

Answer 76

d. History of prophylactic gastropexy

Question 77

According to the 2016 retrospective study by DeGroot, et al published in the Journal of the American Veterinary Medical Association, what was the most common post-op complication documented in those dogs that survived surgery for a primary splenic torsion? a. Ventricular arrhythmias b. Vomiting c. Anemia d. Hematuria/pigmenturia

Answer 77

a. Ventricular arrhythmias

Question 78

According to the same 2016 retrospective study of 102 dogs with primary splenic torsion, of 79 dogs whose spleens were submitted for histopathology, what percentage had splenic neoplasia? a. 0% b. 4% c. 12% d. 27%

Answer 78

a. 0%

Question 79

According to a 2017 retrospective case study by Plavec, et al published in Veterinary Surgey, among 13 dogs with colonic and ileocecocolic volvulus, what radiographic abnormality was found in all study patients. a. Lack of a clearly identifiable descending colon b. Marked gaseous distention of an intestinal loop in the right cranial and mid-abdomen c. Identification of the cecum in the left abdominal cavity d. Colonic dilation, with a diameter which was 1.4-2 times the length of L7.

Answer 79

b. Marked gaseous distention of an intestinal loop in the right cranial and mid-abdomen

Question 80

Which of the following is an ineffective osmole? a. Glucose b. Ketoacids c. BUN d .Acetylsalicylic acid

Answer 80

c. BUN

Question 81

According to the modified Starling equation, the oncotic pressure gradient determines fluid movement between which two spaces? a. Intravascular and interstitial b. Intravascular and subglycocalyx c. Subglycocalyx and interstitial d. Extravascular and intravascular

Answer 81

b. Intravascular and subglycocalyx

Question 82

What whole blood colloid osmotic pressure maintenance target may reduce the risk of edema formation and secondary organ dysfunction in dogs and cats? a. 30 mmHg b. 15 mmHg c. 10 mmHg d. 5 mmHg

Answer 82

a. 30 mmHg

Question 83

With regard to heat and moisture exchangers (HME), which are used to humidify the circuit of mechanically ventilated patients, which of the following statements is true? A. They should be changed every 48 – 72 hours because of the risk of bacterial contamination. B. Ventilator waveforms should be monitored for changes in airway resistance that might suggest obstruction from secretions. C. They are used in combination with hot water humidifiers to help keep the airway secretions moist. D. They are “low profile” and do not contribute to the amount of dead space in the circuit, or to the work of breathing for the patient.

Answer 83

B. Ventilator waveforms should be monitored for changes in airway resistance that might suggest obstruction from secretions.

Question 84

Strategies to prevent ventilator associated pneumonia include: A. Changing the ventilator circuit at least every 48 hours. B. Routine use of H2RAs and PPIs to reduce the rate of gastric bacterial colonization. C. Suctioning the subglottic secretions as needed, and oral cleansing with diluted chlorohexidine every 4 hours. D. Limiting pressure in the ET tube cuff to < 20 cm H2O to prevent tracheal necrosis and maintain mucociliary clearance function.

Answer 84

C. Suctioning the subglottic secretions as needed, and oral cleansing with diluted chlorohexidine every 4 hours.

Question 85

When a high-pressure ventilator alarm goes off, one should assess for… A. endobronchial intubation. B. patient-ventilator asynchrony. C. pneumothorax. D. all of the above.

Answer 85

D. all of the above.

Question 86

The use of lung protective strategies for the management of ALI and ARDS include… A. use of > 5 cm H2O of PEEP. B. use of tidal volumes of > 12 ml/kg. C. achieving hypocapnia through manipulation of rate or tidal volume D. titration of FiO2 to achieve a PaO2 of at least 90 mmHg.

Answer 86

A. use of > 5 cm H2O of PEEP.

Question 87

Which of the following statements is true regarding Gut Associated Lymphatic Tissue (GALT) a. It contains organized populations of neutrophils and mast cells designed to recognized dietary substances that could trigger an immune response b. It contains loose aggregations of lymphoid tissue known as Peyer’s patches c. It is designed to protect against microbial pathogens d. It produces 20% of the body’s immunoglobulins

Answer 87

c. It is designed to protect against microbial pathogens

Question 88

Nonimmunologic mechanisms by which the intestinal barrier protects against luminal pathogens include... a. Peptidases b. Gastric mucin c. Peristalsis d. Paneth cells

Answer 88

c. Peristalsis

Question 89

Which hormone acts on the principle cells in the collecting duct to increase sodium reabsorption and increase potassium secretion? a. Angiotensin II b. Atrial natriuretic peptide c. Aldosterone d. Antidiuretic hormone

Answer 89

c. Aldosterone

Question 90

The following are neurotransmitters important in vomiting. Which of the following best describes the neurotransmitter and its associated receptor, which are important targets for antiemetic therapy? a. Dopamine binds to the D1 (dopamine type 1) receptor in the emetic center and chemoreceptor trigger zone (CRTZ) b. Histamine binds to the H2 (histamine type 2) receptor in the CRTZ c. Acetylcholine binds to the M1 (muscarinic type 1) receptor in the vomiting center and CRTZ d. Serotonin binds to the NK-1 (Neurokinin-1) receptor in the medullary emetic center

Answer 90

c. Acetylcholine binds to the M1 (muscarinic type 1) receptor in the vomiting center and CRTZ

Question 91

End tidal carbon dioxide (EtCO 2 ) in a healthy patient is related to partial pressure of carbon dioxide (PaCO 2 ) in the following way: a. EtCO 2 is typically 1-5mmHg less than PaCO 2 b. EtCO 2 is typically 1-5mmHg more than PaCO 2 c. EtCO 2 is typically the same as PaCO 2 d. These two values are not relatable in a healthy patient

Answer 91

a. EtCO 2 is typically 1-5mmHg less than PaCO 2

Question 92

Which of the following are causes of hypocapnia? a. Pleural effusion and dead space rebreathing b. Pain and hyperthermia c. Sepsis and hypoventilation d. Hyperventilation and excessive anesthetic depth

Answer 92

b. Pain and hyperthermia

Question 93

Which one of these is the main channel type that opens on the cardiac myocyte sarcolemma during the repolarization phase? a. Na + Channels b. Cl - channels c. K + channels d. Ca 2+ channels

Answer 93

c. K + channels

Question 94

Which one of the following statements is correct regarding the electrolyte’s play in transmembrane potentials? a. Hyperkalemia makes the threshold membrane potential less negative, increasing membrane excitability. b. Hypokalemia makes the resting membrane potential more negative, decreasing membrane excitability. c. Ionized hypercalcemia makes threshold membrane potential more negative, increasing membrane excitability. d. Ionized hypocalcemia makes resting membrane potential less negative, increasing membrane excitability.

Answer 94

b. Hypokalemia makes the resting membrane potential more negative, decreasing membrane excitability.

Question 95

Which part of ECG corresponds to ventricular repolarization? a. P wave b. QRS duration c. T wave d. U wave

Answer 95

c. T wave

Question 96

The 2018 surviving sepsis campaign 1 hour bundle recommends the use of vasopressors for the following parameters: a. Lactate greater than 4mmol/l b. Mean arterial pressure less than or equal to 65 mmHg c. Systolic blood pressure less than or equal to 90mmHg d. Lactate greater than 6mmol/l

Answer 96

b. Mean arterial pressure less than or equal to 65 mmHg

Question 97

You have a patient who you have diagnosed with septic peritonitis. You administered 10ml/kg crystalloid bolus on admission. MAP is now 62mmHg and lactate is 3.4mmol/l. According to the hour bundle from the 2018 surviving sepsis update what should be your next steps? a. Administer another 10ml/kg crystalloid bolus, start broad spectrum antibiotics b. Administer another 20ml/kg crystalloid bolus, start vasopressors, start broad spectrum antibiotics c. Administer another 20ml/kg crystalloid bolus, start broad spectrum antibiotics d. Administer another 30ml/kg crystalloid bolus, start vasopressors, start broad spectrum antibiotics

Answer 97

b. Administer another 20ml/kg crystalloid bolus, start vasopressors, start broad spectrum antibiotics

Question 98

What abnormal findings on a neurological exam are consistent with lower motor neuron disease? a. Dysphonia, reflexes clonic or exaggerated b. Proprioception/postural reactions abnormal or absent, decreased muscle tone c. Spinal pain, decreased muscle tone and or muscle atrophy d. Tires easily/weakness after exercise, dysphagia

Answer 98

d. Tires easily/weakness after exercise, dysphagia

Question 99

A canine patient presents with sudden onset pelvic limb weakness that rapidly progressed to inability to walk. Segmental reflexes were absent in all limbs with bilateral mydriasis with decreased pupillary light reflex, decreased gag reflex and decreased jaw tone. In hospital the patient displays urine retention and constipation. Which acute diffuse lower motor neuron disease is most likely? a. Acute idiopathic polyradiculoneuritis b. Tick paralysis c. Botulism d. Fulminant myasthenia gravis

Answer 99

c. Botulism

Question 100

Class IB Antiarrhythmic agents such as lidocaine function via the following mechanism of action: a. Inhibiting the activity of fast sodium channels, thereby lengthening the action potential duration in myocardial tissue. b. Promoting the activity of fast sodium channels, thereby shortening the action potential in myocardial tissue. c. Promoting the activity of fast sodium channels, thereby lengthening the action potential in myocardial tissue. d. Inhibiting the activity of fast sodium channels, thereby shortening the action potential duration in myocardial tissue.

Answer 100

d. Inhibiting the activity of fast sodium channels, thereby shortening the action potential duration in myocardial tissue.

Question 101

Class IV Antiarrhythmic agents such as diltiazem and verapamil work to terminate AV nodal- tachyarrhythmias via the following mechanism of action: a. Blocking nonhydropyridine calcium channels and therefore slowing AV nodal conduction and prolonging the effective refractory period of the AV node. b. Enhancing central and peripheral vagal tone of the autonomic nervous system, thereby slowing AVN nodal conduction and prolonging the AV nodal refractory period. c. Blocking the open state of fast sodium channels and prolonging the effective refractory period in atrial and ventricular tissues. d. Blocking the repolarizing I K channel which results in prolongation of action potential duration and effective refractory period.

Answer 101

a. Blocking nonhydropyridine calcium channels and therefore slowing AV nodal conduction

Question 102

Antithrombin’s inhibitory activity is enhanced up to several ________-fold by interaction with heparins. a. Ten b. Hundred c. Thousand d. Million

Answer 102

c. Thousand

Question 103

Factor VII binding to TF and to membrane surfaces via its Gla domain are ________-dependent interactions. a. Calcium b. Magnesium c. Phosphorus d. Manganese

Answer 103

a. Calcium

Question 104

Factor VII and _________ are considered the main initiators of secondary hemostasis. a. Tissue factor (TF) b. Factor II c. Fibronectin d. Factor IX

Answer 104

a. Tissue factor (TF)

Question 105

Which enzyme is responsible for the conjugation of bilirubin in the liver? a. Biliverdin reductase b. Microbial proteases in ileus c. Heme oxygenase d. Glucuronyl transferase

Answer 105

d. Glucuronyl transferase

Question 106

Which of the following metabolites of bilirubin is mainly excreted in urine? a. Stercobilin b. Urobilin c. Unconjugated bilirubin d. Biliverdin

Answer 106

b. Urobilin

Question 107

Which of the following mechanisms is responsible for the development of sepsis-induced cholestasis? a. Down-regulation of bile acid transporters b. Inhibited conjugation of bilirubin c. Development of biliary hyperplasia d. Up-regulation of aquaporins on canalicular membranes

Answer 107

a. Down-regulation of bile acid transporters

Question 108

While pulse oximetry is an important non-invasive tool to monitor oxygen levels, dyshemoglobinemia can interfere with results in the following way: a. Significant levels of carboxyhemoglobin will falsely increase SpO2 readings. b. Significant levels of oxyhemoglobin will falsely decrease SpO2 readings. c. Significant levels of methemoglobin will falsely increase SpO2 readings. d. Significant levels of deoxyhemoglobin levels will falsely decrease SpO2 readings.

Answer 108

a. Significant levels of carboxyhemoglobin will falsely increase SpO2 readings.

Question 109

Which of the Gla domain coagulation proteins has the shortest half-life? a. Factor II b. Factor VII c. Factor IX d. Factor X

Answer 109

b. Factor VII

Question 110

Assuming your tissue oxygen delivery and demand is normal, which type of hyperlactataemia occurs in sepsis? a. Type A b. Type B 1 c. Type B 2 d. Type B 3

Answer 110

b. Type B 1

Question 111

A seminal consensus article on circulatory shock and hemodynamic monitoring published by Cecconi et al. in 2014 defines shock as... a. Generalized maldistribution of blood flow resulting in failure to deliver and/or utilize adequate amounts of oxygen, leading to tissue dysoxia b. The failure to deliver and/or utilize adequate amounts of oxygen in the presence of hypotension c. Acute circulatory failure associated with inadequate oxygen utilization by the cells d. Life-threatening organ dysfunction caused by a dysregulated host response to infection

Answer 111

c. Acute circulatory failure associated with inadequate oxygen utilization by the cells

Question 112

After a period of ischemic injury followed by reperfusion, the “no reflow” phenomenon represents... a. Recurrent cardiopulmonary arrest due to obstructed coronary blood flow b. microcirculatory hypoperfusion due to vessel obstruction c. Development of a large venous thrombus which decreases venous return d. Preferential shunting of blood away from splanchnic circulation to other vital organs

Answer 112

b. microcirculatory hypoperfusion due to vessel obstruction

Question 113

What is the name of the “effect” that favors tissue oxygenation due to increased PCO2 and/or acidemia? a. Pendelluft b. Bohr c. Haldane d. Hysteresis

Answer 113

b. Bohr

Question 114

Which statement is true regarding acute kidney injury in dogs? a. Estimated MST of approximately 150 days b. The proportion of dogs with Cre normalization decreased significantly with an increase in IRIS AKI grade c. During renal recovery, there is compensatory atrophy d. CKD is diagnosed after AKI when azotemia persists and is stable for >6months

Answer 114

b. The proportion of dogs with Cre normalization decreased significantly with an increase in IRIS AKI grade

Question 115

Which statement is true regarding hemorrhagic shock? a. During compensated shock, the animal is incapable of maintaining mean arterial pressure and metabolic needs b. During decompensated shock, compensatory mechanisms are unable to restore or maintain effective circulating volume and adequate oxygen delivery c. Left unchecked, shock can lead to systemic injury from toxins and anti-inflammatory mediators released from damaged cells d. Post hemorrhage dysrhythmias are uncommon and may be due to sympathetic activation

Answer 115

b. During decompensated shock, compensatory mechanisms are unable to restore or maintain

Question 116

According to a 2024 prospective cohort study to identify clinical diagnostic and prognostic markers of primary immune thrombocytopenia in dogs, what two factors were associated with survival to discharge? a. DOGIBAT score at time of presentation and and nadir platelet count b. Hematocrit and BUN at time of presentation c. Platelet count at time of presentation and sex d. Presence of PSAIg and D-Dimer level >500 ng/dL

Answer 116

b. Hematocrit and BUN at time of presentation

Question 117

Which of the following is correct regarding the transcellular transport of calcium in the GI tract and kidney a. Ca binds irreversibly to mobile cytosolic Ca-binding proteins which have multiple sites for Ca and prevent alteration in intracellular calcium concentration b. 1,25-(OH)2 cholecaclciferol increases the Ca binding protein on the intestinal epithelial brush border to transport Ca into the cell cytoplasm c. In the distal tubule and duodenum, calcium enter the basolateral side passively through the Ca selective channels and is actively transported out of the luminal membrane d. Stimulation of the iCa receptor in the kidney increases NaCl, iCa, and iMg in the proximal convoluted tubule

Answer 117

b. 1,25-(OH)2 cholecaclciferol increases the Ca binding protein on the intestinal epithelial brush border to transport Ca into the cell cytoplasm

Question 118

Crotalidae polyvalent immune fab (CroFab) consists of ovine IgG with which region removed? a. F(ab) region b. F(ab') region c. Fv region d. Fc region

Answer 118

d. Fc region

Question 119

Which component of crotalid venom is though to cause echinocytosis? a. Myocardial depressant factor b. Protein C activator c. Linoleic acid d. Phospholipase A2

Answer 119

d. Phospholipase A2

Question 120

In a study by Viall. et. al published in the JAVMA in 2019, authors concluded which of the following? a. Hypocholesterolemia was a predictor of survival in sick dogs b. Hypotriglyceridemia was a predictor of survival in sick dogs c. Dyslipidemias were not a concern in this population of dogs d. Septic dogs were more likely to have altered lipid profiles

Answer 120

a. Hypocholesterolemia was a predictor of survival in sick dogs

Question 121

The following cell type is a key mediator in development of hepatic dysfunction during SIRs: a. Hepatocyte b. Sinusoidal epithelial cell c. Stellate fat cell d. Kuppfer cell

Answer 121

d. Kuppfer cell

Question 122

The resting membrane potential (E m ) of nonpacemaker ventricular cells is: a. -65 mV b. -90 mV c. +6 mV d. +52 mV

Answer 122

b. -90 mV Pacemaker cell is -65 mV

Question 123

The most important electrolyte to control the resting membrane potential of nonpacemaker cells is: a. Ca 2+ b. Na + c. Cl - d. K +

Answer 123

d. K +

Question 124

3. The membrane potential that opposes movement of a cation/anion down it concentration gradient is: a. Nernst potential. b. Nernst equation. c. Voltage gate channel. d. Electrochemical force.

Question 125

Drug X is highly protein bound. Your patient’s albumin has decreased acutely due to a septic process. You are concerned since hypoalbuminemia will generally increase the concentration of free/unbound Drug X and increase its volume of distribution (Vd). Which of the following concomitant changes might counter your concern? a. Increasing free/unbound Drug X will decrease Drug X efficacy. b. Your patient will lose muscle mass due to catabolism and decrease Vd. c. An increase in inflammatory mediators/globulins will bind Drug X. d. Increasing free/unbound Drug X will increase its metabolism and clearance.

Answer 125

d. Increasing free/unbound Drug X will increase its metabolism and clearance.

Question 126

For effective analgesia, it is generally recommended to administer opioids parenterally. Which mechanism of the metabolism of opioids is this recommendation meant to avoid? a. Metabolism by intestinal epithelial cells b. First pass metabolism by the liver c.Metabolism by phase II conjugation d.Inhibition of cytochrome P450 mediated metabolism

Answer 126

b. First pass metabolism by the liver

Question 127

Which of the following is a pharmacodynamic factor that explains drug tolerance? a. Increased renal excretion b. Increased production of cAMP c. Decreased drug receptor affinity d. Decreased drug absorption

Answer 127

c. Decreased drug receptor affinity

Question 128

In systemic inflammation, cytokines trigger coagulation through the binding of which coagulation factor? a. Factor II b. Factor VII c. Factor VIII d. Factor X

Answer 128

b. Factor VII

Question 129

Activation of pattern recognition receptor, such as Toll Like Receptors, initiates signaling cascades through which transcription regulator? a. Nuclear Factor Kappa B (NFkB) b. Tissue Factor (TF) c. High-mobility group box 1 (HMGB1) d. Complement activation

Answer 129

a. Nuclear Factor Kappa B (NFkB)