11. How can you try to differentiate primary and secondary seizures based on history, clinical signs and basic diagnostic tests? Give 6 major differences (2 marks for each difference).

History - signalment- age (more likely to be 1o if 6m-6y), breed (some breeds eg GSD,boxer 1o more likely), species (cats more likely to be 2o), - familial history- genetic hereditability in suspect breeds for 1o - previous seizures (more likely to be 1o) - progression of seizures (rapid more likely to be 2o) - toxic exposure (secondary) - timing of siezures (2o more likely to be assoicated with eating or activity) - trauma - endocrine diseases (diabetic ketoacidosis, addisons) Clinical signs - partial vs generalised vs status (partial more likely o be secondary as is first presentation in status) - inter-ictal signs mean more likely to be secondary - systemic health (good more likely to be 1o) Basic diagnostics - bloods (liver enzymes, hypoglycaemia, hypokalaemia, t4 abnormal if 2o) - therapeutic trial- 1o well controlled, 2o not - CSF tap- normal for 1o, increase in protein, wbc, positive serology for toxoplasma

10. An 8-year-old entire male Doberman pinscher is presented to you for the investigation of sudden onset exercise intolerance with tachypnoea, irregular tachycardia, cyanosis and frequent coughing. The dog has no significant previous disease history. List your differential diagnoses. (6 marks) What emergency treatment options would be appropriate for this dog? (6 marks)

heart muscle disorders - DCM - mitral valve disease - restrictive cardiomyopathy - congestive heart failure heart rhythm disorders - atrial fibrillation - ventricular tachycardia - ventricular fibrillation - electryolyte abnormalities (potassium, calcium) restriction of heart - pericardial effusion- haemangiosarcoma rupture - pericarditis obstruction to ventricular outflow - pulmonary stenosis - aortic stenosis hypoxaemia- - pleural effusion - pulmonary oedema - pulmonary fibrosis - pulmonary embolism - pulmonary contusions other - sepsis - shock (trauma, GDV) - endocrine collapse - anaemia (haemorrhage) provide oxygen- nasal prongs, mask, oxygen tent IV access, fluids containdicated if in pulmonary oedema but necessary if in hypovolaemic shock, or electrolyte abnormalities frusemide- diuretic used to reduce preload, contrindicated if cardiac tympany, can help reduce pulmonary oedema pimobendan- positive inotrope, calcium sensitiser, prolongs life with DCM ace inhibitors (benazepril)- inhibits RAAS, improves survival with DCM digoxin if in AF,- positive inotrope, risk of causing other arrhythmias ECG to monitor

11. How can you try to differentiate primary and secondary seizures based on history, clinical signs and basic diagnostic tests? Give 6 major differences (2 marks for each difference).

History - signalment- age (more likely to be 1o if 6m-6y), breed (some breeds eg GSD,boxer 1o more likely), species (cats more likely to be 2o), - familial history- genetic hereditability in suspect breeds for 1o - previous seizures (more likely to be 1o) - progression of seizures (rapid more likely to be 2o) - toxic exposure (secondary) Clinical signs - partial vs generalised vs status (partial more likely o be secondary as is first presentation in status) - inter-ictal signs mean more likely to be secondary Basic diagnostics -bloods (liver enzymes, hypoglycaemia

12. An eight-year-old miniature poodle, blinded by cataracts for three years, is presented to you as the owner has just won three thousand pounds on the lottery and wants referral of her dog for cataract surgery. What causes might there be for the opacity in the dog’s lenses? (3 marks) What tests would you undertake and what signs would you look for, to assess whether cataract surgery if likely to be successful? (3 marks) Describe briefly to the owner what sort of surgery is involved in removing the cataract. (3 marks) What pre- and post-operative medications are likely to be needed to ensure long-term success of surgery? (3 marks)

- diabetic cataracts- increased lens glucose converted to sorbitol to increase of osmotic pull of water into lens -post PRA metabolic cataract- secondary to retinal atrophy due to toxic metabolites from liquid peroxidation in degenerate retina -inherited non congenital cataract- progressive in poodle starting from equator (-traumatic cataracts possible) - associated ocular condition that may complicate surgery- opthalmoscopy, especially lens induced uveitis - associated systemic condition that may complicate- especially diabetics- check blood glucose well controlled - associated condition that woudl preclude a return of vision.- PRA as retinal pathology- if cant be visualised use electroretinogram as PLR not adequate. Also retinal detachment. phacoemulsification is the preferred surgery. Ultrasonic frequences of pulsating fluid to break up lens, small incision in cornea to minimise fluid loss. Posterior capsule polished to remove last bits of lens. Suture closed. Can place an artificial lens but many feel unnecessary as extra point of inflammation. Risk of uveitis, glaucoma, posteror capsule opacification, corneal oedema. preoperatve antiflammatory mediacation with topical steroid (pred forte) and NSAID (acular). Possibly a single dose of atropine preoperatively to induce mydriasis if not present due to acular. Possible antibiosis post op (chloramphenicol), as well as post op steroid continuing and NSAID.

11. How can you try to differentiate primary and secondary seizures based on history, clinical signs and basic diagnostic tests? Give 6 major differences (2 marks for each difference).

History - signalment- age (more likely to be 1o if 6m-6y), breed (some breeds eg GSD,boxer 1o more likely), species (cats more likely to be 2o), - familial history- genetic hereditability in suspect breeds for 1o - previous seizures (more likely to be 1o) - progression of seizures (rapid more likely to be 2o) - toxic exposure (secondary) - timing of siezures (2o more likely to be assoicated with eating or activity) - trauma - endocrine diseases (diabetic ketoacidosis, addisons) Clinical signs - partial vs generalised vs status (partial more likely o be secondary as is first presentation in status) - inter-ictal signs mean more likely to be secondary - systemic health (good more likely to be 1o) Basic diagnostics - bloods (liver enzymes, hypoglycaemia, hypokalaemia, t4 abnormal if 2o) - therapeutic trial- 1o well controlled, 2o not - CSF tap- normal for 1o, increase in protein, wbc, positive serology for toxoplasma

10. An 8-year-old entire male Doberman pinscher is presented to you for the investigation of sudden onset exercise intolerance with tachypnoea, irregular tachycardia, cyanosis and frequent coughing. The dog has no significant previous disease history. List your differential diagnoses. (6 marks) What emergency treatment options would be appropriate for this dog? (6 marks)

heart muscle disorders - DCM - mitral valve disease - restrictive cardiomyopathy - congestive heart failure heart rhythm disorders - atrial fibrillation - ventricular tachycardia - ventricular fibrillation - electryolyte abnormalities (potassium, calcium) restriction of heart - pericardial effusion- haemangiosarcoma rupture - pericarditis obstruction to ventricular outflow - pulmonary stenosis - aortic stenosis hypoxaemia- - pleural effusion - pulmonary oedema - pulmonary fibrosis - pulmonary embolism - pulmonary contusions other - sepsis - shock (trauma, GDV) - endocrine collapse - anaemia (haemorrhage) provide oxygen- nasal prongs, mask, oxygen tent IV access, fluids containdicated if in pulmonary oedema but necessary if in hypovolaemic shock, or electrolyte abnormalities frusemide- diuretic used to reduce preload, contrindicated if cardiac tympany, can help reduce pulmonary oedema pimobendan- positive inotrope, calcium sensitiser, prolongs life with DCM ace inhibitors (benazepril)- inhibits RAAS, improves survival with DCM digoxin if in AF,- positive inotrope, risk of causing other arrhythmias ECG to monitor

medicine Flashcards by Sarah Chadwick

An owner presents her pregnant newfoundland bitch, she is concerned that whelping is not progressing as it has done for previous litters. A)what are the clinical signs of dystocia in the bitch,
B)give two diagnostic tests that can be used to assess a whelping bitch with dystocia, how do the help guide treatment,
C) what is the main option for medical management, what considerations should be taken (Ie when should medical management not be attempted) and what further investigation should be attempted prior to medical treatment and how successful is it likely to be
D) describe an anaesthetic and analgesic plan for a bitch requiring c-section (do not cover resuss in puppies) (6,6,6,12)

Tests- radiography- visualisation of puppy skeleton allows you to check there are more puppies, location of those puppies and to check for certain foetal monsters (malpresentation, malposition and malposture)
-ultrasonography- foetal heart beat, myometrial contractions, malposition, malposture, malpresentation, composition of the amniotic and allantoic fluids and assess placental thickness and regularity

medical management- oxytocin administration, not if puppy stuck in pelvic canal or unlikely to be able to be delivered naturally as increasing contractility will worsen an obstruction. Vaginal examination (+/-radiography/ultrasound). Unlikely to succeed as most causes of dystocia in the bitch are foetal pelvic disproportion and are not related to failure of myometrial contractions.

Anaesthesia- time is of the essence, pre clip before induction if possible, fluid therapy (hartmanns 10ml/kg/hr increased if clinical signs of dehydration pre anaesthetic), propafol to induce titrate to effect, no acepromazine or alpha 2 agonist premed or opiod pain relief if possible. If calm and quiet, catheterise without sedation (always have a catherter for IV access), induce anaesthesia with propofol to effect, iso or sevo to maintain, light plane of anaesthesia, epidural for pain management (local anesthetic- bupivicaine- with caution if cardiovascularly unstable), once neonates delivered give methadone for pain relief. If bitch fractious/difficult to catheterise could use fentanyl and diazepam for premed. Line block possible if epidural not for some reason.

How well did you know this?

Not at all

Perfectly

Dystocia- excessive unproductive straining, malodorous or discoloured discharge, over two hours with no sign of an expected puppy, exhaustion and collapse of the bitch, excessive pain (panting, heart rate, irritation of vulva), restlessness
Tests- radiography- visualisation of puppy skeleton allows you to check there are more puppies, location of those puppies and to check for certain foetal monsters (malpresentation, malposition and malposture)
-ultrasonography- foetal heart beat, myometrial contractions, malposition, malposture, malpresentation, composition of the amniotic and allantoic fluids and assess placental thickness and regularity
medical management- oxytocin administration, not if puppy stuck in pelvic canal or unlikely to be able to be delivered naturally as increasing contractility will worsen an obstruction. Vaginal examination (+/-radiography/ultrasound). Unlikely to succeed as most causes of dystocia in the bitch are foetal pelvic disproportion and are not related to failure of myometrial contractions.
Anaesthesia- time is of the essence, pre clip before induction if possible, fluid therapy (hartmanns 10ml/kg/hr increased if clinical signs of dehydration pre anaesthetic), propafol to induce titrate to effect, no acepromazine or alpha 2 agonist premed or opiod pain relief if possible. If calm and quiet, catheterise without sedation (always have a catherter for IV access), induce anaesthesia with propofol to effect, iso or sevo to maintain, light plane of anaesthesia, epidural for pain management (local anesthetic- bupivicaine- with caution if cardiovascularly unstable), once neonates delivered give methadone for pain relief. If bitch fractious/difficult to catheterise could use fentanyl and diazepam for premed. Line block possible if epidural not for some reason.

How well did you know this?

Not at all

Perfectly

You suspect that a canine patient you are treating is suffering from leptospirosis, the dog has azotemia and raised liver enzymes. the owners are upset that they have vaccinated their dog yearly for this disease and don’t understand how it could have acquired infection in spite of that.
A) what will you say to the owners to say how their dog might develop lepto in spite of vaccination
B) what precautions should the owner take
C) name two tests to confirm an infection with lepto
D) how are you going to treat your patient? (4,2,2,4)

It could be a different serovar to the infection (ictoheamorrhagica and canicola in most vaccines, pomona and grippotyphosa are reemerging strains associated with liver disease and renal failure). Overwhelming challenge a possibility. Vaccination doesn’t prevent infection and formation of a carrier state (question does not state dog is clinically sick). May not be leptospirosis! Immunity may not last a full 12 months

Some of the strains are zoonotic, avoid the dogs urine (gloves/face shield) and take special precautions if bitten. Quarantine from other dogs/ animals for at least 3 months after active infection.

Blood/urine culture/ PCR, rising antibody titre (ELISA) with signs, dark field microscopy of urine, microscopic/microcapsular agglutination tests

Antibiotics- doxycycline is best choice as it also targets the renal carrier phase, preventing transmission. Fluroquinolones or penicillin are other options in initial stage, but should be followed by 2-4 weeks of doxy. IVFT as renal and liver failure, possibility of decreased clotting factors or hypoproteineamia- may need plasma/blood transfusion. Prognosis good, less than 10% fatality.

How well did you know this?

Not at all

Perfectly

You are presented with a dachshund off his legs. The dog appears painful in the middle of his back. He has normal voluntary movements on the FLs but has no volnttary movement of his hindlimbs. His knuckling response is normal in the FLs, absent in HLs.
A) how would you describe the gait of this dog in one word
B) In terms of between which spinal cord segments this lesion could be lying, what are the two broad regions of localisation within the spinal cord that could explain this neurological syndrome and how might your neurological exam differ for these two regions? (1,2,9)

Paraplegia

T3-L3, L4-S3

Cutaneous trunci reflex - Intact L4-S3, impaired to approximately two segments caudal to the lesion in T3-L3.
Patellar reflex - Intact T3-L3, impaired/reduced L4-S3 - can loclise further to L4-L6.
Withdrawal reflex - Intact
Knuckling - Impaired or reduced in both
Perineal reflex - Intact T3-L3, impaired or reduced in L4-S3.
Tail tone - Intact T3-L3, impaired or reduced in L4-S3
Cranial nerves and mentation normal in both.
Schiff-Sherrington phenomenon can mean forelimbs held in rigid extension with a T3-L3 lesion, normal in L4-S3.
Due to spinal shock, localisation can be confused as a lesion in L4-S3 can present as a T3-L3 lesion, in addition multiple lesions are a possibility.

How well did you know this?

Not at all

Perfectly

You are presented with a 9 year old female neutered dog that has been lethargic and anorexic for the past week. On physical examination you find the dog to be depressed, pyrexic (40C) and note pallor of the mucous membrane.You take a blood sample for haematology and find the dog to be pancytopenic: neutrophils 0.7 x 109/l (norm - 3-11), RBC 1.8 x 1012/l (nom - 5.5-8.5), and platelets 34 x 109/l (norm - 175-500).
A) What further investigation would you advise and why?
B) List the possible causes of bone marrow suppression in this dog.
C) Explain the difference between acute and chronic forms of leukaemia. (2,4,4)

Bone marrow biopsy to try to discern a cause within the bone marrow for the pancytopaenia.

reduced production

myelofibrosis- idiopathic
aplastic anaemia

neoplastic proliferation of other cells

acute lymphoid/myeloid leukaemia
chronic lymphocytic leukaemia
multiple myeloma
lymphoma

Infectious
- erhlichiosis, parvovirus

drug induced

hyperoestrogenism (iatrogenic/sertoli cell tumour)
irradiation/toxins/drugs (esp chemotherapeutic)

other
-primary myelodysplasia, immune mediat-prolonged stimulation (eg chronic IM anaemia)ed or neoplastic

acute-aggressive, rapid progression, myelosuppression, increased risk of infection, organ failure due to infiltration, DIC. Proliferation of early lymphoblastic precurors which arrests normal cell production- blast cells predominate. Poor prognosis and treatment tends to be unrewarding

chronic- slow progression, mild signs, proliferation of late precurors or mature lymphoid/erythroid cells. normally see lymphocytosis of one line. Can use chemotherpaeutic regimes to good effect. Chronic myeloid can enter blast cell crisis and see acute signs.

How well did you know this?

Not at all

Perfectly

Bone marrow biopsy to try to discern a cause within the bone marrow for the pancytopaenia.

How well did you know this?

Not at all

Perfectly

A 3 year old rabbit is presented to you with copious white discharge from one eye, this having been present for several weeks but not seeming to cause the animal discomfort.
A) What might be the cause of this discharge?
B)What steps would yo take to come to a diagnosis?
C) How might you seek to treat the condition and what prognosis would you give to the owner?
D) How might you assess pain in this species? (2,4,3,3)

Please fill in

How well did you know this?

Not at all

Perfectly

How can you try to differentiate primary and secondary seizures based on history, clinical signs and basic diagnostic tests? Give 6 major differences (2 marks for each difference).

History

signalment- age (more likely to be 1o if 6m-6y), breed (some breeds eg GSD,boxer 1o more likely), species (cats more likely to be 2o),
familial history- genetic hereditability in suspect breeds for 1o
previous seizures (more likely to be 1o)
progression of seizures (rapid more likely to be 2o)
toxic exposure (secondary)
timing of siezures (2o more likely to be assoicated with eating or activity)
trauma
endocrine diseases (diabetic ketoacidosis, addisons)

Clinical signs

partial vs generalised vs status (partial more likely o be secondary as is first presentation in status)
inter-ictal signs mean more likely to be secondary
systemic health (good more likely to be 1o)

Basic diagnostics

bloods (liver enzymes, hypoglycaemia, hypokalaemia, t4 abnormal if 2o)
therapeutic trial- 1o well controlled, 2o not
CSF tap- normal for 1o, increase in protein, wbc, positive serology for toxoplasma

How well did you know this?

Not at all

Perfectly

An 8-year-old entire male Doberman pinscher is presented to you for the investigation of sudden onset exercise intolerance with tachypnoea,
irregular tachycardia, cyanosis and frequent coughing. The dog has no significant previous disease history. List your differential diagnoses. (6 marks)
What emergency treatment options would be appropriate for this dog? (6 marks)

heart muscle disorders

DCM
mitral valve disease
restrictive cardiomyopathy
congestive heart failure

heart rhythm disorders

atrial fibrillation
ventricular tachycardia
ventricular fibrillation
electryolyte abnormalities (potassium, calcium)

restriction of heart

pericardial effusion- haemangiosarcoma rupture
pericarditis

obstruction to ventricular outflow

pulmonary stenosis
aortic stenosis

hypoxaemia-

pleural effusion
pulmonary oedema
pulmonary fibrosis
pulmonary embolism
pulmonary contusions

other

sepsis
shock (trauma, GDV)
endocrine collapse
anaemia (haemorrhage)

provide oxygen- nasal prongs, mask, oxygen tent
IV access, fluids containdicated if in pulmonary oedema but necessary if in hypovolaemic shock, or electrolyte abnormalities
frusemide- diuretic used to reduce preload, contrindicated if cardiac tympany, can help reduce pulmonary oedema
pimobendan- positive inotrope, calcium sensitiser, prolongs life with DCM
ace inhibitors (benazepril)- inhibits RAAS, improves survival with DCM
digoxin if in AF,- positive inotrope, risk of causing other arrhythmias
ECG to monitor

How well did you know this?

Not at all

Perfectly

Write short notes on:

a) The treatment of pemphigus foliaceus in cats (3 marks)
b) Treatment of parasitic skin disease in guinea pigs (3 marks)
c) The treatment of a dog with confirmed atopic dermatitis (3 marks)
d) Treatment of canine cheyletiellosis (3 marks)

pemphigus foliaceus

immune mediated, so immunosupression useful
topical corticosteroids may be suitable for mild lesions
systemic glucocorticoids provide rapid relief assuming not contraindicated by other systemic disease
azathioprine purine analogue interfereing with nuclear synthesis is often used in dogs refractory to glucocorticoids, but not in cats as high risk of immunosuppression
chlorambucil often used in cats refractory alkylating agent cross linking cellular DNA
cyclosporine is a useful adjunct but slow to work on its own due to action on T lymphocytes rather than directly

parasitic skin disease in guinea pigs

topical spot on ivermectin (designed for small animals)
follow with bathing after 48 hours
special shampoos availiable to kill lice

atopic dermatitis

glucocorticoids cheap but may see side effects long term
cyclosporin good alternative, less side effects, more expensive
immune modulation therapy especially if identified a low number of allergic components that can be vaccinated for
apoquel (oclacitinib)- janus kinase inhibitor, hard to get hold of but very effective and less side effects.
omega 3 fatty acids- adjunctive, reduce inflammation
anti histamines often an adjunct to reduce dose

Cheyletiella

weekly bathing in pyrethrin shampoo,
lime sulfur dips every five to seven days for three weeks
fipronil spray one spritz/lb body weight repeated again in three weeks
selamectin topically one dose every 15 days for a total of three doses
ivermectin 200 micrograms/kg every week for three weeks (must be heartworm negative first and not used in herding breeds or crosses thereof)
milbemycin 2 mg/kg once weekly for three weeks
The environment must be treated with a house and carpet spray such as those that are used for fleas. Remember to treat any pet exposed to the affected animal and not just the affected animal.

How well did you know this?

Not at all

Perfectly

The following three drugs are all licensed as anti-emetics in dogs. For each drug, explain the mode of action including whether it works peripherally or centrally; any potential side-effects and give examples of when you might use the drug.

a) Metoclopramide (4 marks)
b) Maropitant (4 marks)
c) Cimetidine (4 marks)

metaclopramide- mixed peripheral and central actions. peripherally to improve coordination of gastric motility and gastric emptying. central blockade of chemoreceptor trigger zone. Used in radiation sickness, chemotherapy, pylorospasm, peritonitis, pancreatitis (abnormal GI motility), drug/toxin induced. side effects- sedation, seizures, abdominal pain, diarrhoea, constipation, hyperactivity

maropitant- NK1 receptor blocker, central action. chemotherapy and radiation induced vomiting (especially delayed), post op vomiting, motion sickness prevention. side effects- drooling, diarrhoea, inappetance, sedation.

cimetidine- h2 receptor antagonist acting peripherally, to reduce stomach acid, often used in cases of gastric ulceration or prophylactically in patients at risk of regurgitation during anaesthesia where vomiting is associated with increased gastric acidity. Side effects- may react with other antiemetics, heart rhythm abnormalities, drowsiness.

How well did you know this?

Not at all

Perfectly

You are presented with a 2-year-old bichon frise that had puppies 2 weeks ago and is now restless, whining and panting with visible muscle tremors and an elevated rectal temperature.

a) Name two possible differential diagnoses (2 marks)
b) What diagnostic tests would you choose to help you make your diagnosis?
(5 marks)
c) For one of the possible diagnoses, describe briefly how you would manage the condition (5 marks)

metritis
eclampsia
history
clinical examination
bloods- CBC for systemic infection, Biochem for electrolytes (especially calcium)
abdominal ultrasound, particularly for fliud in the uterus and possible FNA and cytology for analysis, culture and sensitivity.
ECG for calcium effects on heart

eclampsia- slow IV calcium gluconate to clinical effect while monitoring heart rate. once seizures subside, subcutaneous and then oral calcium. Neonates fed milk replacer and gradually returned to suckling with continuous supplementation with milk replacers to decrease lactational pressure.

metritis- IVFT, antibiosis (systemic), possible spay.

How well did you know this?

Not at all

Perfectly

How can you try to differentiate primary and secondary seizures based on history, clinical signs and basic diagnostic tests? Give 6 major differences (2 marks for each difference).

History

signalment- age (more likely to be 1o if 6m-6y), breed (some breeds eg GSD,boxer 1o more likely), species (cats more likely to be 2o),
familial history- genetic hereditability in suspect breeds for 1o
previous seizures (more likely to be 1o)
progression of seizures (rapid more likely to be 2o)
toxic exposure (secondary)

Clinical signs

partial vs generalised vs status (partial more likely o be secondary as is first presentation in status)
inter-ictal signs mean more likely to be secondary

Basic diagnostics
-bloods (liver enzymes, hypoglycaemia

How well did you know this?

Not at all

Perfectly

An eight-year-old miniature poodle, blinded by cataracts for three years, is presented to you as the owner has just won three thousand pounds on the lottery and wants referral of her dog for cataract surgery. What causes might there be for the opacity in the dog’s lenses? (3 marks)
What tests would you undertake and what signs would you look for, to assess whether cataract surgery if likely to be successful? (3 marks)
Describe briefly to the owner what sort of surgery is involved in removing the cataract. (3 marks)
What pre- and post-operative medications are likely to be needed to ensure long-term success of surgery? (3 marks)

diabetic cataracts- increased lens glucose converted to sorbitol to increase of osmotic pull of water into lens
-post PRA metabolic cataract- secondary to retinal atrophy due to toxic metabolites from liquid peroxidation in degenerate retina
-inherited non congenital cataract- progressive in poodle starting from equator
(-traumatic cataracts possible)
associated ocular condition that may complicate surgery- opthalmoscopy, especially lens induced uveitis
associated systemic condition that may complicate- especially diabetics- check blood glucose well controlled
associated condition that woudl preclude a return of vision.- PRA as retinal pathology- if cant be visualised use electroretinogram as PLR not adequate. Also retinal detachment.

phacoemulsification is the preferred surgery. Ultrasonic frequences of pulsating fluid to break up lens, small incision in cornea to minimise fluid loss. Posterior capsule polished to remove last bits of lens. Suture closed. Can place an artificial lens but many feel unnecessary as extra point of inflammation.

Risk of uveitis, glaucoma, posteror capsule opacification, corneal oedema.

preoperatve antiflammatory mediacation with topical steroid (pred forte) and NSAID (acular). Possibly a single dose of atropine preoperatively to induce mydriasis if not present due to acular. Possible antibiosis post op (chloramphenicol), as well as post op steroid continuing and NSAID.

How well did you know this?

Not at all

Perfectly

Write short notes on the acute treatment and long term management of non-obstructive feline idiopathic (interstitial) cystitis.

? need to treat- will recover in 2-3 days, though repeat bouts become more severe and frequent
Acute-
-Pain relief - NSAIDs possible buprenorphine.
-Enhance water uptake- possibly add salt to diet, tempt more. Change to moist food.
-Pheromones
Feliway- shows a positive correlation with improvement
-Tricyclic antidepressants- amitriptyline (2.5-10mg/cat SID).- anticholinergic, anti-inflammatory, anti alpha adrenergic, analgesic, antidepressant
-Antibiotics? only if infection present
-Antispasmodics? if urethral spasm and functional blockage

Long term-
Causal link with cats perception of stress, can be reduced by:
-Multimodal environmental modification (MEMO)
-Clean up urinary soiling
-Enhance litter tray management
-Consider altering diet- waltham PH/other diets aimed at this, acidification not appropriate unless struvite stones
-Replacing the protective GAG layer (Cystaid)
binding to the urothelium and decreasing bladder wall permeability.

How well did you know this?

Not at all

Perfectly

How can you try to differentiate primary and secondary seizures based on history, clinical signs and basic diagnostic tests? Give 6 major differences (2 marks for each difference).

History

signalment- age (more likely to be 1o if 6m-6y), breed (some breeds eg GSD,boxer 1o more likely), species (cats more likely to be 2o),
familial history- genetic hereditability in suspect breeds for 1o
previous seizures (more likely to be 1o)
progression of seizures (rapid more likely to be 2o)
toxic exposure (secondary)
timing of siezures (2o more likely to be assoicated with eating or activity)
trauma
endocrine diseases (diabetic ketoacidosis, addisons)

Clinical signs

partial vs generalised vs status (partial more likely o be secondary as is first presentation in status)
inter-ictal signs mean more likely to be secondary
systemic health (good more likely to be 1o)

Basic diagnostics

bloods (liver enzymes, hypoglycaemia, hypokalaemia, t4 abnormal if 2o)
therapeutic trial- 1o well controlled, 2o not
CSF tap- normal for 1o, increase in protein, wbc, positive serology for toxoplasma

How well did you know this?

Not at all

Perfectly

An 8-year-old entire male Doberman pinscher is presented to you for the investigation of sudden onset exercise intolerance with tachypnoea,
irregular tachycardia, cyanosis and frequent coughing. The dog has no significant previous disease history. List your differential diagnoses. (6 marks)
What emergency treatment options would be appropriate for this dog? (6 marks)

heart muscle disorders

DCM
mitral valve disease
restrictive cardiomyopathy
congestive heart failure

heart rhythm disorders

atrial fibrillation
ventricular tachycardia
ventricular fibrillation
electryolyte abnormalities (potassium, calcium)

restriction of heart

pericardial effusion- haemangiosarcoma rupture
pericarditis

obstruction to ventricular outflow

pulmonary stenosis
aortic stenosis

hypoxaemia-

pleural effusion
pulmonary oedema
pulmonary fibrosis
pulmonary embolism
pulmonary contusions

other

sepsis
shock (trauma, GDV)
endocrine collapse
anaemia (haemorrhage)

How well did you know this?

Not at all

Perfectly

List the causes of hypercalcaemia in the dog (8 marks).
A good laboratory can give you two values for serum calcium concentrations: what are these and how is it helpful to measure calcium in two ways? (2 marks) What other electrolyte is it important to measure in the blood and why? (2 marks

hypercalcaemia of malignancy
-osteosarcoma through bone destruction and lysis
-lymphoma, multiple myeloma and anal sac adenocarcinoma through production of parathyroid-like protein
primary hyperprathyroidism
nutritional secondary hyperparathyroidism
renal secondary hyperparathyroidism
hypoadrenocorticism
vitamin D toxicity
vitamin A toxicity
chronic kidney disease/acute renal failure
granulomatous disease
physiological (young/post prandial)

ionised calcium and total calcium because the vast majority of calcium is bound to plasma proteins but active calcium must be ionised (free), and so ionised calcium is probably more accurate but harder for laboratories to perform accurately

phosphate because it binds calcium and is affected by parathyroid hormone secretion- likely to be hypophosphatemic

How well did you know this?

Not at all

Perfectly

List six clinical signs used to monitor fluid resuscitation in a dog suffering from septic shock (6 marks). State briefly 3 ways in which monitoring equipment may be used to assist you (6 marks)

Heart rate
CRT
Pulse quality/rhythm
BP
mucus membranes
Respiratory rate

An ECG allows quick and accurate measurement of the heart rate and rhythm so you can see the heart rate coming down and assists in knowing the accuracy of other pieces of monitoring equipment.

A direct arterial blood pressure is the most accurate method of reading blood pressure but is invasive and difficult to maintain. Blood pressure is very important as avoiding hypotension avoids ischaemic damage to organs. It allows a real time measure of the hypovolaemia and adds to the ECG data about heart rate as neither can tell stroke volume. Other methods of reading blood pressure include oscillometry and Doppler.

Pulse oximetry gives an idea of pulse quality and shape as well as potential hypoxaemia. It gives you an idea of how peripheral tissues are coping.

How well did you know this?

Not at all

Perfectly

List two drugs that may be used to control hypertension in small animal practice (2 marks). For both of these drugs indicate:

a) The mode of action (4 marks)
b) Indications for use (4 marks)
c) Possible side effects (2 marks)

ACE inhibitors - benazepril
MOA - inhibits breakdown of angiotensin 1 into angiotensin 2 and inhibits the breakdown if bradykinin. Therefore reduces preload and afterload via venodilation and arteriodilation, decreased sodium chloride and water retention via decreased aldosterone production and inhibiting angiotensin-aldosterone mediated cardiac and vascular remodelling.
Indications for use - treatment of CHF in dogs and cats. Chronic renal insufficiency in cats. Protein losing nephropathies. Reduces blood pressure in hypertension. Hepatic metabolism, no renal, exacerbate prerenal azotemia in hypotension animals and those with poor renal perfusion.
Side effects - hypotension, hyperkalaemia and azotemia, causes azotemia in rabbits.
Amlodipine - not licensed.
MOA - dihydropyridine calcium channel blocker with predominant action at the peripheral arteriolar vasculature resulting in a decrease in afterload. Mild negative inotropic and chronotropic effects that are negligible at low doses.
Indications - systemic hypertension in cats and appears to be safe even when there is concurrent renal failure. Used in dogs for treatment of systemic hypertension and in normotensive dogs as adjunctive therapy for refractory heart failure due to mitral regurg. Decreases proteinuria in cats with systemic hypertension, metabolised in the liver.
Side effects - lethargy, hypotension, inappetence rarely, avoid in cardio genie shock and pregnancy.

How well did you know this?

Not at all

Perfectly

A thirteen year old domestic short haired cat is presented to you with one eye filled with blood. What other ophthalmic and systemic signs might you see on a clinical examination and what diagnoses might you reach? What ancillary tests might be appropriate and what treatment might you use? (12)

How well did you know this?

Not at all

Perfectly

You are presented with an acutely paraplegic Dachshund with a normal cranial nerve examination and normal forelimb examination. In terms of between which vertebrae this spinal lesion could be lying, what are the two broad regions of localisation that could explain this paraplegia (2 marks) and how would your neurological examination differ for these two regions? (9 marks) What important test should be performed last to give an indication of potential prognosis for recovery of ambulation in this dog? (1 mark)

T3-L3, L4-S3 last test - deep pain sensation
Schiff-Sherrington phenomenon possible.
Paniculus reflex - cuts out at dermatome just caudal to the extrusion.
Spinal reflexes in hindlimbs - patellar reflex - femoral nerve, not working lesion in L4-L6.
Withdrawal reflex - potentially hyper reflexive if T3-L3, absent on other.
Perineal reflex - absent if lesion is L4-S3.
Urinary retention if T3-L3, urinary incontinence otherwise as upper motor neuron and lower motor neuron bladder.
This can all be contraindicated as spinal shock can occur whereby a lesion in the L4-S3 region can also have T3-L3 signs.

How well did you know this?

Not at all

Perfectly

A two year old neutered male Labrador retriever presents for the investigation of chronic intermittent diarrhoea of 2 months’ duration. The owner reports that there are flecks of fresh blood and mucus in the faeces, but that the dog’s appetite is normal and there is no weight loss.

a) List your differential diagnoses for this dog’s problem in order of likelihood (6 marks)
b) How would you investigate this diarrhoea? (6 marks)

Likely large intestinal as no weight loss and fresh blood and mucus present. Therefore localises differentials:
Constipation
Dietary indiscretion/abrasion but usually acute.
1 - Chronic inflammatory colitis - lymphocytic-plasmocytic, eosinophilic, granulomatous, histiocytic.
Infections - campylobacter, salmonella, Clostridia, E. coli, giardia, trichuris.
Uraemia colitis.
Secondary to is fat maldigestion/malabsorption so EPI, sibo, IBD, chronic pancreatitis, bile salt deficiency.
Secondary to local irritation - peritonitis, extracolonic mass
Colonic neoplasia or polyps.
2- Colonic motility disorder: irritable bowel syndrome
Investigation:
History and clinical exam - is it SI? Constipation or colitis? Abdominal palpation, rectal palpation.
Faecal sample - gross appearance, culture, flotation for giardia, nematodes, undigested fat, cytology.
Blood samples - rule out renal, hepatic, pancreatic, metabolic, endocrine disease. TLI and folate and B12 if fat suspected.
Radiography - rule out neoplasia, FBs, mega colon, contrast more helpful.
Ultrasound - colonic masses
Proctoscopy and biopsy
Biopsy at laparoscopy

How well did you know this?

Not at all

Perfectly

You suspect that a Basset hound may have a cutaneous intertriginous Malassezia overgrowth. Briefly describe the optimal method by which you would seek to confirm your clinical suspicion. (6) List four treatments that you would expect to be helpful in decreasing Malssezial colonisation of this dog. (6)

History, when did it come about, how long have the owners noticed it, have they been itchy at all etc.
Clinical exam, where is the lesion? What does it look like, how does it smell, is it greasy, is it pruritic usually not but can be on the face, is it painful. Is there hyper pigmentation, is it erythematous.
Investigations - adhesive tape to the area and removed, stained in diff quik and looked at under the microscope, appear as black ovals. Can also take a swab and grow the yeast on Sebrourauds medium. Want to rule out other cause, check for fleas, skin scrapes for parasitic infection with demodex canis or sarcoptes but clinical signs likely to be different. Hair pluck for dermatophytosis. Swab for bacterial infection, maybe secondary to malassezia pachydermatitis.
Treatment - antifungals medicated shampoo with miconazole and chlorhexidine to reduce yeast population.
Systemic antifungal drugs can be used such as ketoconazole.
Topical antibiotic cream for secondary infections.
Surgical resection of tissue resulting in humid conditions for mallassezia growth to allow better ventilation.

How well did you know this?

Not at all

Perfectly

8. For each of the following immunosuppressive drugs, outline their mechanisms of action and potential side-effects. Also indicate for each drug whether it is safe for dogs and cats and whether it is licensed for use in small animals. a) Prednisolone (6) b) Azathioprine (4) c) Cyclosporine (4)

Prednisolone - binds to cytoplasmic receptors and then enters the nucleus to alter DNA transcription. Cellular metabolism alters resulting in antiinflammatory, immunosuppressive and antifibrotic effects. In dogs acts as an adh antagonist. Side effects - suppresses the hpa axis resulting in adrenal atrophy and can cause protein urea and glomerular changes in the dog leading to being pupd. Weight loss and cutaneous atrophy due to catabolic effects leading to pot belly and poor wound healing and polyphagia. Vomiting, diarrhoea and GI ulceration possible. Ophthalmic, topical and oral formulations licensed. Azathioprine - purine analogue that inhibits purine synthesis that is necessary for cell proliferation, especially leukocytes and lymphocytes. Suppresses cell mediated immunity, alters antibody production and inhibits cell growth. Side effects - bone marrow suppression and is genetically influenced, GI upset/anorexia, poor hair growth, acute pancreatitis and hepatotoxicity. Do not use in cats as develop a severe non responsive fatal leucopaenia and thrombocytopenia. Avoid rapid withdrawal. Off license use in both dogs and cats. Cyclosporine - licensed as topical ophthalmic preparation for immune mediated keratoconjunctivitis sicca and oral preparation for atopic dermatitis in dogs. Side effects - hypertrichosis, vomiting and diarrhoea but usually mild and do not need to stop treatment, increased risk of malignancy, care in diabetic and renal failure patients.

11. A 1-year-old Bernese Mountain is suspected of having steroid-responsive meningitis. a) What are the 2 main clinical signs? (2) b) Which 2 diagnostic tests would you advise and what would the most likely findings on these tests be in this case? (4) c) Describe the appropriate treatment including duration of treatment and long term prognosis. (6)

a) Profound spinal pain, especially the neck, depression, fever, hyperaesthesia and stiff gait. b) CSF tap - Rule out any underlying conditions that show steroids to be contraindicated. Advanced imaging of the cervical region to rule out disc protrusion. c)Treatment with immunosuppressive dose of corticosteroids in cases of SRMA usually results in rapid improvement, although there are refractory or chronic cases that require a second immunosuppressive drug. Usually see a response in 48 hours. The treatment is long term and once the clinical signs are controlled, the dose of medication is decreased over months (usually a minimum of four months). The immunosuppressive treatment requires close monitoring by a veterinary surgeon, who decides, based on different examinations and diagnostic tests, when the medication can be decreased and finally discontinued. The prognosis for recovery is good but the potential for relapse exists.

6. Describe the treatment of mitral valve disease in: a) A 2 year-old Cavalier King Charles Spaniel with a grade III/VI murmur and enlarged left atrium but no other clinical signs recognised by the owner. (4) b) A 12 year-old Cavalier King Charles Spaniel with a grade V/VI murmur and acute onset dyspnoea and collapse. (8)

A) Leave and monitor at regular intervals if the owner wishes but would advise starting treatment. Do good radiography and ultrasound for baseline measurements. Pimobendan is a calcium sensitiser and phosphdiesterase inhibitor so increase cyclic AMP in myocardial cells causing increased force of contraction and decreases preload and afterload through direct inhibition of smooth muscle. Shown to improve life expectancy. ACE inhibitors are used to promote bradykinin activity and has no vasopressin activity. Lead to decreased arterial resistance, decreased venous tension, decreased aldosterone so less sodium retention, and prolongs life but unknown why. Decreases preload and afterload. Potentially introduce a beta blocker at the lowest effective dose an observe change in heart. Otherwise use a cardiac diet - mild sodium restriction and high palatability with good protein source to maintain body condition, restrict excessive exercise. B) initial triage and quick history off the owner. Oxygen supplementation with as little stress as possible, IV access is paramount, furosemide to reduce pleural effusion (allow free access to water but care with IVFT, leave until stable and only if the animal is not drinking) and allow for stabilisation, pimobendan, preferably the IV formulation. Thoracocentesis may be warranted. Appropriate nursing care, in sternal, temperature controlled, stress free. May need to sedate but try to use a drug that has few cardiovascular effects as possible. Potentially give an IV CRI of nitroprusside. Monitor blood pressure, oxygenation status and start ace inhibitors, spironolactone, beta blocker, potentially cardiac glycosides if animal is still in cardiac failure. Nitroglycerin after acute phase is over.

4. An unvaccinated 8 week-old mixed-breed puppy has developed a ‘cloudy eye’ according to the owner. a) Describe how you would examine the eye (3) and what ancillary tests might be appropriate.(2) b) What pathological changes could be the basis for 'a cloudy eye' and what might your list of differential diagnoses be? (5) c) Describe the treatments you would give for two of the conditions in your list (2).

Pen torch external examination in light then moderately darkened room, tests PLRs and eye movements. Distant direct ophthalmoscopy to see tapetal reflex and at 0 dioptres, it allows assessment of any opacities in the ocular media such as cataracts that reduce the reflex. Then direct ophthalmoscopy, fundus, then optic disc, +10dioptres for the lens and structures in the anterior segment including the iris. Then examine the cornea and adnexa with 20-30dioptres. Can use indirect ophthalmoscopy, slit lamp examination. Ancillary tests - schirmer tear test, fluorescin dye for corneal ulceration, tropicamide for myriad is if pupil constricted. Pathological basis - cloudiness of the cornea due to infections, scarring, oedema, fatty infiltration or infiltration inflammatory diseases. Cloudiness of the aqueous humour due to white blood cells, proteins, fatty lipids or blood. Opacification or whitening of the lens from cataracts. Disorders if the vitreous body which can be congenital defects, haemorrhage or inflammation. Ulcerative keratitis, CAV-1, vascular keratitis, nuclear sclerosis, cataracts, CDV, diabetes mellitus, GME, toxoplasma, corneal ulcer. DM, cataract surgery, insulin etc Corneal ulcer - chloramphenicol eye ointment, NSAID eye ointment, atropine if painful.

3. Explain the current use of the following blood tests as part of the work up /diagnosis of acute and chronic pancreatitis in dogs and cats: Serum amylase, lipase, TLI , cPLI and fPLI (12)

Amylase and lipase are of no use in the cat, in dogs they are only 50 percent specific but allow for a good general evaluation. Use in conjunction with the clinical signs. Lipase is more sensitive than amylase, both excreted renally, steroids increase both, and lipase if very high is associated with tumours. TLI - in canine it is poorly sensitive, better for EPI. Feline version has variable specificity and sensitivity so should not be relied on solely for cats. PLI - in dogs it is the most sensitive and specific, around 60% but not sure, can do as Elisa snap test in practice so useful for frontline testing. In cats it is a relatively new test and e specific figures are not yet known, it will probably be better than the test we have so far for cats though... Chronic cases can be harder to tell as the enzymes may be normal due to compensation to the disease. All these blood tests should be done in view of the clinical signs and abdominal ultrasound.

Outline how you would establish the diagnosis and instigate a treatment protocol for a 2 year old Border Collie suspected of having idiopathic epilepsy. (10 marks)

Write short notes on the clinical signs, diagnosis and treatment of (a third of 10 marks for each): • Flea allergic dermatitis in a domestic shorthaired cat • Atopic skin disease in a West Highland white terrier • Dermatophytosis (ringworm) in a Persian cat

A 12 year old entire Poodle bitch has diabetes mellitus which has been stable for several months on twice daily doses of Lente insulin. The owner has now noticed that the dog is drinking and urinating a lot and has documented a steadily increasing blood glucose concentration on home monitoring despite increasing daily doses of an intermediate acting insulin. List the possible reasons for this diabetic dog’s apparent lack of response to insulin (5 marks) and discuss your approach to this case (5 marks).

Lack of owner compliance - storage/rolling, technique, dosing, feeding issues and consistency. Insulin resistance - progesterones, infections - pyometra, UTI, dental, Cushings, pancreatitis, hypothyroidism? Increased metabolism of insulin. Somogyi overswing. Approach - bring in for clinical exam, ask history, observe giving insulin, check bottle and syringes, clinical exam for pyo, systemic illness, bloods, endocrine tests, glucose curve, urinalysis, ultrasound, radiography.

Anaemia is a common finding in animals with neoplasia. List 5 mechanisms whereby neoplasia might cause anaemia ad provide one example for each heading. (2 marks for each mechanism and example.)

Haemorrhage- rupture or necrosis around vessels in vascular tumours Sequestration of red blood cells- tumours with abnormal vascualture may cause damage to rbcs- see increased schistocytes Reduced production- tumours of cells in the bone marrow may out compete rbcs for space causing reduced production

You are presented with a 6 y.o. Boxer dog with generalised lymph node enlargement. Describe your diagnostic approach to this problem (6 marks) and discuss what factors you would take into account when considering the management of this case (4 marks).

List the clinico-pathological findings you would expect to see in a haematology and biochemistry screen and urine sample of a dog with hyperadrenocorticism. (6 marks) Outline two clinicopathological diagnostic tests you could use to try to confirm your diagnosis. (4 marks)

Biochemistry - hypercholesteraemia, markedly increased ALP, mildly raised other liver enzymes ALT, AST and GGT. Haematology - right-shifted neutrophilia, eosinopaenia, monocytosis, leukopaenia. Urinalysis - dilute, proteinuria can have UPC of 4,5,6; sometimes glucosuria, silent infection commonly present, look for struvite on sedimentation and culture and sensitivity. Urine creatinine to cortisol ratio shows high cortisol. ACTH stimulation test - specificity 80-85, sensitivity 60-85, draw graph. Low dose dexamethasone suppression test - specificity 70-80, sensitivity 85-90. Draw graph.

A 16 month old male entire Persian cat presents with a three week history of inappetance, pyrexia, weight loss and abdominal swelling. Physical examination reveals the presence of ascites with a palpable fluid wave and ultrasound examination confirms this is free fluid. a. List the types of free abdominal fluid which might be found and the possible causes of each. (10 marks) b. Outline how you would take a sample of abdominal fluid from this cat for analysis and list the tests you would ask the laboratory to perform on the sample. (5 marks) c. An abdominal paracentesis sample shows a yellow fluid which is identified in the laboratory as an exudate. What differential diagnoses would you now consider for this case, putting them in order of likelihood? (5 marks) d. How would you investigate this case further to reach a diagnosis? (10 marks)

Haemoabdomen - trauma, splenic rupture, aortic rupture. Chyloabdomen - erosion of lymphatics by a neoplasia, lymphangiectasia. Exudate - septic peritonitis from penetrating wound to abdomen, intestinal rupture, infected uterine rupture, infected urinary tract rupture Chemical peritonitis due to urine or bile presence, changes modified transudate into exudate, looks green if bile. Acute necrotising pancreatitis, neoplasias if necrotic, FIP. Transudate - hypoalbuminaemia, increased hydrostatic pressure but more commonly modified transudate modified transudate - FIP, neoplasia, abdominal organ strangulation, increased vascular hypertension. Peritoneal fluid - some fluid is produced normally by mesothelial cells, not enough to cause ascites though. Abdominocentesis - ultrasound guided is best, if not available put patient in lateral recumbency, insert needle near umbilicus. If no fluid obtained, four quadrant abdominocentesis. FIP, septic peritonitis from uroabdomen, penetrating wound, intestinal perforation. Investigate as per usual - cats with FIP have hyperglobinaemia, low albumin to globulin ration, alpha 1 acid glycoproteins often elevated. Lymphopenia, +- neutrophilia +- anaemia. Effusion, straw coloured, total protein more than 35, albumin to globulin less than 0.4, less than 5000 cells, most neuts and macrophages. Ultrasound abdomen etc to rule out other causes, look under tongue. Serology - for FCoV, not FIP, 25-40 percent cats exposed, 80-100 percent of multicast households, suggestive but not diagnostic. Can do RT-PCR but no consistent mutation responsible for the different strains but likely to be diagnostic for effusions. Histopathology shows granulomatous lesions on serosal surfaces as white fibrin out plaques, histology and immunohistochemistry can be used.

A 16-year-old castrated male cat is presented with a history of polydipsia and weight loss for the last 2 months. On clinical examination, the cat is fractious and in poor body condition. You auscultate a grade 2/4 left-sided systolic heart murmur and a gallop rhythm but no adventitious respiratory noises. Abdominal palpation reveals small, irregularly shaped kidneys. The cat has a normal body temperature and also has gingivitis and dental tartar. a) List your differential diagnoses in this case in order of likelihood. (6 marks) b) How would you investigate this case further? (12 marks) c) Name one of the most likely diseases this cat may have from your list of differentials in section a). If the cat has this disease and requires dental extractions, what treatment would you implement prior to anaesthesia and how would you provide multimodal analgesia? (12 marks)

. Write short notes on the clinical indications for AND the potential side effects of: a) Cyclosporine in canine dermatology b) Potassium bromide in canine neurology c) Doxycycline in feline medicine (10)

Clinical indications - used as an adjunct in treatment of atopic dermatitis as licensed product atopica. If want to reduce use of preds can use ciclosporine, has some efficacy. Side effects - has anti insulin effects so care in diabetic patients, has shown renal problems in humans but not yet in dogs, hypertrichosis, vomiting and diarrhoea that is self limiting, anorexia, muscle weakness and cramps. Increased malignancy chance? Potassium bromide - control of seizures in dogs in which the seizures are refractory to treatment with phenobarbital or where use of phenobarbital or imepitoin in is contraindicated. Usually used in conjunction, can take 3-4 months to reach peak plasma levels. Do not use in cats due to severe coughing development due to eosinophilic bronchitis, or in dogs at risk of pancreatitis, plus care with renal disease. Doxycycline - bacteriostatic agent that inhibits protein synthesis at initiating step by interacting with 30S ribosome. Drug of choice for feline chlamydophilosis such as chlamydophila felis that is a contributor to cat flu complex, especially with eye lesions. When tetracycline is needed but renal impairment as faecally excreted. Can cause nausea, vomiting and diarrhoea, oesophagitis and oesophageal ulceration, water bolus to reduce risk.

Discuss how you would manage pseudopregnancy in the bitch. (10)

Briefly describe 4 laboratory tests available for the diagnosis of pancreatitis in small animals, outlining the advantages, disadvantages and potential usefulness in dogs and cats. (10)

a) List your differential diagnoses for unilateral epistaxis in a six year old ME Bassett hound. b) Outline how you would further investigate the case. (10)

Hypercalcaemia is the most common paraneoplastic syndrome encountered in the dog. a) List three tumours associated with hypercalcaemia of malignancy in the dog b) List three clinical signs of hypercalcaemia in the dog,outlining the pathophysiology of each clinical sign. (10)

A six year old male neutered boxer is brought to your clinic with a superficial corneal ulcer. Outline the pathogenesis of these types of ulcer. Briefly describe your approach to the case and possible therapeutic options. (10)

You are presented with a ten year old German shepherd dog in status epilepticus. It has no prior history of seizures and has been fitting for the last hour. a) List your differential diagnosis, indicating the most likely ones. b) Outline the immediate steps you would you take to stop the seizures c) Assuming the dog recovers, what long term treatment could you use prevent more seizures occurring? (10)

Brain tumour Toxic- heavy metal Metabolic- acquired shunts etc Idiopathic epilepsy v v unlikely Immediately minimize stimuli (lights down, pad ears) check time and give rectal diazepam assuming no IV. Attempt to get an IV ASAP possibly using retropulsion of eyeballs. After 10 mins give phenobarbital IV. After 20 mins more diazepam. After 30 mins give some propofol IV Repeat phenobarbital and increase dose of propofol until seizure activity ceases, if necessary can use emg to assess activity. Long term look for diagnosis- use MRI/ct for brain tumour. Thorough history to rule out toxic exposure. Abdominal ultrasound for shunts. Bloods to assess. Full neuro exam for post ictal signs. Treat cause if possible (RT for tumour, surgical removal) If repeat seizure risk can use any of potassium bromide (takes a very long time to equilabrate often used as an adjunct), phenobarbital (not if liver disease but generally less toxic), imepitoin (like phenobarbital but better).

. a) List the differential diagnoses for a six month old female entire bitch with urinary incontinence. b) Briefly describe the diagnostic tests required to investigate this case. (10)

What are the effects of introperative hypothermia in small animals? (10)

- anaesthetic agents inhibit cold induced constriction - see redistribution hypothermia as core heat travels to periphery, and then increased loss to environment - decrease the requirement for anaesthetic due to decreased metabolism so the patient can easily become too deep. hepatic and renal blood flow decreased - affect cardiovascular function ( blood pressure, heart rate, and plasma catecholamine concentrations) increased myocardial demand - shifts oxyhemoglobin dissociation curve to the left, which increases oxygen binding to hemoglobin, thus reducing available oxygen for tissues, decreased myocardial supply- myocardial ischaemia - increased bleeding as coagulation is impaired by cold induced decrease in platelet function, reduced thromboxane B2 at site and increased fibrinolysis - shivering in recovery massively increases oxygen requirements so decreases effective ventillation and increases pain (but hypoxia inhibits) - in humans- increase in SSI as vasocontriction of skin inhibits immune cell access and tissue hypoxia

You are presented with a 7 year old Golden Retriever with severe unilateral epistaxis. The owner had noticed a slightly haemorrhagic nasal discharge a few days previously. a) Discuss this presentation and construct a list of possible causes of this problem. (10 marks) b) Describe how you would proceed to investigate this problem with the aim of reaching a diagnosis. (15 marks) c) Discuss whether the animal might need supportive care, how you would assess this and what sort of care you might provide. (5 marks)

You are presented with a 5-year old Dachshund with a history of sudden-onset apparent weakness and inco-ordination of both hindlimbs. The dog has also stopped attempting to jump-up or climb stairs. The owners are not aware of any traumatic cause. a) You determine that the brain and forelimbs are apparently normal. What remaining spinal cord segments could be damaged to result in the clinical signs described? (1 mark) b) What further tests could you include in your clinical examination to determine the location of the lesion more precisely? (5 marks) c) You believe the dog to be in discomfort. List three possible diagnoses for the condition and state which is the most likely. (4 marks)

A five year old male Netherland dwarf rabbit is presented to you with a persistent white ocular discharge in both eyes. a) What are your differential diagnoses? (2 marks) b) What examinations and tests would you carry out? (5 marks) c) What treatments might be appropriate? (3 marks)

Write short notes on sudden onset blindness in the dog. (10 marks)

The Veterinary Medicines Regulations set out a “Prescribing Cascade” for situations where there is no suitable medicine authorized in the UK for a condition affecting a non-food producing species. Outline the provisions of this “Prescribing Cascade” for non-food producing animals. (10 marks)

Write short notes on the treatment of: a) feline Otodectes infestation (4 marks) b) canine demodectic mange (3 marks) c) canine cheyletiellosis (3 marks)

In a dog with a prostatic abscess: a) briefly discuss the choice of antibiotic (3 marks) b) describe two drainage techniques (7 marks)

Which feline viruses are commonly screened for in practice using an ELISA-based ‘SNAP’ test? (1 mark) a) For two viruses, describe what the test is detecting in the serum sample in the case of a positive result. (2 marks) b) A clinically healthy cat in a rescue centre tested positive on the ‘SNAP’ test to one of the viruses. Write brief notes on the advice you might give relating to prognosis, further testing and rehoming, explaining your reasoning. (7 marks)

Outline the tests (and their limitations) that can be used to evaluate renal function in dogs. (10 marks)

You are presented with an 8 year old neutered male domestic shorthaired cat, which has developed severe respiratory distress over the last 24 hours. The owners feel that the cat has also been quieter than normal over the last 2 weeks. a) Construct a differential diagnosis list in order of likelihood. b) Describe your approach to the diagnosis and management of this case over the first 48 hours (30)

Decreased thoracic capacity Pneumothorax, hydrothorax, haemothorax, chyelothorax, pyothorax, pleural effusion SOL- mediastinal mass, cardiomegaly (HCM), diaphragmatic hernia, fractured ribs Decreased pulmoanry exchange Pulmonary oedema, pulmonary haemorrhage, paraquat poisoning, pulmonary embolism, bronchopneumonia, interstitial pneumonia Pulmonary infiltrate- feline asthma, neoplastic, inflammatory Airway bloackage Tracheal collapse, stentic nares, nasopharyngeal polyp, laryngeal collapse/paralysis, tracheal/fb obstruction, neoplastic obstruction Generalised Anaemia, metabolic acidosis (hyperkalaemia, renal failure), pulmonary contusions Order of likelihood Pleural effusion from HF Mediastinal mass (lymphoma) Feline asthma Metabolic acidosis Trauma related- hameothorax, hernia, fractures, heamothorax, chylothorax, pneumothorax, Bronchopneumonia Pyothorax Triage- ensure patent airway, place in oxygen tent, ensure regular pulse (consider resuss if not), improvement in oxygen? Consider draining if not (thoracocentesis) monitoring/pulse ox. Consider IV catherterisation if wont stress MINIMAL STRESS Once stable return to owner for history (fight/trauma/medication/previous cough/toxic exposure/other signs) Clinical examination- TPR, auscultate, percuss, oral exam, abdominal palpation, wounds, fractures, signs of trauma, bladder, kidneys, Baseline bloods if possible and arterial blood gas/ BP X ray U/s with thoracocentesis and analysis, FNA Consider future bronchoscopy/echo/ BAL etc Chest drain if fluid, fluids, oxygen, pain relief, sedation if stressed, IV steroids, diuretics, ?ace inhibitors

a) Give four characteristics of a regenerative anaemia that you may detect on a blood smear. How would you determine more accurately in the laboratory that the anaemia is in fact regenerative? b) List the differential diagnoses for regenerative anaemia in the dog (10)

``` Reticulocytes Nucleated RBCs Polychromasia Increased cell volume (larger) Basophilic stippling Howell Joly Bodies In a lab- absolute reticulocyte count, increased MCV, decreased MCHC, red cell distribution width ``` ``` Haemorrhage (more than 3 days ago) Trauma, bleeding neoplasm, gastric ulceration, epistaxis, haematuria, melena, haematemesis, haemoabdomen, haemothorax, haemopericardium Intravascular hameolysis Autoimmune, babesia, neonatal isoerytholysis, microvascular neoplasms (haemangiosarcoma), erhlichia, leptospira, DIC, bacterial Inherited defects Pyruvate kinase WHWT Hyperphosphataemia (insulin) Toxins- onions, garlic, naptholene, ```

4. Write short notes on the clinical signs and diagnosis of the following diseases: a) Canine babesiosis b) Feline parvovirus c) Feline calicivirus (10)

Babesiosis- Babesia canis canis, Babesia canis vogali Protozoa, Spread by ticks, mostly not in UK, pet travel scheme, invade RBCs and multiply causing haemolysis, visualise on blood smear, regenerative anaemia, Exercise intolerance, haemaglobinuria, weakness, pale membranes, increased RR and HR Feline parvovirus- Feline panleukopaenia, vaccinated for infects bone marrow and other rapidly dividing cells, 99% similar to canine parvo, haemorrhagic diarrhoea, panleukopaenia, susceptible to other infections, young kittens, crypt epithelium, fetal cerebellum, myocardium. Peracute severe depression low temp, rapid death. Acute- vomiting diarrhoea, abdominal pain and high temp. In utero- fetal resorption in first trimester, then cerebellar hypoplasia. PCR, ELISA, isolate and barrier nurse. Feline calicivirus Many serotypes. Part of cat flu complex, stomatitis and oral ulcers, shifting lameness, fever lasting 2-3 days, sneezing and oculonasal discharge, possible systemic peripheral oedema and vasculitis. Oropharyngeal swab and virus isolation.

1. Briefly discuss the indications of the following drugs in the treatment of congestive heart failure in dogs: a) angiotensin-convering-enzyme (ACE) inhibitors b) pimobendan c) frusemide (10)

ACE inhibitors- inhibits RAAS to reduce blood pressure- prolong life, if given before onset of CHF, particuarly high blood pressure, promotes cardiac remodelling (protective), also renal disease Pimobendan- calcium sensitiser and positive inotrope (phosphodiesterase inhibitor) prolongs life in Dobermans with DCM if given before onset. IV formulation now availiable for use in acute treatment. Frusemeide- decreases preload by loop diuretic suitable for all cardiac associated effusions except pericardial effusions. Can cause chronic hypokalaemia- consider giving with spironolactone and supplement.

.List the possible causes of sudden onset, severe pruritus in a 3 year old West highland white terrier. Outline how you would investigate this case to reach a diagnosis (10)

Ectoparisites- Fleas, sacroptes scabei, psorptes, cheyletiella, tromibicula autumnalis, otodectes, lice, demodecosis Allergic- Contact allergy, atopic dermatitis, flea allergic hypersensitivity, food allergy Fungal- Dermatophysosis, mallassesia Bacterial- staphylococcal superficial pyoderma, secondary to other causes. Pustular dermatitis History, clinical signs, clinical exam- pattern lesion distribution, zoonosis Exclude parasites Visual inspection, otoscopy, wet paper test, sellotape, skin scrape, sample from several areas. Other Impression smear, culture and sensitisation, hair pluck, punch biopsy, woods lamp, intradermal skin test, serology for allergens, diet trial, therapeutic trial reasonable

List the causes of prostatomegaly in the entire male dog. Write short notes on the optimal treatment for an 8 year old male German shepherd dog with a large prostatic abscess and mild pyrexia.

Bilateral symmetrical hyperplasia Prostatitis +/- abscess Prostatic cyst Neoplasia Antibiotic with good penetration both to prostate and abscess, clindamycin, (TMPS wont penertrate pus), culture and sensitivity with prostatic wash to re assess- fluroquinolones only after C+S. Long course. Recheck response on ultrasound. Analegesia, NSAID, assess renal function first. Castrate. Prosectomy not advised as have to to cystectomy.

. You are presented with a dog with a mandibular mass. a) List four types of tumour which commonly arise in the oral cavity of the dog b) Briefly describe how you would attempt to make a diagnosis and stage the lesion.

Acanthomatus epulis (BCC), Peridonatal odonogenic fibroma, malignant melanoma, SCC History Clinical exam FNA diagnosis, may need to immunostain for malignant melanoma, incisional/excisional biopsy plus histo Check local LNs via u/s plus FNA Thoracic radiographs Abdominal ultrasound (possibly plus x ray)

13. You are presented with an 11 year old, neutered female Collie with acute onset ataxia in all 4 limbs and a head tilt and horizontal nystagmus with a fast phase to the right. Her mentation is normal. The dog is vaccinated. The clinical examination and the rest of the neurological examination are normal. - Where do you localise the lesion? - List three differential diagnoses - Give a brief description of your diagnostic approach in this patient. (10)

cerebellum left sided lesion or r sided otitis interna (vesibular disease or paradoxical) Idiopathic vestibular disease Neoplasia- of the inner ear (SCC, STS, lymphoma), brain (esp cerebellar- meningioma/glioma/dermoid cyst/lymphoma) Otitis media/interna extending from otitis interna ``` History General clinical exam Neurological exam Full otoscopic examination Consider x rays and MRI ```

14. A domestic short-haired cat is presented to you with redness and some swelling of the conjunctiva in both eyes. Describe your examination of the eye - what causative factors might you be looking for, what tests would you do and what treatment might be appropriate for the potential causes of the disease? (10)

History General clinical exam Examine visually from afar, PLRs, preliminary examination of globe and cornea Opthalmic examination- dark room- transparency of ocular layers , distant direct at 0 diaptres for tapetal reflex and isoscoria, 0 dioptres for fundus etc, 10 dioptres for cataracts, lens abnormalities Lookig for ulcers, foreign bodys, viral, chalamydia, immune mediated, bacterial (staphs), entropion Fluroscin test for corneal ulceration, schirmer tear tests, oropharyngeal swab fo PCR, VI, Treat with antibiotic eyedrops (chloramphenicol), consider systemic antibiosis as secnd line. If suspect IM use steroids. Surgery for entropion

3. Briefly describe 3 methods that may be used to diagnose demodicosis in dogs and cats (6 marks). List 6 treatments that may be used in the management of canine generalised demodicosis (6 marks)

You are presented with an acutely non-ambulatory tetraparetic Labrador retriever. The signs developed while running after a ball. Cranial nerve examination and mentation are normal. a) Between which two spinal cord segments could this lesion be localised? (3 marks) b) How might your neurological examination differ for these two regions? (6 marks) On further examination, the right front and right hindlimb are clearly more severely paretic than the left side. The dog is not painful. c) What is the most likely diagnosis? (1 mark) d) Which diagnostic test(s) would be needed to confirm your suspicion? (1 mark) e) If your suspicion would be correct, is it likely that the dog will improve in the next weeks? (1 mark)

How might feline infectious peritonitis (FIP) present in a cat? (6 marks) List the clinicopathological findings consistent with a diagnosis of FIP. (6 marks)

You are presented with a 5 year-old neutered female cocker spaniel with signs of anorexia, lethargy and jaundice. a) List your differential diagnoses for jaundice in this dog (6 marks) b) Outline the further investigations you would undertake to obtain a diagnosis (6 marks)

. What would your general approach to fluid therapy be in: a) A cat with chronic renal failure that is 10% dehydrated (6 marks) b) A dog with severe, acute vomiting that is hypovolaemic (6marks)

Describe the changes you would expect to see on a haematology screen in a dog with suspected IMHA (immune-mediated haemolytic anaemia) (10 marks). What confirmatory test(s) would you request? (2 marks)

5. List the differential diagnoses for haematemesis in the dog (3 marks). List three groups of drugs you would consider using for symptomatic treatment in a dog with haematemesis and briefly explain why you would use them (7 marks).

6. A client complains that despite frequently worming his outdoor cat, he still sees white grain of rice-like objects adhering to the skin and fur around the cat’s anus. What are these (2 marks), why is the worming regimen not working (4 marks) and what will you advise your client to do in order to control the problem? (4 marks)

9. Hypercalcaemia is the most common paraneoplastic syndrome encountered in the dog. a) List the tumours which are most frequently associated with hypercalcaemia in the dog (4 marks) b) List the clinical signs of hypercalcaemia and explain the underlying pathophysiology for each sign. (6 marks)

10. a) Give three clinical signs associated with neck pain (1 mark each). b) List six causes of neck pain (1/2 mark each).

12. Pre analytical errors are one of the most common causes of incorrect laboratory reports. a) List four of the most common causes related to sampling (4 marks) b) For each sampling error indicate what would happen to the results of routine biochemistry and CBC (6 marks)

13. What is the role of desensitising vaccination in the treatment of atopic dermatitis? (10 marks)

14. You are presented with a twelve year old cross-bred dog. The owners are concerned that the centres of the animal’s eyes look cloudy although his vision does not seem to be affected. What conditions might be causing this? (4 marks) How you differentiate them? (3 marks) What pathological processes might be underlying these changes? (3 marks)

You are presented with a 6 year old neutered male Domestic Short Haired cat seen by the owners over the past day repeatedly strining in its litter tray. A) provide a list of differentials for this presentation and describe how you would determine whether the cat had urinary retention. b) describe in detail how you would manage this cat if it had a urethral obstruction. (30)

A 5yr old neutered female Jack Russell terrier presents to you in a state of collapse following acute vomiting. It is showing signs of shock and has a very painful tense abdomen. A) what are your differential diagnoses in this case? B) outline your initial emergency treatment of this patient and what investigations you would perform to reach a diagnosis. (30)

Bile acids are often measured when evaluating animals with liver disease. Briefly outline the metabolism of bile acids. What situations lead to an increase in bile acids? (10)

You are presented with a 7 year old golden retriever with a 3 week history of sneezing and a unilateral mucopurulent nasal discharge. List the differential diagnoses for this case and write short notes on the techniques you might use to reach a diagnosis. (10)

List the causes of prostatomegaly in the entire male dog. For ONE of these conditions state the likely clinical signs, most appropriate diagnostic technique(s) and therapy. (10)

List the clinical signs of hyperadrenocorticisim in the dog. A) what non-specific changes can be seen on CBC, biochemistry screen and urinalysis of dogs with HAC. B) what specific tests might you perform to confrim a diagnosis hyperadrenocorticsm and distinguish between the adrenal and pituitary dependant forms. (10)

List three diuretics that may be used in small animal practice. For one of these diuretics indicate a)mode of action, b) indications for use, c)possible side effects. (10)

Write brief notes on the diagnosis and management of an oesophageal forgein body in a young west highland white dog. (10)

You are presented with a 6-year old Domestic Short Haired cat that has recently been involved in a road traffic accident. On clinical examination you suspect a fractured pelvis but also note some bruising on the ventral abdomen. The owners have not seen the cat urinate for 24hours. a) describe how you would initally stabilise this patient and determine whether the cat has urinary tract trauma. b) describe in detail how you would manage this cat if it had a bladder rupture including, breifly, the surgical technique you would use. (30)

A 3yr old female entire maltese terrier is presented to you for wekaness and depression. You notice pale, icteric mucous membranes and a manual PCV is measured as 10% (normal range 37-55%) list the differentials, indicate which are most likely in this case. How would you investigate this case to confirm your diagnosis? For one of your likely diagnoses, briefly discuss the way in which you would manage the case and the problems you might encounter during the treatment. (30)

Write short notes on the diagnosis and management of canine cutaneous mast cell tumours (10)

Describe the clinical and laboratory findings that are consistent with a diagnosis of feline infectious peritonitis (FIP) (10)

Describe the options available for the management of a cat with chronic renal failure (10)

a dog is presented to you with one pupil much smaller than the other. List the conditions might cause this anisocaria. What other ocular signs could help you differentiate between them? What tests could you use to confirm your diagnosis? (10)

You have diagnosed a portosystemic shunt in a 4-mnth old Yorkshire terrier and would like to refer the dog for surgery. Write short notes on the possible operative and postoperatiev complications that you might discuss with the owners prior to referral. (10)

Write short notes on the diagnosis and management of two of the following a) canine leishmaniasis, b) mycoplasma haemofelis (Haemabartonella felis) infection in the cat, c) feline toxoplasmosis (10)

A 6yr old female labrador retriever is presented to you after the owner noticed bruising on her abdomen. Describe how you would investigate this problem including your list of differentials. (30)

Construct a table comparing the management of diabetes mellitus in dogs and cats (10)

What is meant by non-regenerative anaemia and how may it be recognised on a haematology examination? List the causes fo non-regengerative anaemia in the dog. (10)

List the clinical signs which may be present in a cat with flea allergic dermatitis. How would you advise an owner to control fleas in a household with two cats with free access to the outdoors. (10)

What dietary factors are important in cats with chronic renal failure and why? (10)

List four cases of collapse at exercise and outline the tests you would use to reach a final diagnosis for each (10)

A dog is presented to you with a protruding third eyelid. What diseases might be causing this and how would you differentiate between them? (!0)

3yr old domestic short haired cat presents to you for investigation of anorexia and depression. Clinical examination reveals slightly poor body condition and very jaundiced mucous membranes. List your differential diagnoses for this cat's jaundice, indicating the most likely. Describe how you would investigate this case further to ascertain the cause of jaundice. (30)

List the differential diagnoses of neck pain in a 6yr old female Shih Tzu. Write short notes to describe how you would attempt to reach a diagnoses (10)

Write short notes on the clinical signs, diagnosis and management of demodectic mange in the dog. (10)

Write short notes on the clinical signs diagnosis and treatment of dilated cardiomyopathy in the doberman pincher (10)

Hypothyroidism can be a challenge to diagnose in dogs. List the clinical signs you might expect in a hypothyroid dog. What is "eythyroid sick syndrome"? What blood tests could you perform to diagnose hypothyroidism in a dog and differentiate it from euthyroid sick syndrome. (10)

A 4 year old cocker spaniel is presented with chronic ear disease. list the surgical procedures available for management of this case and the indications for each. (10)

A 2mnth sharpei puppy is presented to you with inturning eyelids associated with excess facial skin. What sequelae might occur as a result of these changes? What surgical techniques could be used to correct this? (10)

Laboratory measurement of liver enzymes is useful in the evaluation of dogs and cats with liver disease. Write short notes on the liver enzymes commonly measured in small animals, including the various possible causes of an increase in each enzyme. (10)

You have diagnosed an unsulinoma in a 10yr old crossbreed dog. List your treatment options and discuss what advice you would give to the owner of this dog with respect to these treatmentoptions (10)

List the possible side effects associated with the use of the following drugs in dogs and outline how you would monitor for and prevent these side effects: a) doxorubicin, b) cyclophosphomide c) cisplatin (10)

medicine Flashcards

(110 cards)