Mid-Sem 2 Exam Flashcards
(139 cards)
1
Q
“Coco” a 5 month old male entire chihuahua presents to you with a history of dullness since early puppyhood & failure to learn house training skills. On physical exam you notice an enlarged dome-shaped head & open fontanelles. You perform a neurological exam & abnormal findings include dull mentation, bilateral ventrolateral strabismus, bilateral absent menace response with intact pupillary light reflexes & postural reaction deficits in all 4 limbs.
- What is the most likely differential diagnosis?
- Assuming the owner has no financial constraints list 3 diagnostic tests you could perform to confirm your most likely differential diagnosis.
A
- Hydrocephalus (congenital)
- Ultrasound examination of the brain through open fontanelles
- CT of the head
- MRI of the head
- Ultrasound examination of the brain through open fontanelles
2
Q
Sally, a 3 year old female spayed Golden Retriever presents to your clinic after having her first generalised seizure. Outline your initial diagnostic approach.
A
- History - e.g. possible access to toxins
- Physical & neurological exam
- CBC, serum biochemistry & urinalysis to rule out extracranial disease (fasting glucose & liver function test)
- Establish a pattern of frequency & severity
- Advanced imaging (MRI) & CSF tap
3
Q
Methocarbamol would be a rational choice of medication for managing which kinds of intoxication?
- Grape / raising poisoning in dogs
- Permethrin, metaldehyde, strychnine & some mycotoxicoses
- Lily poisoning in cats
- Ingestion of non-polar medications such as propanol, lidocaine, moxidectin or bupivacaine
- Ethylene glycol intoxication
A
- Permethrin, metaldehyde, strychnine & some mycotoxicoses
4
Q
What medication can you give to counteract the severe depression sometimes caused by apomorphine?
A
Naloxone
5
Q
How does activated charcoal work in the management of certain toxicities?
- It binds to heavy metals under acidic conditions
- It has a large surface area, some toxins adsorb to it
- It binds to highly polarised (ionic) toxins
- It binds covalently to alcohols & other hydrocarbons
A
- It has a large surface area, some toxins adsorb to it
6
Q
What are likely clinical features of unsalted macadamia nut intoxication in dogs?
- Seizures
- Acute kidney injury
- Acute hepatopathy & jaundice
- Hind limb weakness, vomiting & diarrhoea
A
- Hind limb weakness, vomiting & diarrhoea
7
Q
What are likely consequences of xylitol (e.g. sugar-free gum) intoxication in dogs?
- Petechial haemorrhages especially retinal haemorrhages
- Hyperkalaemia & hyperphosphataemia
- Hypoglycaemia & sometimes hepatopathy
- Hyperglycaemia & sometimes nephropathy
A
- Hypoglycaemia & sometimes hepatopathy
8
Q
Sammy is a 9 year old male castrated domestic short haired cat that presents to you with clinical signs of chronic kidney disease.
a) List 2 clinical signs that might be found in Sammy
b) Apart from azotaemia list 2 other possible clinicopathological abnormalities you might find on haematology or biochemistry profiles in Sammy if he has chronic kidney disease.
c) You diagnose Sammy with stage III chronic kidney disease with hypertension. Describe an appropriate treatment plan for Sammy.
A
a) List 2 clinical signs that might be found in Sammy
- Weight loss, polyuria, polydipsia, inappetence, vomiting, diarrhoea, dehydration, lethargy, dull dry coat, poor body condition
b) Apart from azotaemia list 2 other possible clinicopathological abnormalities you might find on haematology or biochemistry profiles in Sammy if he has chronic kidney disease.
- Non-regenerative anaemia, stress leukogram, hyperphosphatemia, hypokalaemia, elevated SDMA, hypocalcemia
c) You diagnose Sammy with stage III chronic kidney disease with hypertension. Describe an appropriate treatment plan for Sammy.
- Renal diet
- Treatment for hypertension: Amlodipine, ACE inhibitor (Benazepril), telmisartan
- IV fluids / SC fluid
- Phosphate binder
- Anti-emetic (Maropitant, Metoclopramide)
- Gastric protectant (Omeprazole)
- Appetite stimulant (Mirtazapine)
- Potassium supplement
9
Q
A 12 year old spayed Doberman Pinscher had a soft tissue sarcoma resection 9 months ago. Since surgery she has been treated with low dose cyclophosphamide & firocoxib to inhibit local tumour regrowth. She has had stranguria for the last week & a free catch urine sample shows haematuria on a urine dipstick analysis. What are the two most likely causes of these abnormalities?
- Cyclophosphamide-induced sterile haemorrhagic cystitis, bacterial cystitis
- Von Willebrand disease, cyclophosphamide-induced sterile haemorrhagic cystitis
- Bacterial cystitis, firocoxib toxicity
- Firocoxib toxicity, Von Willebrand disease
A
- Cyclophosphamide-induced sterile haemorrhagic cystitis, bacterial cystitis
10
Q
A 9 year old entire male cattle dog is presented for a 2cm diameter raised pink epidermal mass with a partly ulcerated surface, located in the perianal region. What is the most appropriate diagnostic test & recommended therapy if you suspect a perianal gland adenoma?
- Fine needle aspiration for diagnosis, treat with wide margin surgical excision
- Fine needle aspiration for diagnosis, treat with piroxicam
- Incisional biopsy for diagnosis, treat with piroxicam
- Incisional biopsy for diagnosis, treat with castration
A
- Incisional biopsy for diagnosis, treat with castration
11
Q
Regarding osteosarcoma in dogs, which of the following statements is correct?
- The prognosis for osteosarcoma is excellent with median survival time about 24 months with aggressive treatment
- The tumour most commonly metastasises to lungs, regional lymph nodes & spleen
- The commonest presenting complaint is pathologic fracture of the affected limb
- The recommended treatment of osteosarcoma is limb amputation followed by chemotherapy
A
- The recommended treatment of osteosarcoma is limb amputation followed by chemotherapy
12
Q
An 8 year old male castrated kelpie is lame on the left forelimb. Investigation releaves hypercalcemia & a destructive lesion of the distal radius; the biopsy diagnosis is osteosarcoma. Amputation is declined. Which of the following drug combinations would be an appropriate first line approach for palliative treatment of this dog?
- Prednisolone & firocoxib
- Zoledronate & doxycycline
- Zoledronate & meloxicam
- Prednisolone & meloxicam
A
- Zoledronate & meloxicam
13
Q
Regarding hemangiosarcoma in dogs which of the following statements is INCORRECT?
- Adequate staging for suspected splenic hemangiosarcoma should include thoracic radiographs & bone marrow examination
- Dermal, subcutaneous & visceral hemangiosarcoma display different biologic behaviours
- Surgery for splenic hemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy
- Approximately 30% of dogs survive at least 12 months after surgery with adjuvant chemotherapy for splenic hemangiosarcoma
A
- Approximately 30% of dogs survive at least 12 months after surgery with adjuvant chemotherapy for splenic hemangiosarcoma
14
Q
The serious adverse effects of cytotoxic chemotherapy are commonly seen in which organs?
- Liver & bone marrow
- Urinary tract & liver
- Gastrointestinal & urinary tracts
- Bone marrow & gastrointestinal tract
A
- Bone marrow & gastrointestinal tract
15
Q
A dog is presented with polydipsia, polyuria & mild inappetence. Initial laboratory investigation shows mildly increased total serum calcium
1. Briefly outline the approach to determining whether this abnormality is significant
2. What pathologic process is the single most likely cause of hypercalcemia in dogs? In your answer give one specific example.
A
- Recheck total calcium - if still high then check ionised calcium
- Neoplasia - e.g. Lymphoma, anal sac apocrine carcinoma, osteosarcoma, myeloma
16
Q
A 12 year-old pug dog has a 5mm diameter, raised pink, 7mm diameter slightly raised hairless epidermal nodule on the dorsal surface of the right carpus. The nodule has been present & unchanged for at least the last 8 months. Ipsilateral prescapular & axillary lymph nodes are not palpable. Fine needle aspiration cytology diagnoses the nodule as a mast cell tumour. Following surgical excision, the tumour is graded as Patanaik Grade 1 or Kiupel low grade, completely excised with narrow margins. From the following options, select the most appropriate advice for the owner.
- Prognosis for cure is poor, adjuvant chemotherapy is strongly advised
- Prognosis for cure is guarded & limb amputation is advised
- Prognosis for cure is fair to good, monitor for local recurrence
- Prognosis for cure is guarded, distant metastasis is likely
A
- Prognosis for cure is fair to good, monitor for local recurrence
17
Q
Which neurological condition will not improve with spinal cord decompression surgery?
- Lumbosacral stenosis
- Cervical spondylomyelopathy
- Intervertebral disc extrusion
- Fibrocartilaginous embolism
A
- Fibrocartilaginous embolism
18
Q
Which of the following statements is correct regarding the inter-fragmentary strain theory?
- A smaller fracture gap will always lead to a lower strain
- Mesenchymal stem cells differentiate into cells type needed for fracture healing irrespective of the inter-fragmentary strain
- Resorption of bone from the fracture gap will decrease the inter-fragmentary strain
- It is calculated by dividing the original fracture width by the fracture width when loaded
A
- Resorption of bone from the fracture gap will decrease the inter-fragmentary strain
19
Q
You find a haematoma between the fracture fragments during open reduction of a non reconstructible comminuted humeral fracture. Which of the following statements is NOT CORRECT regarding the haematoma?
- It should be removed to allow fracture fragments to contact one another
- It is the first stage of secondary bone healing
- It signals the inflammatory cascade
- It is what biological fracture healing is based on
A
- It should be removed to allow fracture fragments to contact one another
20
Q
Which of the following is not a function of autogenous cancellous bone grafts?
- Osseous structural support
- Osteogenesis
- Osteoinduction
- Osteoconduction
A
- Osseous structural support
21
Q
Regarding ligamentous injuries in dogs, which of the following statements is INCORRECT?
- In second degree sprain injury to the medial collateral ligament of the hock of a dog, stressed radiographs of the region will show no instability of the tibiotarsal joint
- A second degree sprain of the lateral collateral ligament of the carpus of a great dane may require surgical stabilisation with ligament repair
- Conservative treatment with rest, support dressing and antiinflammatories are indicated in a first degree sprain injury to the medial collateral ligament of the hock in a cat
- A third degree sprain injury to the hock of a racing greyhound has a poor prognosis for return to racing
A
- In second degree sprain injury to the medial collateral ligament of the hock of a dog, stressed radiographs of the region will show no instability of the tibiotarsal joint
22
Q
Regarding fracture of the metatarsal bones in dogs. Which of the following statements is INCORRECT?
- Fractures that affect large breed dogs or are significantly displaced may be best managed surgically
- A fracture of the base of the 5th metacarpal bone of the dog may cause collateral ligament instability
- Surgical stabilisation is always required if all 4 metatarsals are fractured
- Shaft fractures of the metatarsals can be treated with alignment & splinting
A
- Surgical stabilisation is always required if all 4 metatarsals are fractured
23
Q
Regarding carpal arthrodesis in a dog. Which of the following statements are INCORRECT?
- The carpus must be arthrodesed at a weight bearing angle of around 10 degrees
- Despite use of a bone plate a cast is usually applied to the limb for 6-8 weeks after surgery
- Removal of all articular cartilage & application of bone graft to the joint spaces is indicated
- The most common indication is carpal hyperflexion injury from falls
A
- The most common indication is carpal hyperflexion injury from falls
24
Q
Which of the following fracture repair methods cannot be made to provide inter-fragmentary compression?
- Plate & screws
- External skeletal fixator
- Pin & tension band
- Cerclage wire
- Lag screw
A
- External skeletal fixator
25
A 15kg 3 year old Kelpie has been in a motor vehicle accident & sustained a moderately displaced transverse fracture of the femoral diaphysis. You are developing a plan for stabilising this fracture. Considering the following stabilisation techniques, which would NOT be an appropriate method of fixation.
- Intramedullary pin & type 1 external fixator applied to the lateral surface of the femur
- Intramedullary pin & circumferential cerclage wire
- Intramedullary pin with supplemental plate fixation (plate / rod construct)
- Intramedullary locking nail
- Intramedullary pin & circumferential cerclage wire
26
You perform the Ortolani manouvre by abducting the leg & palpate a "klunk" which is diagnostic for hip dysplasia. This klunk is due to which of the following femoral head movements?
- Subluxation out of the acetabulum dorsally
- Subluxation out of the acetabulum ventrally
- Crepitus over the osteophytes
- Relocation into the acetabulum
- Relocation into the acetabulum
27
A 2 year old dog presents to you with a recent history of being hit by a car. The dog is non weight bearing in the right hind limb. He is painful in hip extention & stands with the limb externally rotated. Which is the most likely diagnosis?
- Craniodorsal hip luxation
- Aseptic necrosis of the femoral head
- Caudoventral hip luxation
- Femoral fracture
- Craniodorsal hip luxation
28
Which type of bandage should be used to protect the shoulder after reduction of a medial shoulder luxation?
- Ehmer sling
- Robert Jones bandage
- Velpau sling
- Carpal flexion bandage
- Velpau sling
29
You are presented with a 1-year-old maltese dog with intermittent hindlimb lameness with a skipping gait. Between episodes of non-weight bearing lameness he appears completely normal. What is your top differential diagnosis?
- Cranial cruciate ligament rupture
- Hip dysplasia
- Avascular necrosis of the femoral head
- Medial patella luxation
- Medial patella luxation
30
Regarding biopsy of a tumour which of the following is correct?
- Excisional biopsy is the preferred method as it gives a large sample of tissue including the margin to determine invasiveness
- A incisional biopsies are small they can be done with local anaesthesia & therefore do not require clipping or skin preparation in most cases
- Biopsy is indicated in almost every case except if the biopsy will not alter treatment or carries the same risk as the definitive surgery
- The biopsy wound does not need to be excised at the definitive surgery if it will compromise the wound closure
- Biopsy is indicated in almost every case except if the biopsy will not alter treatment or carries the same risk as the definitive surgery
31
Regarding surgical treatment of a soft tissue sarcoma on the lateral elbow of a dog, which statement is INCORRECT?
- Marginal resection & external beam radiation therapy might be an appropriate in certain circumstances
- Incisional biopsy is always indicated to determine the grade of the tumour prior to surgery
- Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread
- Wide excision with 3cm margins laterally & a deep fascial plane would be an adequate surgical plan
- Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread
32
Regarding traumatic wounds in cats which of the following statements are correct?
- Feline granulation tissue develops more quickly in cats compared to dogs so they are vulnerable to formation of indolent pocket wounds
- Enrofloxacin is the most appropriate antibiotic for a cat bite abscess as it is effective against the bacterial flora of the skin & oral cavity
- Feline granulation tissue develops more quickly compared to dogs but the processes of wound contraction & epithelialisation are slower
- Cat bite abscesses are best treated by drainage & lavage. Antibiotics are generally recommended.
- Cat bite abscesses are best treated by drainage & lavage. Antibiotics are generally recommended.
33
A 4-year-old cat sustained a large axillary skin defect secondary to a cat fight. Regarding axillary skin wounds in cats which of the following statements is INCORRECT?
- In this region, movement & skin tension may delay wound healing
- A suitable treatment option is to manage infection, close the wound & immobilise the area
- Granulation tissue in cats forms more rapidly & is more abundant compared to dogs
- In the region, loss of subcutaneous tissue as a result of trauma may delay healing
- Granulation tissue in cats forms more rapidly & is more abundant compared to dogs
34
Orthopaedic surgery - hyperextension / hyperflexability of the carpus. What are the treatments?
?
35
Orthopaedic surgery - Blood supply for bone healing.
?
36
Orthopaedic surgery - Strain, forces & bone healing.
?
37
Orthopaedic surgery - Shoulder with OCD what is the best treatment option & what is the prognosis?
Best treatment = Arthroscopy
Prognosis = ?
38
Orthopaedic surgery - Cat has a fracture, what do you use to fixate it? What are the contraindications of casting? Prognosis & stability of each treatment.
?
39
Orthopaedic surgery - Ligament stability for a joint; active & passive. i.e. biceps active vs passive = medial and cranial intra joint caudal ligament
What is its shape i.e. straight = cranial or y-shaped = caudal medial?
?
40
Oncology - Which is the most common chemotherapy used in general practice?
- Chlorambucil
- Cisplatin
- Vincristine
- Cyclophosphamide
?
41
Which chemotherapy is commonly used for cases of immune mediated thrombocytopaenia?
- Diagnose the thrombocytopaenia
- Then give immune suppressive steroid - Dog is lower dose than cats (>2mg is immunosuppressive dose in dogs, cats need
3-4mg/kg) BSA allometric scaling??
42
Boxer with a skin lesion. What is it likely to be?
Mast cell tumour
43
Doberman's & German Shepherds are predisposed to what condition & how do we confirm it?
- Thrombocytopaenia
- Confirm with buccal bleeding test
44
Neurology - how to localise a lesion?
?
45
Which is not a common sign of chocolate toxicity?
- Vomiting
- Tachycardia
- Abdominal discomfort
- Abdominal discomfort
46
Rat bait toxicity scenario.
?
47
Urinary surgery section - Cystic calculi treatment & diagnosis.
Diagnosis:
- Palpation - may sometimes feel the stones through abdomen if large enough
- Urinalysis - may reveal presence of crystals, blood or bacteria
- Radiographs - can detect stones especially those that are radiopaque e.g. calcium oxalate & struvite
- Contrast study - contrast cystography where dye is introduced into the bladder before taking xrays
- Ultrasound - can detect both radiopaque & radiolucent stones. Can detect smaller stones than xray
Treatment:
- Diet modification - prescription diets can help dissolve certain types of stones e.g. struvite stones by altering the pH of the urine & reducing the concentration of stone-causing minerals.
- Urinary acidifier or alkalalinizer medications
- Cystotomy = surgically removing stones from bladder
- Urohydropropulsion = non-surgical technique used to flush small stones out of the bladder by filling the bladder with fluid & then applying pressure to expel the stones through the urethra
48
Urinary surgery section - Transitional cell carcinoma of bladder. How to diagnose & next treatment plan steps?
Diagnosis
- Use blood panel i.e. Lymphocytes, neutrophils, epithelial cells
- Neoplastic cells - abnormal shapes, nuclei & size, high mitotic figures = abnormal (most likely cancer)
Treatment:
- Thoracic radiographs for mets first for any mast cell tumours & transitional cell carcinomas before any treatments commence
49
How to neurolocalise to the forebrain (Cerebrum) - i.e. what are the functions of the forebrain?
Behaviour:
- Distance exam - assess your patient's behaviour - changes can be due to a problem with the prefrontal cortex. E.g. dog is normally very friendly & then all of a sudden it becomes quite reserved / aggressive.
Vision:
- Absence of menace response - e.g. if there was a right forebrain issue (i.e. mass) you would get contralateral abscene of menace (absence of menace on left side)
Fine motor activity:
- Knuckling / paw placement test - left forelimb testing the knuckling goes to right forebrain - takes signal down & flips it to left side (if there is an issue with the forebrain the message might not get flipped to the opposite side)
Other clinical presentations of forebrain disease:
- Seizures
- Circling - towards side of lesion
- Head pressing
- Noxious nasal response (contralateral)
50
What are the functions of the cerebellum & hence possible signs of cerebellar disease?
Functions:
- Posture & equilibrium
- Muscle tone
- Fine movement coordination
Possible signs of cerebellar issues:
- Jerky / stiff movements
- Abnormal gait - hypermetric gait (overstepping) or over-reaching
- Trunk swaying
- Wide-based stance
- Intention tremor
- Menace deficit (ipsilateral)
51
Differentiate between peripheral & central vestibular disease.
Peripheral:
- Middle to inner ear
- Head tilt - towards lesion
- Ataxia - vestibular
- Nystagmus - fast phase AWAY from lesion
- CN dysfunction - VII facial paresis / paralysis
- No postural reaction deficits
Central:
- Lies in brainstem & cerebellum
- Head tilt - toward lesion (except paradoxical)
- Ataxia - vestibular +/- proprioceptive / cerebellar
- Nystagmus - fast phase away or toward lesion
- CN dysfunction - CN V-XII possible
- Postural reaction deficits - most reliable sign!
52
Differentiate between an upper motor neuron lesion & lower motor neuron lesion.
Upper motor neuron lesion (*Think upper = increased):
- Motor function - paresis or paralysis
- Reflexes - normal to increased
- Extensor muscle tone - normal to increased
- Muscle atrophy - mild / chronic
- Gait - long stride, "loppy"
Lower motor neuron lesion (*Think lower = less):
- Motor function - paresis or paralysis
- Reflexes - decreased to absent
- Extensor muscle tone - decreased to absent
- Muscle atrophy - severe / fast
- Gait - short / choppy
53
What 4 major questions should you ask yourself everytime with regard to neurological disease?
1. Is the animal neurological?
2. Where is the disease?
- Brain or spinal cord? C1-C5, C6-T2, T3-L3 or L4-caudal?
3. How severe is the problem?
4. What types of disease process might explain clinical signs?
- DAMNIT V
54
Where do seizures always localise to?
The forebrain
55
List & define the 4 phases of seizure activity.
1. Prodrome:
- Hours to days before
- Behaviour changes include: restlessness, clingy behaviour, vocalising, anxiety
2. Aura:
- Seconds to minutes before
- Hide, agitation or seeking behaviour
3. Ictus:
- The seizure itself
4. Post-ictal phase:
- Lasts minutes > days at times
- Prolonged seizures have longer post-ictal stage
- Blindness, disorientation, restlessness, ataxia, deafness
56
List & describe the two different types of seizure activity & what their clinical signs are.
1. Generalised seizures ("grand mal seizures"):
- Involves both cerebral hemispheres
- Clinical signs: tonic phase (sustained contraction of muscles, irregular breathing, urination, defecation, hypersalivation), clonic phase (paddling or rhythmic movement), loss of consciousness
2. Focal (partial) seizures:
- Involves only one region of the cerebral hemisphere
- 2 forms: simple focal seizures (conciousness preserved) vs. complex focal seizures (consciousness impaired)
- Clinical signs: any portion of body may seizure e.g. facial twitches, contraction of limbs
57
Define these important terms relating to seizures:
- Seizure
- Epilepsy
- Cluster seizures
- Status epilepticus
- Seizure = transient, unregulated, excessive depolarisation of a group of neurons within the brain
- Epilepsy = a patient with recurrent seizures
- Cluster seizures = 2 or more seizures in a 24hr period
- Status epilepticus = seizure activity lasting more than 5 mins
58
Differentials of seizures using "DAMNIT-V" depending on age & interictal period.
Young (<6 months):
- Metabolic - shunts, hypoglycaemia
- Anomalous - hydrocephalus
- Toxicity
- Infection
6mths - 6yrs:
- Idiopathic epilepsy (*most likely)
- Inflammatory brain disorders
- Metabolic & toxic
- Neoplasia
>6yrs:
- Neoplasia (*most likely)
- Inflammatory brain disorders
- Metabolic - insulinoma
Normal examination between seizures (inter-ictal period):
- Idiopathic epilepsy
- Some silent tumours
- Metabolic disease
Abnormal examination between seizures:
- Neoplasia
- Inflammatory brain disorders
- Anomalous
59
Describe the diagnostic work-up for seizures.
1. History
2. Physical & neurological exam
3. CBC, biochemistry & urinalysis to rule out extra-cranial disease:
- Fasting glucose
- Liver function test
4. Establish a pattern of frequency & severity
5. Advanced imaging (MRI) & CSF tap
60
How do you know when to recommend maintenance anti-epileptic drug (AED) treatment?
1. Inter-ictal period of <6 months (i.e. 2 or more epileptic seizures within a 6 month period)
2. Status epilepticus or cluster seizures
3. The post-ictal signs are considered especially severe (e.g. aggression or blindness) or last longer than 24 hours
4. The epileptic seizure frequency and/or duration is increasing and/or seizure severity is deteriorating over 3 inter-ictal periods
61
Discuss the different maintenance anti-epileptic drugs.
Phenobarbital:
- MOA = GABA agonist (+/- glutamate blocker)
- Half life: 2 weeks to steady state
- Excretion: 60% metabolised by liver, rest excreted unchanged via urine. Expect some level of increased liver enzymes (but not escalating too high too quickly > liver failure)
- Side effects: PU/PD, polyphagia, ataxia, lethargy / sedation, myelosuppression
- Dose - dogs: starting dose 2-5mg/kg PO q12hrs (loading dose 4mg/kg q4hr for a total of 4 doses to decrease the time to reach steady state)
- Dose - cats: 1.5-2.5mg/kg PO q12h (reaches steady state faster ~10 days)
Potassium Bromide:
- MOA = replaces Cl- providing excess anions & hyperpolarises neurons
- Half life: approx 2-3 months to reach steady state
- Excretion: via urine (renally) = good for patients with liver issues, not good for patients with renal issues. Increased excretion with high Cl- diets = not good.
- Side effects: Ataxia / lethargy / sedation, GI irritation / pancreatitis, falsely elevated Cl- levels
- DON'T USE BROMIDE IN CATS! Adverse side effects (fatal pneumonitis)
Imepitoin (Pexion):
- MOA = partial GABA agonist
- Half life: reaches steady state in 30h
- Excretion: primarly faecally excreted, well absorbed orally
- Questionable success in patients but lower side effects so good drug to use if client is worried about side effects with pheno
Levetiracetam (Keppra):
- MOA = binds to SVA2 glycoprotein +/- presynaptic Ca2+ channels
- Half life: steady state reached in 15-20h
- Excretion: 66% excreted in urine, rest hepatic
- Advantage = lower side effects, effective & well tolerated in cats
- Disadvantage = have to give 3 times a day > tricky for owner compliance
Zonisamide:
- Typically a 3rd line drug
- MOA: modulates GABA & glutamate neurotransmission & inhibits hypersynchronisation of neurons by blocking Na+ & Ca2+ channels
- Half life: reaches steady state in 3-4 days
- Excretion: hepatic metabolism + renal excretion
- Increased clearance with concurrent phenobarbital (have to increase dose)
- Tolerated well in cats, anecdotal evidence of efficacy
62
Emergency anti-epileptic drugs (AEDs).
- IV Midazolam or Diazepam to break seizure (don't give Diazepam to cats > acute hepatic failure)
- Propofol = a last resort
- Inhalant anaesthesia
63
Discuss hydrocephalus.
- Hydrocephalus = excess CSF has leaked into the dog's skull > brain swelling ("water on the brain"). Increased pressure in the skull will press on the brain tissues > brain damage.
- High incidence in toy & brachycephalic breeds.
Clinical signs (usually within first 6 months):
- "Setting sun sign" (eyes driven downwards)
- Seizures - not common
- Seizures, difficulty house training, abnormal vocalisation, abnormal behaviour, cognitive dysfunction, abnormal mentation, depression - coma
Treatment:
- Medical - prednisone, furosemide, acetazolamide, omeprazole (decrease CSF production)
- Surgical - shunting: successful outcome more likely in animals with minimal clinical signs. Shunts not proven more effective than medical management.
64
Discuss canine cognitive dysfunction.
- Mainly occurs in older dogs (8 yrs & older)
- Slowly progressive signs of behavioural change & dementia
- Senile plaques = accumulation of beta-amyloid protien - similar to Alzheimer's disease in humans
Treatment:
- L-deprenyl (Selegiline)
- Anxiety - gabapentin, fluoxetine, benzodiazepine
- Diet - anti-oxidants + faty acids +/- medium chain triglycerides (Hills b/d)
- Environmental enrichment
65
Discuss Chiari-Like Malformation.
- Congenital hypoplasia of supraoccipital bone > decreased caudal cranial fossa volume > herniation of cerebellum
- Heritable - Cavalier's particularly susceptible
Clinical signs:
- Pain most common sign (e.g. Cavalier's that randomly scream)
- +/- Cervical or cerebellovestibular dysfunction
- Phantom scratching
- Scoliosis
Diagnosis:
- Radiographs & MRI
Treatment:
- Medical: analgesia (e.g. gabapentin) to decrease phantom scratching, drugs to decrease CSF production (omeprazole, acetazolamide, furosemide)
- Surgical: foramen magnum decompression - success rate ~80%. Pain relieved but scratching persists (still require medication)
66
Discuss Discospondylitis.
- Discospondylitis= infection of the intervertebral disc & adjacent vertebral body endplates
- Young adult, male, medium to giant breeds - Great Danes overrepresented
- L7-S1 = most common site
Route of infection:
- Haematogenous - most common (usually from UTI)
- Foreign body - grass seed
- Iatrogenic
Diagnosis:
- Radiographs - irregular end plate lysis +/- extension into body > collapse of disc space & end plate sclerosis
- CT more sensitive
- Culture - urine, blood, aspiration of infected disc space (more sensitive)
Treatment:
- Antibiotics
67
Discuss acute idiopathic polyradiculoneuritis.
- Acute inflamamtion of nerve roots & peripheral nerves
- Unknown pathogenesis but suspected to be immune-mediated
Clinical signs:
- Stiff short-strided gait if ambulatory
- Can be recumbent
- Some dogs appear painful, some have respiratory issues
Diagnosis:
- History & clinical exam findings
- CSF
Treatment:
- Supportive care & physiotherapy
68
Discuss Myasthenia gravis.
2 types:
- Congenital - lack of Ach receptors
- Acquired - Ach receptor dysfunction
Clinical signs:
- Episodic muscle weakness that worsens with exercise, resolves with rest
- Concurrent megaoesophagus > aspiration pneumonia
- Facial, laryngeal or pharyngeal weakness
- Occurs in animals aged 7 weeks - 15 years
Diagnosis:
- Clinical signs
- Ach receptor antibody test
- Tensilon / neostigmine response
Treatment:
- Neostigmine / pyridostigmine
69
Discuss Intervertebral Disc Disease.
2 types:
- Type 1 (Extrusion) - chondroid metaplasia > decreased glycosaminoglycans & loss of water binding capacity in nucleus pulposus. Typically affects dogs >2 years & small dogs e.g. Daschunds.
- Type 2 (Protrusion) - fibroid metaplasia > progressive thickening of the annulus fibrosis. Typically affects dogs >2 years, medium to large breed dogs.
Diagnosis:
- Radiographs - narrowing of IVD space, increased opacity within intervertebral foramen, mineralised disc material within vertebral canal
- CT - hyperdense material within intervertebral foramen
- MRI - more accurate at site of compression & differentiating between extrusion & protrusion
Treatment:
- Goals - patient is comfortable, able to ambulate, able to urinate
- Medical management - strict crate rest 6-8 wks, pain management (Gabapentin, NSAIDs), physical therapy, bladder & urinary management
- Surgical management - Hemilaminectomy (TL disc herniation) or ventral slot (cervical disc herniation). Post-op care - crate rest, pain management, bladder management
70
What is the DAMNIT-V acronym when related to toxicity / snake bite?
D = Degenerative, developmental e.g. generative myopathy
A = Anatomical, autoimmune, allergic e.g. polyradiculoneuritis, polymyositis, myasthenia gravis
M = Metabolic, mechanical e.g. HypoA, DM, hypoK+, hypoca++
N = Neoplastic, nutritional e.g. paraneoplastic
I = Infectious, inflammatory, idiopathic e.g. neospora, toxoplasma
T = Toxin, trauma e.g. lead toxicity, ionophore toxicity, OP & carbamate toxicity (Cephalosporin e.g. Amoxyclav)
V = Vascular
71
What are some common clinical signs of LMN disease associated with flaccid paralysis (toxicity / poisoning)?
Presence of LMN signs in 2 or more limbs:
- Skeletal muscle weakness displayed as gait abnormalities / paresis
- Lethargy
- Decreased muscle tone
- Dysphonia and/or dysphagia
- However LMN affected pets typically maintain normal mentation, proprioception, nociception & spinal reflexes
72
How to diagnose LMN disease (flaccid paralysis / poisoning)?
Initial:
- Complete Blood Count (CBC)
- Biochemistry panel
- Urinalysis
- Coagulation check (PT / APTT / ACT)
- Clip, tick search, tick treatment
Others:
- Anti-venom kits
- MRI
- CSF sampling
- Muscle biopsies
- Chest rads, cancer search
73
Discuss the different types of toxins involved in snake envenomation.
Types of toxins:
- Neurotoxins - e.g. tiger, brown, copperhead, black, death adder, taipan. Act at neuromuscular junctions causing ascending lower motor neuron paralysis. Pre-synaptic toxin: alters the structure of the axolemma membrane inhibiting ACh release from the presynaptic nerve terminals (rapid & sufficient anti-venom is needed to prevent this). Post-synaptic toxin: blocks ACh receptors (can be reversed with anti-venom).
- Coagulotoxins - e.g. tiger, brown, taipan, black / death adder. Snake toxins are more commonly pro-coagulant than they are anti-coagulant. Widespread clot formation can develop rapidly with pro-coagulant toxins known as venom-induced consumptive coagulopathy (VICC).
- Myotoxins - e.g. tiger, black, copperhead, taipan. Cause muscle cell lysis. Always treat myolysins with anti-venom even if presentation is delayed as the toxin will continue to cause muscle damage until neutralised with anti-venom.
- Haemolysins - e.g. tiger, black, copperhead.
- Cytotoxins - e.g. whip, black.
74
Discuss snake envenomation - diagnosis, clinical signs, clinical pathology & prognosis.
To ID the snake or not?
- Historically there has been a strong focus on identifying the snake so a monoclonal anti-venom can be used. The risks of this are too great.
- Local knowledge (i.e. which snakes live in which areas) & biochemical parameters are safer & should be used.
- Actively discourage owners from bringing in the snake & never rely on their ID unless they are a registered snake handler
Diagnosis:
- Location - are you in an area where snake bite is likely?
- If there are signs of LMN disease then assume snake envenomation until proven otherwise
- Coags (APTT & PT) - most sensitive (will be prolonged within 30 mins of envenomation, APTT will rise first)
- CK - can take up to 8 hours
- Snake venom detection kits - can take a while to run & costly (about 2/3rds cost of vial of anti-venom so may as well just give the anti-venom)
- Urinalysis in dogs (cats need serum) - myoglobinuria, haemoglobinuria, haematuria, glucosuria, proteinuria, casts. Urine sample is most sensitive (usually appears & is diagnostic before the coagulopathies)
Clinical signs:
- Can be biphasic
- Initially trembling, tachypnoea, salivation, vomiting, urination, defecation, collapse after which the animal may appear to recover & walk through the door looking 100% normal
- Rapid progressive weakness & ascending LMN paresis: reduced / absent gag, ataxia, HL flaccid paresis / paralysis progressing to FL flaccid paresis / paralysis, reduced palpebral reflex, mydriasis, dyspnoea (open mouth breathing), cyanosis
75
Discuss tick paralysis - pathophysiology, history, clinical signs, diagnosis & prognosis.
Pathophysiology:
- Holocyclotoxins act at the level of the neuromuscular junction & inhibit ACh release, they can also cause a reduction in myocardial contractility > pulmonary oedema.
- Laryngeal dysfunction & megaoesophagus > aspiration of pooled saliva & pneumonitis / pneumonia.
- Death is through a combination of resp failure (primary resp muscle fatigue / paralysis, laryngeal paralysis or secondary pneumonia) & occasionally electrical failure of the heart.
History:
- Recent interstate travel (ticks found in northern Vic, NSW & QLD).
- Progressive ascending paralysis over 1-3 days
Clinical signs:
- Weakness in hindlimbs progressing to forelimbs
- Unilateral lameness
- Ataxia
- Resp difficulties
- Changes to phonation / vocalisation
- Vomiting / regurgitation
Diagnosis:
- Presence of a paralysis tick located on or removed from an animal showing appropriate clinical signs is pathognomonic.
Prognosis:
- Excellent prognosis with early presentation, anti-serum administration, no complications (aspiration or ventilator associated pneumonia) & no cost restrictions.
76
Discuss polyradiculoneuritis - pathophysiology, history, clinical signs, treatment & prognosis.
- Most frequently identified acute generalised peripheral neuropathy in dogs worldwide.
Pathophysiology:
- Believed to be an immune-mediated disorder affecting the ventral spinal nerve roots
History:
- Overseas - raccoon exposure 7-10 days prior
- Raw meat (Campylobacter) - e.g. chicken necks
- Vaccination or drugs
Clinical signs:
- Initally develop in the pelvic limbs with a rapid ascending progression to involve the thoracic limbs
- Develops over 1-7 days (slower than snake & tick)
- Neurologic exam may reveal flaccid tetraparesis or tetraplegia, decreased to absent withdrawal
Treatment & prognosis:
- Supportive therapy only at this time - steroids will worsen the weakness
- Prognosis is good to excellent but disease course is long (most dogs take 4-12 wks to recover)
77
Discuss treatment strategies for LMN (flaccid paralysis / poisoning) patients.
(STEP 1) Respiratory unstable patient:
- Provide resp support - O2 fly-by, nasal prongs, O2 box etc.
- Give anxiolytic - Butorphanol IM/IV
- If the animal is failing to tolerate oxygenation & visible deterioration is being seen then the animal needs to be intubated
(STEP 2) Respiratory stable patient:
- Triage examination
- Full neurologic asessment
- Gait score (1 = mild ataxia / paresis, 2 = able to stand / sit but cannot walk, 3 = unable to stand but can maintain sternal recumbency, 4 = unable to maintain sternal recumbency)
- Resp score
STEP 3:
- Place IV cath & collect triage blood samples (PCV / TS, electrolytes, lactate, acid-base, glucose coagulation), internal CBC & biochem + lab CBC & biochem panels
- Avoid the jugular until coagulopathy is ruled out (can cause brain blood flow issues)
STEP 4:
- Collect urine
STEP 5:
- Once triage blood work & in-house biochem results are back you should be in a position to speak to owners.
STEP 6:
- Immobilise - this refers to immobilising the patient if they are showing excitation. Tick patients are at risk of cardiac arrest if excited & snake patients can worsen their condition as the venom will be mobilised faster.
STEP 7:
- Start IVFT
STEP 8:
- Anti-venom - generally give 2x vials of multi Tiger Brown. An animal that is not neurologically stabilising with antivenom requires more antivenom. Give 1 vial every 30 mins until neurologically stable.
STEP 9:
- Nursing care (the most important aspect) - standard recumbency care
STEP 10:
- Monitoring
78
Discuss how to manage a rat bait (anti-coagulant rodenticide) toxicity case.
- Brodifacoum = most common 2nd gen rat bait:
- Clinical signs frequently respiratory but can be inappropriate bleeding from anywhere - cavitary bleeding or melena most common.
- Here in Adl we have some of the 3rd gen anti-coagulants due to the ongoing mouse plague. Presentations are more severe: collapsed animals (particularly cats) who have eaten the dead / affected rat. Present laterally recumbent, profoundly anaemia & need transfusion therapies to survive.
Diagnosis:
- PT elevates before aPTT. Clinical signs can only occur if aPTT is elevated.
- Testing PT at 48-72 hrs is a common way of determining if Vit K therapy is required.
- If aPTT is delayed, definitive treatment is required (plasma transfusion + Vit K therapy)
Treatment:
- Needs chest drained & needs transfusion
- Needs Vit K therapy - Koagulon SQ or oral
- +/- Additional plasma if clotting times increase / fail to normalise after the whole blood transfusion
- Emesis? No - probably not worth the risk
- GI lavage? Could consider after transfusion depending on amount believed to have eaten (may save additional plasma transfusions)
- Activated charcoal? Yes - as not able to primary decontaminate (Use a Sorbitol dose in first treatment)
- Monitoring PT / aPTT q6 hrly while hospitalised
- Once coags are normal discharge home & then recheck not required until 48 hrs after end of treatment course.
79
Discuss iron-based rodenticide toxicity.
Pathogenesis:
- In animals with large acute exposure, the ability of enterocytes to sequester the absorbed iron to ferritin is overwhelmed, allowing non-bound iron to damage the cells & enter the systemic circulation. Here it is bound to transferring until that buffering system becomes saturated too. At this point there is free iron in the systemic circulation, available to cause cellular damage.
Clinical signs:
- STAGE 1 (0-6 hrs post ingestion) - obtundation, abdominal pain, GI upset with possible vomiting and/or diarrhoea that may be haemorrhagic. Greatest mucosal damage occurs on empty stomach.
- STAGE 2 (6-24 hrs) - apparent recovery of the patient (the latent period) with GI signs subsiding & patient becoming more alert.
- STAGE 3 (12-96hrs) - lethargy, recurrence of GI signs, metabolic acidosis, cardiovascular collapse, coagulation deficits, hepatic necrosis, liver failure, acute kidney injury, CNS signs (seizures, comas) & possible death.
- STAGE 4 (2-6 wks) - if animal survives may develop GI strictures due to fibrosis & scarring.
Diagnosis:
- Baseline PCV / TS, blood gases, electrolyte & blood glucose (CBC & biochem if >60mg/kg)
- Blood iron levels
- Take radiographs (iron will show up in most cases & often will adhere to gastric mucosa, gastrotomy may be needed to remove)
Treatment & management:
- Early GIT decontamination - emesis if able, GA lavage & enema if not
- Activated charcoal will not bind the iron!
- If >60umo/l ingested should receive GIT protectants (PPIs & sucralfate) due to direct mucosal damage
- Anti-emetics may be needed
80
Discuss secondary (indirect) bone healing.
- Secondary bone healing occurs when bone is not absolutely rigidly stabilised. So there is a degree of an unstable mechanical environment. E.g. casts, external fixators. It is how bone heals in nature without human intervention. A fracture callus will ALWAYS form.
Stages of secondary bone healing...
Soft callus (soft tissue density on radiograph):
1. Haematoma
2. Granulation tissue
3. Fibrous tissue
4. Fibrocartilage
Hard callus (mineralisation on radiograph):
5. Mineralisation of fibrocartilage via endochondral ossification
6. Formation of fibrous (woven) bone
7. Haversian remodelling of fibrous bone into lamellar bone (cortical). Collagen organised into sheets (lamellae), mechanically strong but takes months to year to be complete.
- As the callus progresses through the different stages it becomes progressively stiffer. Correspondingly the fracture ends become progressively more stable.
- The larger a callus becomes the more stable the fracture becomes.
- Generally the large the callus the more unstable the fracture was, provided a good blood supply is present
- A fracture is clinically healed once woven bone bridges the fracture ends circumferentially
81
Discuss primary (direct) bone healing.
- Will only occur if strain is <2% (rigid stability) & fracture gap is <1mm
- No fracture callus forms
- In clinical practice can only be achieved with interfragmentary compression plating
- 2 types (which can occur at the same time in a fracture): contact primary bone healing & gap primary bone healing
Contact primary bone healing:
- Requires zero gap (i.e. direct contact of fracture ends & rigid stability)
- Haversian remodelling occurs across the fractured surfaces, slowly bridging the fracture with longitudinally oriented osteons
- Takes longer than other types of bone healing
Gap primary bone healing:
- Gap must be <1mm & rigid stability (strain <2%)
- First the gap is filled with transversely oriented lamellar bone
- By 3 weeks Haversian remodelling starts to occur resorbing previous lamellar bone & laying down new lamellar bone oriented longitudinally
82
Define delayed union, non-union & malunion in bone healing.
Delayed union:
- Where bone healing is continuing but at a less than ideal rate
- If no bridging callus has formed by 12 weeks (if indirect healing is expected) it is classified as delayed union.
- As an animal ages it takes longer for bone healing to occur so indirect (secondary) bone healing is actually quicker than direct (primary) bone healing.
Non unions:
- Where bone healing is not occurring or cannot occur
- If on serial radiographs there is cessation of hard callus formation & a radiolucent line is visible at the fracture site. The fracture ends are unlikely to unite without surgical intervention.
- Local factors / causes - instability, poor biology at fracture site, open fracture or osteomyelitis, large fracture gap (2x bone diameter)
- Systemic factors / causes - old age, concurrent disease, poor nutrition, delayed return to function, unrestricted exercise
- Viable (vascular) non-unions = still have a blood supply & variable callus formation, generally instability is preventing bone union.
- Non-viable (avascular) non-unions = have poor or no blood supply, this is why they have no callus. Fracture gap has filled with fibrous +/- cartilaginous tissue only. More difficult to achieve union than viable (vascular) non-unions! Treatment = debridement of necrotic tissue & bone, open up medullary canal at fracture, rigid fixation, cancellous bone grafting.
Malunion:
- Bone union is complete but proper establishment of the normal mechanical axis & normal function has not been achieved.
- Dogs can compensate if length & joint orientation is maintained (i.e. condyles not rotated)
- If the dog cannot compensate (i.e. there is rotation) then need to re-break bone with bone saw so it's straight & then plate it.
- This is a common complication of casting
83
Discuss open fractures & their treatment / management.
- Open fracture = a fractured bone that has come in contact with the outside enviro
- Open fractures are 2x more likely than closed fractures to develop delayed union & 4x more likely to develop a non-union
Grades of open fractures:
- 1 = small puncture <1cmin the region of fracture. Bone can retract. Mild contamination.
- 2 = larger lacerations >1cm with moderate soft tissue trauma e.g. bite wounds. Moderate contamination.
- 3 = extensive soft tissue / vascular trauma with significant loss of tissue & exposed bones. E.g. gun shot or shearing injuries with insufficient skin to cover wound. Major contamination.
Immediate treatment:
- Cover wound with a quick sterile dressing to prevent further contamination
- Place support bandage
- Start IV antibiotics e.g. 1st gen cephalosporin +/- metronidazole (if bite wound) for 3-5 days
For grade 2 & 3 once stable for anaesthesia:
- Clean & debride wound aseptically
- Remove foreign material & devitalised tissue to convert into clean wound
- Be conservative with removing bone & preserve any soft tissue attachment to bone
- Lavage copiously 1-2L saline +/- chlorhex
- Some grade 3 need open wound management for several days prior to fracture stabilisation
- Culture bone ends
Open fracture stabilisation:
- Rigid stability required so IM pin, orthopaedic wire & casts are contraindicated (won't provide the stability you need)
- External skeletal fixator method of choice in grade 2 & 3 fractures
84
Discuss the different types of fracture healing assessment scores.
Average / overall score:
- Each factor that affects bone healing is given a score of 1-10 then all scores are averaged.
- The higher the score the better the prognosis i.e. healing occurs more rapidly so can use fixation method which is less rigid.
Fracture assessment - mechanical:
- Determines the stregth of the implant necessary
- Low (poor) score = implant immediately takes all limb load
- High (excellent) score = bone takes partial load bearing
Fracture assessment - biologic:
- Determines time implant must be functional i.e. time to bone union
85
1. Which of the following statements regarding canine mammary neoplasia is correct
a. The most common tumour type is sarcoma
b. After two oestrus cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing
c. More than 90% of mammary tumours are malignant
d. The most appropriate surgical treatment is unilateral mastectomy if the tumour is confined to one side
b. After two oestrus cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing
86
A 4 year old cat is presented for acute onset tetraparesis after being seen playing with a brown coloured snake. A snake venom detection test and coagulation test result are compatible with brown snake envenomation. To reduce the chance of a systemic adverse reaction, what should the cat be medicated with before/during infusing a vial or brown snake antivenom.
a. Low dose adrenaline only
b. Anti-histamine and corticosteroids together
c. Corticosteroid only
d. None of the above
d. None of the above
87
Consider the patients below and their signalments. Which patient would be at the highest risk of an adverse systemic reaction whilst receiving tick paralysis anti-serum?
a. A 5 year old cat that has received tick anti-serum only once before
b. A 13 year old cat that has received a blood transfusion
c. A 6 month old dog that is naïve to all transfusions
d. A 16 year old dog with severe chronic kidney disease
a. A 5 year old cat that has received tick anti-serum only once before
88
6. When using the gait and respiratory scoring system for tick paralysis in a dog or cat, which of the following factors is not associated with a worse prognosis?
a. Low respiratory score on presentation
b. High gait score on presentation
c. Old age
d. Rapid worsening of clinical signs
a. Low respiratory score on presentation
89
What is not a common sign of chocolate toxicity?
a. Vomiting
b. Tachycardia
c. Abdominal discomfort
c. Abdominal discomfort
90
A dog is presented with a 1cm diameter raised pink hairless dermo-epidermal mass on the lateral left tarsus, diagnosed by fine needle aspirate as a mast cell tumour. What clinical staging examinations are advisable?
a. Bone marrow evaluation, thoracic radiographs, and abdominal ultrasound
b. Prescapular lymph node palpation, thoracic radiographs, and bone marrow cytology
c. Popliteal lymph node palpation and cytology, abdominal ultrasound examination
d. Abdominal and thoracic radiographs, buffy coat and bone marrow evaluation
c. Popliteal lymph node palpation and cytology, abdominal ultrasound examination
91
A 9 year old male cattle dog is presented for a 2cm diameter raised pink epidermal mass with a partly ulcerated surface, located in the perianal tissue just to the right of the dorsal anus. The mass is suspected to be a perianal adenoma. Select from the options below the most appropriate diagnostic test and recommended therapy.
a. Fine needle aspiration for diagnosis, treat with wide margin surgical resection
b. Fine needle aspiration for diagnosis, treat with piroxicam
c. Incisional biopsy for diagnoses, treat initially with castration
d. Incisional biopsy for diagnosis, treat with piroxicam
c. Incisional biopsy for diagnoses, treat initially with castration
92
A 3 year old black labrador is presented for a rapidly growing solitary hairless nodule on the lateral surdace of its 4th toe on the right front limb. Evaluation of cytology from a fine needle aspirate of the nodule identifies a round cell tumour. Which of the following diagnoses does this rule out?
a. Mast cell tumour
b. Transmissible venereal tumour
c. Plasma cell tumour
d. Squamous cell carcinoma
d. Squamous cell carcinoma
93
A 12 year old female spayed Doberman had a soft tissue sarcoma resection 9 months ago. Since surgery she has been treated with low dose cyclophosphamide and firocoxib to inhibit local tumour regrowth. She has had a stranguria for the last week and a free catch urine sample shows haematuria on a urine dipstick analysis. What are the two most likely causes of these abnormalities?
a. Von Willebrand’s disease, cyclophosphamide induced sterile haemorrhagic cystitis
b. Bacteria cystitis, firocoxib toxicity
c. Firocoxib toxicity, Von Willebrand’s disease
d. Cyclophosphamide induced sterile haemorrhagic cystitis, bacterial cystitis
d. Cyclophosphamide induced sterile haemorrhagic cystitis, bacterial cystitis
94
A 6 year old Doberman Pinscher with asymptomatic early dilated cardiomyopathy undergoes forelimb amputation for osteosarcoma. Which of the following drugs would be contraindicated for adjuvant chemotherapy following amputation?
a. Zoledronate
b. Cisplatin
c. Carboplatin
d. Doxorubicin
d. Doxorubicin
Doxorubicin is known to have cardiotoxic effects, which can exacerbate existing heart conditions like dilated cardiomyopathy. Therefore, using doxorubicin in a patient with this condition could lead to worsening cardiac function or heart failure
95
Which of the following states is true about the treatment of nasal lymphosarcoma in cats?
a. Short term prognosis following either chemo or radiation is very poor
b. There is an excellent long term prognosis with most cats cured
c. There is a good medium to long term prognosis with chemo or radiation therapy
d. There is a good medium to long term prognosis without therapy
c. There is a good medium to long term prognosis with chemo or radiation therapy
96
A cat is diagnosed with a low grade alimentary lymphosarcoma, and is treated with chemotherapy. What cytotoxic drug is commonly used in general practice to treat this malignancy?
a. Cyclophosphamide
b. Vincristine
c. Chlorambucil
d. Cisplatin
c. Chlorambucil
Chlorambucil is often combined with prednisone and is the drug of choice for treating low-grade (indolent) lymphomas, such as low-grade alimentary lymphosarcoma in cats. It is well-tolerated and effective in managing this type of malignancy.
97
A dog is undergoing cytotoxic chemotherapy treatment for lymphosarcoma. The dog originally presented with generalised superficial lymphadenomegaly and splenomegaly, and the diagnosis was based on histopathology of an enlarged lymph node. Within a couple of weeks of starting treatment, the dog has achieved complete clinical remission. What does complete clinical remission mean?
a. The dog is cured from lymphosarcoma, providing the course of chemotherapy is completed
b. The dogs lymph nodes and spleen are normal size, but microscopic disease is likely still present
c. The dogs lymph nodes have returned to normal size, but the spleen is still enlarged
d. Abnormal lymphocytes will no longer be found on the blood smear or in the lymph nodes
b. The dogs lymph nodes and spleen are normal size, but microscopic disease is likely still present
98
A dog is presented with polydipsia, polyuria and mild inappetence. Initial laboratory investigation shows mildly increased total serum calcium. Outline the approach to determining whether this abnormality is significant. What pathologic process is he single most likely cause of hypercalcaemia in dogs.
- Recheck total calcium. If still high then check ionised calcium, if normal no further investigation is needed.
- Hypercalcaemia of malignancy (neoplasia).
99
A 10 year old cat is presented because of 2 weeks inappetence. On physical examination, the only significant abnormality is a palpably enlarged spleen and slight dehydration based on skin tent Haematology and serum biochemistry are unremarkable apart from slightly elevated urea and ruine specific gravity of 1.045. What is the best interpretation of the cats problems? What is the next most logical investigation to obtain a diagnosis?
- Mild azotaemia (likely pre-renal), inappetence may be related to the splenomegaly
- Fine needle aspiration of spleen is the next most logical step.
100
A cat is suspected to have low grade alimentary lymphosarcoma.
What is the main condition it must be differentiated from?
What is the best diagnostic test to reach a firm diagnosis?
Assuming the diagnosis is confirmed to be low grade alimentary lymphosarcoma, what is the standard treatment and what is the prognosis for the cat?
- Inflammatory bowel disease
- Tissue biopsy of the affected intestine with histopathology
- Standard treatment is chemotherapy (chlorambucil), prognosis is good for medium to longer term survival
101
List 2 toxins found in Australian brown snake venom. Briefly describe the mechanism of action of each toxin you have listed.
- Neurotoxin, myotoxin, procoagulant, anticoagulant, haemolysin
- Neurotoxin: inhibits release of presynaptic acetylcholine from the neuromuscular junction causing flaccid paralysis
- Myotoxin: binds to skeletal muscle fibres causing progressive destruction of the muscle cells. Procoagulants are prothrombin activators causing massive consumption of fibrinogen and a coagulopathy.
- Anticoagulants inhibit coagulation proteins causing a coagulopathy and haemolysins cause acute destruction of RBC’s caysing anaemia and haemoglobinuria.
102
A 7 year old male entire Labradoodle presents with one day history of stranguria and haematuria. List four differential diagnoses for this dog & describe you diagnostic approach to this case.
- Urolithiasis, UTI, neoplasia, reflex dyssnergia, benign prostatic hyperplasia, paraprostatic cyst, prostatitis, toxins
Describe your diagnostic approach to this case:
- Full physical examination with digital rectal examination
- Full blood test, urinalysis with urine culture and sensitivity (cystocentesis sample)
- Abdominal radiographs to assess urinary tract and rule out urethral obstruction
- Abdominal ultrasound to rule out neoplasia and examine the prostate
103
Which of the following is not a cause of polyuria?
a. Increased ADH secretion
b. Reduced medullary toxicity
c. Osmotic diuresis
d. Structural renal disease
a. Increased ADH secretion
104
A 14 year old female spayed DSH cat presents to your with chronic kidney disease. On presentation her serum creatinine measures 300umol/L, she is treated with intravenous fluid therapy for 24 hours and her creatinine measures 200umol/L once she has been rehydrated. Her urine protein creatinine ratio is 0.1 and her systolic blood pressure is 140mmHg/ According to the IRIS guidelines for staging of chronic kidney disease in cats she is:
a. Stage 2, substage non-proteinuric and normotensive
b. Stage 3: substage non-proteinuric and normotensive
c. Stage 2: substage proteinuric and normotensive
d. Stage 2: substage non-proteinuric and hypertensive
a. Stage 2, substage non-proteinuric and normotensive
Stage 2 CKD: Serum creatinine between 140-250 µmol/L in cats. However, because this cat's creatinine level decreased to 200 µmol/L after rehydration, it falls into Stage 2.
Non-proteinuric: Urine protein creatinine ratio (UPC) < 0.2 (0.1 in this case).
Normotensive: Systolic blood pressure < 150 mmHg (140 mmHg in this case).
105
Which of the following is not a common cause of feline lower urinary tract disease?
a. Bacterial infection
b. Idiopathic
c. Urethral plugs ? not sure
d. Uroliths
c. Urethral plugs ? not sure
105
Which of the following statements regarding SDMA is NOT correct?
a. SDMA levels start to increase when there is a 75% loss of kidney function
b. SDMA is not impacted by lean muscle mass
c. SDMA is an earlier marker of renal dysfunction than creatinine
d. SDMA is a newly identified renal function marker
a. SDMA levels start to increase when there is a 75% loss of kidney function
This statement is incorrect because SDMA levels start to increase with only about 25-40% loss of kidney function, making it a more sensitive and earlier marker of renal dysfunction compared to creatinine, which usually increases when there is a 75% loss of kidney function. The other statements about SDMA are correct
106
In a dog, which of the following can be used to definitively confirm the bladder has not ruptured or is leaking?
a. The potassium level in the abdominal fluid is the same as the level in the serum
b. The bladder is palpable
c. The animal is able to urinate normally
d. There is not abdominal effusion on abdominal radiographs
e. Any of the above
f. None of the above
f. None of the above
None of the listed options can definitively confirm that the bladder has not ruptured or is leaking. To definitively confirm the integrity of the bladder, a contrast study, such as a positive-contrast cystography, is typically required. This involves introducing a contrast agent into the bladder and taking radiographs to visualize any leakage of contrast material into the abdominal cavity, which would indicate a rupture or leak
107
A 20kg male neutered kelpie presents to you with a complete urethral obstruction. On radiographs you see three radiopaque uroliths lodges at the base of the os penis and several more in a distended bladder. What is the most appropriate initial treatment?
a. Evaluate the dogs medical status and stabilise the dog before attempting to relieve the urethral obstruction
b. Under anaesthesia try to retropulse the uroliths into the bladder to immediately remove the obstruction
c. Perform a urethrostomy to remove the uroliths, as retropulsion rarely relives the obstruction
d. Obtain a urine sample for analysis and use medical dissolution
a. Evaluate the dogs medical status and stabilise the dog before attempting to relieve the urethral obstruction
108
The same dog presents to you 1 year later with another urethral obstruction at the same location. You decide to perform a permanent urethrostomy. At what location is it best to perform this?
a. Prescrotal
b. Scrotal
c. Perineal
d. Prepubic
b. Scrotal
The scrotal location is preferred for a permanent urethrostomy because the urethra is wider and more superficial in this area, making it easier to access and less prone to complications compared to other locations. Additionally, there is less surrounding tissue that could contribute to post-operative complications.
109
Your practice receives an urgent phone call about Jack, a Kelpie and valuable working dog. He jumped out of the ute going 80km/h. Mr Jones said he was initially able to walk on three legs but is now collapsed with blue mucous membranes.
List the immediate steps you should take when Jack is presented.
- Stabilization: IV access, continual monitoring
- Bloodwork: CBC, biochem, electrolytes, coagulation profiles
- Oxygen
- Fluids
- Analgesia / sedation
- Radiographs
- AFAST / TFAST ultrasound
110
A malignant carcinoma was diagnosed via biopsy from the 2nd digit of the right hindleg. Choose the correct statement regarding the --- lymph node on the same leg.
a. The lymph node may be the sentinel lymph node for this tumour and should be evaluated by palpation and biopsy
b. Routine removal of the lymph node is indicated as part of the tumour treatment
c. If there is no evidence of tumour cells in a fine needle aspirate of the node then the tumour has not spread to that location
d. If there is no evidence of lymph node enlargement then cytologic assessment of the lymph node is not required
a. The lymph node may be the sentinel lymph node for this tumour and should be evaluated by palpation and biopsy
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Regarding surgical treatment of a soft tissue sarcoma on the lateral elbow of a dog which statement is incorrect?
a. Incisional biopsy is always indicated to determine the grade of the tumour prior to surgery
b. Marginal resection and external beam radiation therapy might be appropriate in certain circumstances
c. Wide excision with 3cm margins laterally and a deep fascial plane would be an adequate surgical plan
d. Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread
d. Low grade tumours can be shelled out as they have a pseudocapsule that prevents tumour spread
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Regarding bone tumours in dogs which of the following statements are incorrect?
a. The recommended treatment of osteosarcoma is limb amputation followed by chemotherapy
b. Bone biopsy may be performed using a Jamshidi needle prior to definitive treatment to exclude osteomyelitis
c. The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment
d. The most common sites of tumour metastasis of bone tumours are the lungs, regional lymph node, and other bones
c. The prognosis for osteosarcoma is grave with survival times around 4-6 months even with aggressive treatment
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Regarding haemangiosarcoma in dogs which of the following statements is correct?
a. The prognosis is generally good for splenic haemangiosarcoma after surgery and most dogs have a median survival time of >12 month with optimal treatment
b. Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy
c. Adequate staging for splenic haemangiosarcoma should include incisional biopsy to exclude benign lesions prior to definitive surgery, thoracic radiographs, and ultrasound of the heart and abdomen
d. The biologic behaviour and prognosis of dermal, subcutaneous and visceral haemangiosarcoma is similar
b. Surgery for splenic haemangiosarcoma should include splenectomy ideally followed by adjuvant chemotherapy
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Regarding wound healing which of the following is most correct?
a. Second intention healing is characterised by formation of granulation tissue, wound contraction and epithelialisation
b. Secondary intention healing is characterised by formation of granulation tissue, wound contraction and epithelialisation
c. Secondary closure is wound closure after a period of open wound management but before granulation tissue forms
d. Delayed primary closure is closure of the wound with sutures after granulation tissue has formed
b. Secondary intention healing is characterised by formation of granulation tissue, wound contraction and epithelialisation
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Regarding traumatic wounds in cats, which of the following statements are correct?
a. Enrofloxacin is the most appropriate for a cat bite abscess as its effective against the bacterial flora of the skin and oral cavity
b. Cat bite abscesses are best treated by drainage and lavage, antibiotics are generally recommended
c. Feline granulation tissue develops more quickly in cats compared to dogs so the are vulnerable to formation of indolent pocket wounds
d. Feline granulations tissue develops more quickly compared to dogs but the process of wound contraction and epithelialisation are slower
b. Cat bite abscesses are best treated by drainage and lavage, antibiotics are generally recommended
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A 4 year old cat sustained a large axillary skin defect secondary to a cat fight. Regarding axillary skin wounds in cats which of the following statements is correct?
a. Granulation tissue in cats forms more rapidly and is more abundant compared to dogs
b. In this region, movement and skin tension may delay wound healing
c. In the region, loss of subcutaneous tissue as a result of trauma may delay healing
d. A suitable treatment option is to manage infection, close the wound and immobilise the area
a. Granulation tissue in cats forms more rapidly and is more abundant compared to dogs
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Which of the following statements regarding mammary neoplasia is most correct?
a. Surgical lumpectomy is an appropriate treatment for a small solitary mas in a single gland in the dog and cat
b. Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat
c. Surgical lumpectomy is an appropriate surgical treatment for a small solitary mass in the cat but not the dog
d. Surgical lumpectomy is never an appropriate treatment for a small solitary mass affecting a single gland in the dog or cat
b. Surgical lumpectomy is an appropriate treatment for a small solitary mass affecting a single gland in the dog but not the cat
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Signs that might be observed during a cushings reflex due to increased intracranial pressure:
Hypertension: Elevated blood pressure as the body attempts to maintain cerebral perfusion despite the increased ICP.
Bradycardia: A slow heart rate, which occurs as a compensatory response to the hypertension.
Irregular respiration: Abnormal or irregular breathing patterns due to pressure on the brainstem, which controls respiratory function.
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Below are radiographs of a 3 year old male golden retriever with chronic right hindlimb lameness, what is the diagnosis?
- Chronic osteoarthritis and effusion
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Below are radiographs of a 12 year old female spayed border collie, acutely non-weight bearing lame in the right pelvic limb. What is the diagnosis?
- Pathologic fracture
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Below are radiographs of a 15 year old female spayed Jack Russel Terrier with back pain and no neurological abnormalities detected on physical examination. What is the diagnosis?
- Discospondylosis
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Below are radiographs of a 7 month old male neutered cat who is acutely non-weight bearing lame in the left pelvic limb. What is the diagnosis?
- Femoral neck fracture
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Sammy is a 9 year old male castrated domestic short haired cat that presents to you with clinical signs of chronic kidney disease.
List two clinical signs that may be seen.
Apart from azotaemia, list two other possible clinicopathological abnormalities you might find on haematology or biochemistry profiles in Sammy if he has chronic kidney disease.
You diagnose Sammy with stage III chronic kidney disease with hypertension. Describe an appropriate treatment plan for Sammy.
Clinical signs:
- Weight loss, PU, PD, inappetence, vomiting, diarrhoea, dehydration, lethargy, pale mm, dull dry coat, poor BCS, oral ulceration
Abnormalities on haematology / biochem:
- Non regenerative anaemia, stress leukogram, hyperphosphataemia, hypokalaemia, elevated SDMA, hypocalcaemia
Treatment plan:
- Renal diet, treatment for hypertension (amlodipines, ACE inhibitors – benazepril), Fluids, anti-emetics, gastric protectants, appetite stimulants
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An 8 year old male castrated kelpie is lame on the left forelimb. Investigation reveals hypercalcaemia and a destructive lesion of the distal radius. The biopsy diagnosis is osteosarcoma, amputation is declined. Which of the following drug combinations would be an appropriate firs line approach for palliative treatment of this dog?
- Zoledronate and meloxicam
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The serious adverse effects of cytotoxic chemotherapy are commonly seen in which organs?
- Bone marrow and gastrointestinal tract
126
A dog is presented with polydipsia, polyuria and mild inappetence. Initial laboratory investigations show mildly increased total serum calcium.
Briefly outline the approach to determining whether this abnormality is significant.
What pathologic process is the single most likely cause of hypercalcaemia in dogs? In your answer give 1 specific example
- Recheck total calcium, if still high check ionised calcium
- Neoplasia, hypercalcaemia of malignancy. Anal sac adenocarcinoma, osteosarcoma, myeloma
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A 12 year old pug dog has a 5mm diameter, raised, pink, 7mm diameter slightly raised hairless epidermal nodule on the dorsal surface of the right carpus. The nodule has been present and unchanged for the last 8 months. Ipsilateral prescapular and axillary lymph nodes are not palpable. Fine needle aspiration cytology diagnoses the nodule as a mast cell tumour. Following surgical excision, the tumour is graded as Patnaik grade 1, or Kiupel low grade, completely excised with narrow margins. From the following options, select the most appropriate advice to the owner.
- Prognosis for cure is fair to good, monitor for local recurrence
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Which neurological condition will not improve with spinal cord decompression surgery?
- Fibrocartilagenous embolism
129
A 6 month old female German Shepherd dog has been urinary incontinent, since the owners acquired her at 8 weeks old. Your investigation revealed she has a left extramural ectopic ureter. The right ureter is entering the bladder normally. Both her kidneys are normal on ultrasonic evaluation. Her USH was 1.035, urinalysis was normally, urinary culture negative and there was no azotaemia or electrolyte abnormalities on her biochemistry panel. CBC was normal.
Discuss the two surgical options available for this dog. In your answer mention your preferred option and why.
?
130
Which of the following statements is correct regarding inter-fragmentary strain theory?
- Resorption of bone from the fracture gap will decrease the inter-fragmentary strain
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You find a haematoma between the fracture fragments during open reduction of a non reconstructive comminuted humeral fracture. Which of the following statements is not correct regarding the haematoma?
- It should be removed to allow fracture fragments to contact one another
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Which of the following is not a function for autogenous cancellous bone grafts?
- Osseous structural support
133
Regarding ligamentous injuries in dogs, which of the following statements is incorrect?
- In second degree sprain injury to the medial collateral ligaments of the hock of a dog, stressed radiographs of the region will show no instability of the tibiotarsal joint
134
Regarding fracture of the metatarsal bones in dogs. Which of the following statements is incorrect?
- Surgical stabilisation is always required if all 4 metatarsals are fractured
135
Regarding carpal arthrodesis in a dog, which of the following statements is incorrect?
- The most common indication is carpal hyperflexion injury from falls
136
A 19 week old German Shepherd is presented to you for a unilateral forelimb lameness. The puppy was running in the backyard yesterday playing with the other puppy. The owner noticed a moderate lameness today. The puppy did not eat all of his morning meal and has a temperature of 39.4 You locate the pain to the elbow joint, which appears moderately swollen. The owners are very worried and request you take an x-ray just to make sure he has not broken his leg. Examine the radiograph below, of the options given what is the best treatment for this puppy?
- You perform and arthrocentesis and submit for cytology and bacterial culture, and start the dog on cephalexin and firocoxib in the interim and advise repeat radiographs in 3-4 weeks.
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A 15kg 3 year old kelpie has been in a motor vehicle accident and sustained a moderately displaced fracture of the femoral diaphysis. You are developing a plan for stabilising the fracture. Considering the following stabilisation techniques, which would not be an appropriate method of fixation?
- Intramedullary pin and circumferential cerclage wires
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