What is the most common pancreatic tumor in dogs?
Insulin-secreting β-cell Pancreatic Tumor
T/F: Low cholesterol can be an indicator of liver dysfunction
True
High cholesterol on the other hand could indicate an inability to excrete cholesterol appropriately (would be seen with hepato-biliary disease and bile duct obstruction)
What is the #1 most common clinical sign associated with insulinomas in dogs?
Seizures!
AV fistulas result in increased blood volume in the left heart. As that heart muscle stretches out, what is a common sequela that is seen?
Mitral insufficiency
T/F: Somatotropin is responsible for protein synthesis, fat metabolism as an energy source, and gluconeogenesis
True
If you have normal forelimbs and UMN signs in the hindlimbs, which region of the spinal cord is most likely affected?
T3-L3
T/F: Cats suffer from Type I Diabetes Mellitus
False
Cats typically suffer from Type II Diabetes Mellitus, not Type I
If you have LMN signs in the forelimbs and UMN signs in the hindlimbs, which region of the spinal cord is most likely affected?
C6-T2
What is the main cause of hyperthyroidism in cats?
Thyroid tumors: Adenomatous hyperplasia
These are typically benign and almost always bilateral
Congenital secondary hypothyroidism is most common in which breed of dog?
Giant Schnauzer
T/F: High levels of ammonia in the bloodstream are associated with hepatic encephalopathy
True
T/F: Hyperthyroidism is more common in cats than in dogs
True
List the common signs associated with LMN lesions:
- Paresis or paralysis
- Loss of muscle tone
- Hyporeflexia (or areflexia)
- Muscle atrophy (rapid & severe)
T/F: Cerebrocortical lesions result in contralateral deficits
True
So a lesion in the right cerebral cortex would present with signs on the left side of the body
What is considered the **test of choice **for assessing liver function?
Ammonia tolerance test
Which nerve is likely affected if a patient presents with a dropped lip, drooping ear, and loss of palpebral reflex?
Facial Nerve (VII)
*It also innervates the lacrimal and salivary glands so lesions might result in dry eyes (Schirmer tear test) and decreased salivary production. *
T/F: UMN and LMN lesions both result in paralysis or paresis
True
Which etiology is not likely to be associated with liver failure due to fibrosis?
- Drugs (e.g. phenobarbital)
- Endocrine (e.g. Cushing’s)
- Cu toxicity
- Toxicity (e.g. cycads)
Endocrine (e.g. Cushing’s)
This would be more ‘innocent bystander’ damage to the liver; vacuolar changes as a result of glycogen accumulation
Which breed of dog is most commonly affected by congenital pituitary dwarfism?
German Shepherd
Crossed-extensor reflex in a dog in lateral recumbency is indicative of a ____ lesion
(UMN/LMN)
UMN
*There are long spinal reflexes between limbs that are usually suppressed by UMNs. Damage to the UMNs releases this inhibition and flexion of one limb in response to a noxious stimulus is accompanied by extension of the contralateral limb. *
Which reflex tests the integrity of the pudendal nerve?
Perineal Reflex
*Pinching of the skin in the perineal region should result in contraction of the anus, lifting of the vulva and dropping of the tail. This tests the integrity of the pudendal nerve. *
T/F: With a central AV shunt, you should observe increased cardiac output and increased heart rate
True
The most likely etiology of hypoglycemia in an 8-year-old obese laborador with hindlimb weakness is:
- Hepatic carcinoma
- Portosystemic shunt
- Low glycogen reserves
- Insulinoma
Insulinoma
Inflammation of the gall bladder is termed:
cholecystitis
What is the most historically important clinical finding in Cushing’s?
Polyuria/Polydipsia
In practice, there is a tendency to be too suspicious of Cushing’s. If the animal is not PU/PD, they do not have Cushing’s
In which nerve are the efferent and afferent pathways of the patellar reflex?
Femoral nerve
T/F: All peristalsis requires intact myenteric plexus
True
Recall from physiology that the myenteric plexus is an arrangement of nerve fibers and cells situated within the muscular tissue layer. The synchronized contraction of the various enteric layers results in peristalsis
T/F: With a central AV shunt, you should observe an overall decrease in total peripheral resistance
True
Direct communication between an artery and vein that bypasses the capillary circulation is referred to as:
Arterio-venous Fistula (or malformation)
With an AV Fistula, the artery communicates directly with the main vein rather than branching off into arterioles, resulting in localized turbulent bloodflow
T/F: Calcitonin is released in response to decreased calcium, and acts to increase calcium
False
- Calcitonin is released in response to increased calcium, and acts to decrease calcium*
- “Calcitonin tones it down”*
T/F: Somatotropin will be released in response to hypoglycemia; hypersomatotropism can cause insulin resistance and hyperglycemia
True
We need to screen diabetic cats more for this condition. We will only really suspect hypersomatotropism in diabetic cats
A 2-year-old lab vomited once yesterday, ate dinner and seemed normal. The next day the owner came back and found more piles of vomit, some with food and some just fluid. The dog is more quite than usual but still BAR. What is your diagnosis based on history and radiographs?
- Foreign body - partial obstruction
- Foreign body - complete obstruction
- Linear foreign body
- Infiltrative neoplasia
Foreign body - complete obstruction
Which reflex tests the integrity of the sciatic nerve?
Cranial tibialis reflex
Here the belly of the cranial tibialis muscle is given a sharp tap and the hock should flex. This reflex tests the integrity of the sciatic nerve.
What is the most metabolically active thyroid hormone?
T3
T/F: Cortisol will cause hyperglycemia by stimulating gluconeogenesis and decreasing glucose utilized by cells by decreasing insulin sensitivity
True
If there is extensive fibrosis and nodular regeneration in the liver, this would be described as:
Hepatic cirrhosis
If you have a patient with seizures, head pressing, and ataxia with concurrent increased ammonia, you can confirm hepatic encephalopathy. What is the cause of hepatic encephalopathy?
Liver failure
This patient will likely either have liver cirrhosis or a portosystemic shunt!
List the common signs associated with UMN lesions:
- Paralysis/paresis
- Normal to hyperreflexia
- Normal to increased muscle tone
- Minimal (disuse) atrophy
Which facial nerve supplies the muscles of mastication?
Trigeminal Nerve (V)
An adynamic state of gastrointestinal muscle is termed:
Ileus
Which is not a contributory factor to insulin resistance in cats?
- Acromegaly
- Hyperadrenocorticism
- Obesity
- Exercise
- Glucagon
Exercise
Which part of the brain is responsible for arousal of the cerebrum?
Reticular Activating System (RAS)
T/F: A dog with hyperadrenocorticism due to a pituitary tumor will have ↑ cortisol, ↓ ACTH, and ↓ CRH
Wrong, sucka!
The dog will have ↑ cortisol, ↑ ACTH, and ↓ CRH
If you have a pituitary dependent adenoma or hyperplasia, there will be increase in cortisol. This change is typically the result of bilateral adrenal hyperplasia due to an increase in ACTH. But because of the feedback effect at the level of the hypothalamus, the corticotropin-releasing hormone will decrease
A cat diagnosed with acromegaly will most likely have which additional endocrinopathy?
Diabetes mellitus
What hematological abnormalities do we expect in cirrhotic liver failure and is a prognosticator of outcome?
- polycythemia
- prolonged aPTT
- shortened aPTT
- thrombocytosis
- inflammatory leukogram
prolonged aPTT
The adrenal cortex zona glomerulosa secretes which hormone?
Aldosterone
If you have UMN signs in all four limbs, which region of the spinal cord is most likely affected?
C1-C6
The myxedema seen in this labrador is associated with which endocrine disorder:
hypothyroidism
Which reflex tests the integrity of the pudendal nerve?
Perineal reflex
*Pinching of the skin in the perineal region should result in contraction of the anus, lifting of the vulva and dropping of the tail. This tests the integrity of the pudendal nerve *
If you see an animal come in with stiff front legs and reduced muscle tone in the the back legs, what is this known as?
Schiff-Sherrington Syndrome
*Following damage (usually severe) to the spinal cord (T3 to L3) the forelimbs may become rigidly extended with marked increase in extensor tone. Voluntary movement is still present although markedly reduced by the hypertonia. Ascending spinal cord tracts in the spinal cord from L1 to L5 inhibit extensor muscles of the thoracic limbs. Transection of these pathways removes the inhibition and results in extension of the thoracic limbs. *
The most common cause of hyperlactatemia is:
hypoperfusion of the liver
Hyperlactatemia is an important prognostic indicator in terms of hypertension and perfusion. It is seen in things like voluvlus and gastric dilatation
T/F: ↑ Thyroid hormone can result in ↑ fat, carbohydrate metabolism, basal metabolic rate, heart rate, strength of heart contraction, respiration and GI motility
True
Which of the following is considered an indicator of liver failure (loss of function)?
- ↑ ALT and AST
- ↑ ALKP
- ↑ BUN
- Abdominal transudate with normal [Alb]
- Anemia with icterus
- ↑ [cholesterol]
Abdominal transudate with normal [Alb]
*Either albumin is low (causing a transudate) or there is so much portal hypertension from cirrhosis *
T/F: Hormones can alter target organ protein synthesis but can not effect gene transcription
False
Hormones can alter target organ protein synthesis and gene transcription
If you have normal forelimbs and LMN signs in the hindlimbs, which region of the spinal cord is most likely affected?
L4-S3
T/F: Aldosterone is controlled by potassium concentration and angiotensin III
True
T/F: Hypoadrenocorticism is most common in young to middle-aged, female dogs
True
T/F: Coughing is commonly seen with left-sided congestive heart failure
True
Which abdominocentesis would be most compatible with a non-strangulating obstruction?
Which of the following will occur secondary to bowel obstruction?
- Bowel wall edema
- Luminal fluid accumulation oral to the obstruction
- Hypermotility
- Hypomotility
- Pain
- Extravasation of cells
all of these things
T/F: Coughing is often seen with right-sided congestive heart failure
False
Coughing is often seen with _left_-sided congestive heart failure
T/F: Hepatic arteriovenous malformation can result in neurological signs
True
‘Unprocessed’ blood will be entering systemic circulation (high in ammonia) and elevations in various compounds can result in impediment of neuronal function - _hepatic encephalopathy_
What is the primary stimulus for peristalsis?
Distention of the GI tract
The most common types of portosystemic shunts that we see in animals are:
Single Congenital Extrahepatic Shunts
T/F: AV fistula formation may be associated with trauma
True
Which reflex tests the integrity of the radial nerve?
Extensor carpi radialis reflex
This reflex tests the radial nerve and is obtained by percussing the belly of the extensor carpi radialis muscle. Extension of the carpal joint should result.
_______ is the site of intelligence and goal-directed behaviors in the brain
Thalamocortex
*The thalamocortex is the site of intelligence and goal-directed behaviors. Lesions here may cause compulsive circling, head pressing, a decrease or absence of awareness of what is going on around the animal. *
T/F: Metabolism of glucose is considered [by Dr. Koster] the most important function of the liver
True
- If you have to remove the liver from a patient, they would likely die of hyperglycemia before anything else*
- Damn.*
Name the condition associated with high flow shunts that is characterized by unoxygenated blood (that’s meant to go up to the lungs) being shunted into the general circulation, leading to cyanosis:
Eisenmenger Syndrome
Increased volume in pulmonary circulation results in pulmonary hypertension
What is the most common cause of primary hypothyroidism in the dog?
Lymphocytic thyroiditis
Schiff-Sherrington Syndrome is associated with a lesion in which portion of the spinal cord?
T3-L3
T/F: Ascites is commonly seen with left-sided congestive heart failure
False
Ascites is commonly seen with _right_-sided congestive heart failure
The most likely etiology of hypoglycemia in a 7 week old toy poodle is:
- Hepatic carcinoma
- Portosystemic shunt
- Low glycogen reserves
- Insulinoma
Low glycogen reserves
Endocrine homeostasis is mainly controlled by which mechanism?
- Hypothalamic, pituitary negative feedback
- Paracrine control
- Autonomous secretion
Hypothalamic, pituitary negative feedback
What is the cause of acromegaly in dogs?
Excessive progesterone
Excessive progesterone (luteal phone or exogenous) will stimulate the mammary glands to release growth hormone, resulting in insulin resistance and a change in the dog’s appearance
An owner calls about a 20-year-old QH gelding that has been rolling, pawing, and sweating for the past 2 hours. There is no previous history of illness.
What clinical syndrome is being demonstrated in this horse?
How would this be different that in other species?
Colic
Horses run a higher risk of gastric rupture because they can’t vomit!
Which nerve is being tested with the extensor carpi radialis reflex?
Radial nerve
T/F: Elevated liver enzymes are a good indicator of liver function
False
Elevated liver enzymes are a good indicator of liver _damage_
~ ___% of the adrenal gland is destroyed before clinical signs of hypoadrenocorticism become apparent
~ 85% of the adrenal gland is destroyed before clinical signs of hypoadrenocorticism become apparent
The diagnosis in a dog with a normal potassium and sodium concentration, but is hypotensive, hypoglycemic, with no cortisol stimulation on an ACTH stimulation test is:
- Addisonian crisis
- Atypical Addison’s disease
- Septic shock
- Glucagonoma
Atypical Addison’s disease
Recall that Atypical Addison’s disease is characterized by glucocorticoid deficiency alone. If we’re seeing normal sodium and potassium levels, we can determine that there is not a deficiency in mineralocorticoid
When observing an animal’s mental status, what is the term used to describe an animal that is severely depressed but can be aroused with painful stimuli?
Stupor
The most likely etiology of hypoglycemia in a 6-month-old Yorkshire Terrier is:
- Hepatic carcinoma
- Portosystemic shunt
- Low glycogen reserves
- Insulinoma
Portosystemic shunt
T/F: Feline hyperthyroidism can cause cardiomyopathy and hypertension
True!
From where does the majority of the liver’s blood supply come from?
Portal vein (80%)
20% comes from the hepatic artery
The most likely etiology of hypoglycemia in an 10-year-old Golden Retreiver with PU/PD and elevated ALT/ALKP is:
- Hepatic carcinoma
- Portosystemic shunt
- Low glycogen reserves
- Insulinoma
Hepatic carcinoma
What is the most common site for AV malformation?
Liver
T/F: Brain stem lesions result in contralateral deficits
False
Brainstem lesions result in ipsilateral deficits, so if there is a lesion on the left side of the brainstem, signs would appear on the left side of the animal
Hepatic AV malformations can result in a lack of hepatotrophic factors from splanchnic circulation, which results in:
lack of development and function of the liver
- hypoglycemia
- hypoalbuminemia
- hypocholesterolemia
- hypokalemia
- clotting factor deficiencies
- stunted growth
- etc.
Which nerve is likely affected if a patient presents with head tilt and leaning?
Vestibular nerve
*Vestibular dysfunction is usually indicated by the presence of downward rotation of the head on the side of the lesion (head tilt); leaning, circling or falling to the affected side and involuntary oscillation of the eye (nystagmus). *
T/F: In heart failure, the normal compensatory mechanisms activated by decreased cardiac output may be detrimental to the heart
True
In heart failure, the normal compensatory mechanisms activated by decreased cardiac output may be detrimental to the heart, causing further decline in cardiac output
Eccentric hypertrophy of the heart is caused by:
chronic increased diastolic pressure (volume overload)
Eccentric hypertrophy is characterized by elongation of cells by addition of sarcomeres in series (end-to-end). This results in a larger ventricle with an increased chamber size, but with walls of normal thickness
T/F: Eccentric hypertrophy is seen with volume overload
True
T/F: Concentric hypertrophy is seen with volume overload
False
- Concentric hypertrophy is seen with pressure overload*
- Eccentric hypertrophy is seen with volume overload*
During heart failure, you will see an increase in RAAS and a decrease in sympathetic tone
False
During heart failure, you will see an increase in both sympathetic tone and RAAS
T/F: Cortisol increases the body’s sensitivity to insulin
False
Cortisol will cause hyperglycemia by stimulating gluconeogenesis and decreasing glucose utilized by cells by decreasing insulin sensitivity
When the pituitary gland produces too much growth hormone (GH), this is termed:
Acromegaly
