Questions Flashcards
(345 cards)
1
Q
What molecules is POMC (pro-opiomelanocortin) a precursor of?
A
Adrenocorticotropic hormone (ACTH) and beta-lipotropin (B-LPH)
Various melanocyte stimulating hormones happen next in the pathway.
2
Q
What class of antibiotics are also motilin agonists?
A
Macrolides to include erythromycin and azithromycin
3
Q
What is the rate cutoff for distinguishing between AIVR and ventricular tachycardia?
A
180 bpm
4
Q
What type of organism is most likely to result in a Type II immune response? What cells are associated with such a response?
A
Parasites / helminths
CD4+ TH2 cells, eosinophils, basophils, mast cells
5
Q
What is the ryanodine receptor, and what receptor is it attached to?
A
It is a protein located in the wall of the sarcoplasmic reticulum. It is connected to a dihydropyridine receptor located in the wall of the T tubule. When the AP travels down the T tubule, it changes the DHP receptor, which then open the ryanodine receptor, allowing calcium out of the sarcoplasmic reticulum.
6
Q
What does vitamin D toxicity cause the serum phosphorus and calcium to do? What is the biologically active form of vitamin D? Does this increase or decrease PTH activity?
A
It causes hypercalcemia and hyperphosphatemia.
1,25-dihydroxycholecalciferol
Decreases PTH activity (negative feedback since PTH activates it in the kidney)
7
Q
Describe the pathway for norepinephrine production.
A
The amino acid tyrosine is converted to dopamine, which is then converted to norepinephrine.
8
Q
What commonly used antibiotics concentrate within the urine?
A
Aminopenicillins
Other commonly used in people include TMS, nitrofurantoin and fluoroquinolones
9
Q
What class of antibiotics is best used to treat actinomycosis?
A
Penicillins
10
Q
What is the mechanism of action of calcitonin?
A
Inhibits osteoclast activity (doesn’t directly decrease parathyroid activity)
11
Q
What pharmacokinetic value determines the extent of exposure of a drug over time following its administration?
A
AUC
12
Q
Where are bile acids reabsorbed along the GIT? What is this pathway called?
A
Ileum
Enterohepatic circulation
13
Q
What value is higher in chylous effusions than in serum, and should be measured to confirm a diagnosis of chylous effusion?
A
Triglycerides
14
Q
CD25 is associated with what type of T cell?
A
T regulatory cells
15
Q
What do the following hormones do in regards to increasing or decreasing fatty acid release?
- Epinephrine
- Growth hormone
- Thyroid hormone
- Glucagon
- Insulin
A
- Epinephrine - increase
- Growth hormone - increase
- Thyroid hormone - increase
- Glucagon - increase
- Insulin - decrease
16
Q
Where is glucagon manufactured?
A
The pancreatic alpha cells
17
Q
What does the parietal cell secrete?
A
Hydrogen protons (with Cl)
In people, intrinsic factor is also secreted from the parietal cells.
18
Q
What hormones increase pancreatic secretions?
A
Acetylcholine, secretin and cholecystokinin
19
Q
What is the mechanism of action for sildenafil?
A
It is a phosphodiesterase V inhibitor. This blocks degradation of the second messenger cAMP, and ultimately increases NO production.
20
Q
What is the pathophysiologic mechanism behind foxglove toxicity?
A
This is a cardiac glycoside, with the same MOA as digoxin - inhibition of Na-K-ATPase pump. This results in intracellular accumulation of Na and Ca - positive inotropy occurs, but also significant arrhythmias, often bradyarrhythmias. Vomiting and lethargy are common.
21
Q
Which diuretic is potassium sparing? Why are the other ones potassium wasting?
A
Spironolactone. This inhibits aldosterone action on the principal cells in the distal nephron, preventing K secretion.
Other diuretics are primarily potassium wasting because they increase flow through the nephron, lowering the amount of potassium seen by the principal cells, favoring a concentration gradient to move potassium out of the principal cells into the urine.
22
Q
What causes acetylcholine to be released from the pre-synaptic neuron terminal?
A
Influx of calcium into the neuron via voltage gated calcium channels triggered by the action potential reaching the nerve terminal.
23
Q
What is the Frank-Starling law of the heart?
A
Increased volume in the ventricle (ie preload) stretches the cardiac myocytes / sarcomeres out to a longer length, facilitating a stronger heart beat. The farther stretched the sarcomeres are, the more they can contract and more blood they can move.
24
Q
What is the form of babesia that causes RBC lysis?
A
Merozoites, which form from asexual reproduction of the sporozoites which invaded the RBC.
25
Best treatment recommendation for babesiosis?
Atavaquone and azithromyzin combination
26
What is the mechanism of action of sulfa drugs?
Inhibition of folate / folic acid synthesis by bacteria, and a subsequent inability to produce additional DNA. Often this makes the drugs more bacteriostatic as opposed to bacteriocidal.
27
What is insulin’s action on lipoprotein lipase?
Activates lipoprotein lipase to facilitate movement of fats into adipocytes.
(Cleaves the triglycerides from circulating lipoproteins so they can get into the adipocytes)
28
Where do aminoglycosides cause nephrotoxicity?
Proximal tubule (glucosuria, ketonuria, casts)
29
What is the function of surfactant in the lungs?
To decrease surface tension within the alveoli, preventing collapse
30
Where on the Wigger’s diagram is represented by atrial contraction?
There is a small bump labeled ‘a’ in most diagrams. Causes a modest elevation in ventricular volume and pressure, prior to the large pressure increase in the ventricle associated with ventricular systole.
31
How do bradykinin and prostaglandins increase GFR?
They cause afferent arteriolar vasodilation.
Other molecules to do this include NO and dopamine. (And kind of angiotensin 2 and ANP)
32
How do pH alterations impact the ability of oxygen to bind to hemoglobin?
Acidosis — decreased binding (as would be expected in the tissues where oxygen needs to be dropped off)
Alkalosis — increased binding
33
What can cause a false positive protein reaction on a urine dipstick?
Alkalosis (>7.5)
34
What is thrombomodulin and where is it located?
Thrombomodulin is an anticoagulant molecule expressed on vascular endothelial cells.
It binds to thrombin (normally pro-coagulant, removing it from circulation) and activates protein C, which is anti-coagulant (inhibits factors 5 and 8).
35
Which organ converts lactate to glucose in an anaerobic states?
Liver
The lactate is typically produced in the muscles, and then uptaken by the liver.
This is why in cases with liver dysfunction, LRS is not an ideal fluid therapy.
36
How does hemorrhage stimulate thirst?
With hemorrhage, there is reduced blood flow through the kidneys. This activates the RAAS, and results in production of angiotensin II. This is the most potent stimulator of thirst.
37
Which channel closes during the third portion of the cardiac action potential (resulting in repolarization)?
Slow calcium channels close.
38
What happens during the process of apoptosis?
Proteins called capsases become activated, which triggers destruction of the cytoskeleton, resulting in cellular shrinkage. The nucleus also becomes fragmented. The cell debris eventually gets eaten by macrophages.
39
What is the main action of secretin on the pancreas? What is the main stimulus for secretin (should be intuitive)?
What do the other hormones that act on the pancreas do?
Secretin results in increased bicarbonate secretion in the pancreatic juices. It is stimulated by the presence of H+ in the duodenum.
CCK and Ach promote production of pancreatic enzymes.
40
What type of anemia occurs with chronic blood loss?
Microcytic hypochromic - reflective of iron deficiency anemia
41
What are the name of the parasympathetic nervous plexi within the wall of the GIT?
Submucosal (controls secretions / hormones)
Myenteric (controls muscle movements / peristalsis)
42
What nerve supplies parasympathetic innervation to the urinary bladder?
Sympathetic? Somatic?
Pelvic nerve (S1-3)
Hypogastric (L1-4)
Pudendal (S1-3)
43
There are two ways that cytotoxic T cells kill other cells. What are they?
1. Perforin pathway (forms pores in the target cell)
2. CD95 pathway, results in activation of a death-inducing signaling complex (DISC) that triggers apoptosis
44
What do the juxtaglomerular cells secrete? In response to what?
Renin - low pressure in the renal afferent arteriole (where the juxtaglomerular cells are) signals secretion of this molecule.
Apparently they also release renin when told to do so by the macula densa as a part of the juxtaglomerular complex.
45
What does a low fractional excretion of sodium (<1%) signify in a patient with an acute azotemia? In a clinically normal animal?
In an acutely azotemic patient, it signifies volume depletion. The kidneys try and reabsorb as much sodium (and water) in this state to restore volume. A higher value may indicate tubular injury.
In a normal patient, it is actually normal for a FE of Na to be <1%.
46
Classic signs of LMN disease?
Neurogenic atrophy, hypo to a-reflexia, hypotonia, short and choppy gait
47
What are the signs of Horner’s disease?
Ptosis
Enophthalmos
Miosis
Elevated third eyelid
Sweating and nasal congestion may be obvious in horses
48
Is glucose found in the urine of healthy dogs? Why not?
No. It reabsorbed completely in the proximal tubule with sodium via SGLT2.
49
What is the formula for accuracy?
Sensitivity?
Specificity?
PPV?
NPV?
(TP + TN) / (TP + TN + FP + FN)
Sensitivity - TP / TP + FN
Likelihood that animal with disease tests positive
Specificity - TN / TN + FP
Likelihood that an animal without disease tests negative
PPV - TP / TP + FP
Likelihood that a test positive represents an actual positive
NPV - TN / TN + FN
Likelihood that a test negative represents an actual negative
50
What is odds ratio?
The chance that a case (ie diseased patient) was exposed to the disease versus a healthy was exposed to disease
A x D / B x C
51
Limited amounts of this molecule lead to ketosis?
Oxaloacetate — this molecule is produced during carbohydrate metabolism via the CAC. It is what binds to acetyl CoA (ketone body) and allows for further processing of acetyl CoA in the CAC. Without oxaloacetate (as would occur during diabetes when glucose can’t be utilized), ketones can’t be processed and start to accumulate, leading to ketosis.
52
How do ketone bodies form? What are names of the ketone bodies?
They form from metabolism of triglycerides. Acetyl CoA is split from triglycerides (mostly in the liver), and two acetyl CoA molecules join together - acetoacetic acid. This is what can enter the CAC for ATP production.
Acetoacetic acid can be converted to beta-hydroxybutyric acid and acetone. All of these are ketone bodies.
53
What removes particulate debris in the lungs?
Resident macrophages
54
What are Heinz bodies made of? What is the most common cause of them?
Precipitates of denatured hemoglobin
Oxidative damage to RBC
55
What is zoonotic from dogs and horses?
Staphylococcus aureus
56
What molecule is the cause of gross lipemia following 24 hours?
Very low density lipoproteins (VLDLs)
57
What are the two main ways the dogs acquire neosporosis?
Vertically via transplacental transmission from infected dams (bradyzoites reactivate to tachyzoites).
Horizontally via ingestion of tissue cysts (bradyzoites) in infected intermediate hosts.
58
Iron is transported in the bloodstream in what form?
Transferrin
59
What type of hypoxia is not responsive to supplemental oxygen therapy?
Anemia
And maybe cyanide poisoning, and R to L shunts
60
How is Pythium acquired?
Through breaks in skin / GIT if ingested from contaminated water
61
What two organ systems can be affected by Cyanobacteria toxicity / blue-green algae?
Liver
CNS
Toxins produced by the bacteria / algae cause the signs.
62
What does the T helper 2 response involve?
These lymphocytes secrete IL-4 and IL-5 to increase IgE production and recruit eosinophils, respectively.
63
What type of cells recognize MHC
II molecules?
T helper lymphocytes AKA CD4
64
What is chloride exchanged with in the GIT in order to be absorbed? Where?
Bicarbonate via a HCO3-Cl exchanger, in the ileum and colon
65
What is the predominant carbohydrate breakdown product absorbed by the intestines?
Glucose (80%)
Galactose and fructose are also absorbed, but there is not as much of them.
66
How does tetanus antitoxin work?
What is a toxoid?
It is an antibody that binds to free circulating tetanus toxin, facilitating its clearance from the body.
Toxoid is a chemically altered toxin that can be given like a vaccine to help the body respond to a real toxin.
67
What drug class is lidocaine a part of?
It is a class 1b anti-arrhythmic, sodium channel blocker
68
What is a strong stimulus for erythropoietin stimulus?
Hypoxia, primarily in the kidneys
69
What is the definition of functional residual capacity?
The amount of air left in the lungs after a normal expiration.
70
What two heart diseases can cause a hyperkinetic femoral pulse?
PDA
Aortic insufficiency
Increased diastolic runoff causes a decreased diastolic pressure, which is what is palpated as hyperkinetic (pulse pressure is systolic minus diastolic pressure)
71
What does TLR4 recognize? TLR5?
LPS, flagellin
72
What are the three pathways used to activate complement, which are part of the innate or adaptive immune response, what was does the classical pathway involve?
1. Alternative pathway (actually the most common), recognizes PAMPs
2. Lectin pathway, also recognizes PAMPs
3. Classical pathway, involves antibodies bound to antigen
The first two are part of the innate immune response, and the classical is part of the adaptive response given its reliance on antibody production.
The classical pathway activates / involves a C1 complex.
73
What is a common RBC morphological feature associated with IMHA?
Spherocytosis
74
Hormones secreted from the anterior pituitary gland?
ACTH
Growth hormone (somatotropin)
TSH
Prolactin
LH
FSH
(MSH is as well)
75
What happens when alveolar oxygen concentration (PAO2) drops below normal levels (ie ~70 mmHg)?
Pulmonary vasoconstriction due to the hypoxic-pulmonary vasoconstriction response to promote V/Q matching
76
What is the S3 heart sound, and in what disease state is it heard in?
S3 represents early ventricular filling, and is audible when the ventricle is enlarged as in DCM.
77
What is a common endocrine cause of hypokalemia in cats?
Hyperaldosteronism
78
Delayed hypersensitivity is associated with what cell type? What is another name for delayed hypersensitivity?
T lymphocytes (remember specifically cytotoxic T cells and TH1)
Type IV hypersensitivity
79
What percent of the population falls within 1 standard deviation of the mean? 2? 3?
68
95
99
80
What activates the carotid body?
Low levels of PaO2; potentially also hypoxia…
(O in body for O2)
81
A combination of clear plasma with red urine could be compatible with?
Renal hematuria OR rhabdomyolysis; urine centrifugation would result in a clear supernatant with renal hematuria, but stay red with rhabdomyolysis due to myoglobinuria.
82
What is one of the ways that the kidneys keep the body from becoming hypervolemic / hypernatremic when excess water and sodium are absorbed/consumed?
What is a disease state where this is important in?
Pressure natriuresis and diuresis
Hyperaldosteronism
83
What viral organism is a cause of myocarditis in puppies and cerebellar hypoplasia in cats?
Parvovirus
84
What is the definitive means of diagnosing rabies?
Direct IFA (which detects antigens) on brainstem tissue.
85
What are 3 stimuli for H+ release by the parietal cells?
Gastrin
Ach
Histamine
86
What do natural killer cells produce? What part of the immune response are they?
Interferon gamma
Innate immune response
87
What type of hypersensitivity reaction is IMHA?
Type II - attack against a membrane associated antigen
88
What is the primary constituent of chylomicrons?
Triglycerides (how these are transported all over the body, to and from adipocyte stores)
89
Dogs with peri-anal fistulas often have what disease process concurrently?
Treatment of choice?
Breed of dog over-represented for this condition?
Colitis
Cyclosporine
German shepherd
90
What is the mechanism of phenylpropanalamine?
Alpha 1 adrenergic receptor agonist
Used for urinary incontinence to target these receptors in the urethra
91
What is the most specific modality for diagnosing pancreatitis in dogs?
Pancreatic lipase
92
During peak viremia of FIV, what cell does the virus replicate in and eventually cause depletion of?
CD 4 T lymphocytes
93
A staffordshire bull terrier with a right sided grade III/VI heart murmur that presents with an increased respiratory rate and bilateral crackles most likely has:
Pulmonary hypertension caused by idiopathic pulmonary fibrosis (Staffies and Westies are predisposed to idiopathic pulmonary fibrosis)
94
What is the treatment recommendation for sinonasal aspergillosis following endoscopic debridement?
Topical clotrimazole
95
What medication is used for treatment of granulomatous colitis? What breed is primarily affected?
Enrofloxacin
Boxers
96
What cell type depletion causes lymphopenia in feline retroviral infections?
CD4 T helper cells
97
What cell type recognizes cancerous cells lacking MHC I molecules?
Natural killer cells (aka large granular lymphocytes)
98
“How do bacteria cause DIC?”
Inhibition of anti-thrombin
99
Reduced prostacyclin concentrations are commonly implicated in what disease process? What other molecule is decreased that we can actually intervene with pharmacologically?
Pulmonary hypertension
Nitric oxide (PDEVi results in elevated NO levels)
100
What are the cells associated with estrus on vaginal cytology?
Which stages are associated with neutrophils? Neutrophils and bacteria? Basal cells?
Estrus = superficial / shrunken angular cells without nuclei
Anestrus = just nucleated basal cells
Proestrus = early you have lots of basal cells with bacteria and neutrophils; later you get less basal cells and more superficial cells
Diestrus = reverse of proestrus (superficial cells turn into basal cells); some neutrophils
101
What diagnostic should be done in a male beagle that is PU/PD and is hyposthenuric, and has no other lab or clinical abnormalities?
Water deprivation test to rule out psychogenic polydipsia v diabetes insipidus.
If DI confirmed, then give desmopressin to distinguish between nephrogenic (no response) and central (response).
102
What is the mainstay of dietary modification regarding treatment of calcium oxalate urolithiasis?
Increasing water consumption
103
Following IVF therapy, a persistently azotemic cat with ureterolithiasis and associated pyelectasia should be treated with a:
Subcutaneous ureteral bypass system
104
What class of antibiotics is amoxicillin a part of, and what is its mechanism of action?
It is a beta lactam antibiotic that reduces bacterial cell wall synthesis (peptidoglycan).
105
What lab values would be consistent with a diagnosis of primary hyperparathyroidism?
Elevated calcium (ionized)
Normal or high PTH
Low phosphorus
106
What is the mechanism of action for pimobendan?
It is a positive inotrope that causes troponin C sensitization to calcium, as well as being a PDEIII inhibitor
107
What oral medications can be used to treat dogs with atropine responsive second degree AV block?
Propenthaline and hyoscyamine
108
What is the first treatment choice for a cat with diabetic ketoacidosis?
Rehydration with Norm-R
Not NaCl because it is acidifying
109
What is a main tenet of antibiotic stewardship?
Transition / use a narrow spectrum choice based off of culture and sensitivity testing
110
What would support the diagnosis of steroid responsive meningitis arteritis in a young Boxer dog?
Elevated IgA levels in serum; elevated IgA CSF levels are not as specific as serum because they are also elevated in other inflammatory CNS conditions.
111
Production of effusion in cats with FIP is caused by what molecule?
VEGF (vascular endothelial growth factor) produced by infected macrophages / monocytes
112
What chemotherapy can result in anaphylaxis following repeated exposure?
L-asparaginase
113
What two classes of chemotherapeutics act via disruption of the mitotic spindle?
Vinca alkaloids - they block formation of the mitotic spindle activity during metaphase
Taxanes - block depolymerization of the mitotic spindle once it’s formed, at the end of metaphase.
114
What chemotherapy medication for CHOP can be given while awaiting MDR1 mutation testing?
Cyclophosphamide
115
What is the role of calcitriol therapy in patients with CKD?
CKD can result in renal secondary hyperparathyroidism, and elevated PTH levels. Calcitriol (which is just synthetic vitamin D) can inhibit PTH production.
116
What is the most effective way to diagnosis a PTE?
CT angiography
117
How does hypercalcemia result in PU/PD?
It causes nephrogenic diabetes insipidus (ADH receptor inhibition at the level of the kidney).
118
What is the main treatment option for dogs with copper storage disease in the symptomatic period?
D-penicillamine to chelate the excess copper.
119
Silibinin/silymarin is used for treatment of this toxicity?
SAMe? What is the injectable form of this medication?
Amanita mushroom toxicity
Acetaminophen toxicity; n-acetylcysteine
120
What is a very common clinicopathologic finding of hyperthyroidism in cats?
ALT elevation
121
What is SDMA reflective of, and what do increases in this value reflect?
SDMA is a surrogate for GFR, and when it’s high, GFR is reduced.
122
What should a CKD cat with proteinuria be treated with?
ACE-inhibitor like enalapril
123
Dogs that have severe proteinuria with otherwise normal labwork. What is the most likely protein that is being lost?
Albumin
AT3 is the same size and is presumably also lost, leading to hypercoagulability.
124
What is the main pathophysiologic mechanism that leads to clinical signs in dogs with PDAs?
Left sided congestive heart failure as the left heart is volume overloaded.
125
What breeds are over-represented for taurine-related DCM?
Golden Retrievers and Cocker spaniels (American and English)
126
What are some common essential amino acids in cats?
What happens with deficiency of the first one?
Arginine (dogs too) and taurine (cats only)
Hyperammonemia because arginine is crucial in the urea cycle.
127
What is an essential fatty acid in dogs and cats?
Linoleic acid (cats also need archadonic acid)
128
What is a sequela of hyperlipidemia in older miniature Schnauzers?
Glomerular disease and subsequent proteinuria; the high circulating lipid levels can cause lipid thromboemboli in the glomeruli.
129
What two routes of administration are subject to first pass metabolism?
Rectal and oral
130
What is considered a hallmark cranial nerve abnormality associated with myasthenia gravis?
Fatiguable palpebral reflex
131
What is a hallmark cranial nerve abnormality associated with cerebellar disease?
An ipsilateral absent menace response
132
What is a very sensitive and specific test to diagnose clinical toxoplasmosis in cats?
IgM levels in CSF
A cat who is positive for FIV as well should raise your suspicion even more!
133
Most common clinical manifestation of Lyme disease in dogs?
Arthritis
134
What is the classic liver enzyme elevation associated with hepatic lipidosis in cats?
ALP
If GGT is elevated, consider something else or something in addition to lipidosis.
135
What is a cellular marker that can be used to diagnosis acute leukemia?
CD34
136
What are some B cell markers?
CD 20, CD 21, CD 45, CD 79
137
What is the best diagnostic test to detect dynamic airway collapse?
Fluoroscopy
138
What is a major acute phase protein in cats?
What are three other ones?
Serum amyloid A
Others include CRP (main one in dogs), haptoglobin and alpha-1-acid glycoprotein
139
What is the treatment of choice for splenic mast cell disease?
What is the other name of this form?
Splenectomy
Visceral
140
What is the mechanism of action for capromorelin?
Ghrelin agonist
141
What vector borne diseases are associated with morulae in neutrophils?
Anaplasma phagocytophilum and Ehrlichia ewingii
142
What is the treatment recommendation for cats with cytauxzoonosis?
Atovaquone and azithromycin
143
What is the most important prognostic factor in lymphoblastic lymphoma?
Immunophenotype (ie B is bad, but T is terrible)
WHO substage status is also prognostic (A v B, with B being worse)
144
A LDDST with no suppression at either four or eight hours is indicative of what?
This confirms hyperadrenocorticism, but does not allow distinction between pituitary or adrenal dependent disease.
An endogenous ACTH level could be considered next. A HDDST could be too.
145
What gastrointestinal neoplasm is frequently associated with hypoglycemia?
Leiomyosarcoma
146
What is the first line treatment for a hypertriglyceridemic patient?
Low fat diet
147
What is the most common cause of insulin resistance in cats?
Hypersomatotropism
148
What does the combination of a high total T4 and TSH indicate?
Immune mediated thyroiditis
The high TSH indicates low circulating thyroid hormone levels, indicative of hyperthyroidism, while the total T4 is high due to interference from anti-thyroglobulin antibodies.
149
What is the clinical consequence of eating a fish-only diet as a cat? Why?
What are common associated clinical signs?
Thiamine deficiency (B1) because these diets contain thiaminase
Cervical flexion and central vestibular dysfunction; blindness, abnormal PLRs and seizures can also occur
150
What does a splintered QRS complex on ECG indicate?
What breed of dog is tricuspid valve dysplasia most commonly seen in?
Tricuspid valve dysplasia
Labradors
151
What are common signs of lead toxicity, and what is a classic CBC change associated with it?
Gastrointestinal signs + abdominal pain + tremoring/seizures/mentation changes
Nucleated RBCs without significant anemia (but an anemia is often present, just mild)
152
What is an important treatment option for Ivermectin toxicity?
Lipid emulsion
153
Classic triad of signs associated with marijuana intoxication?
Mydriasis
Ataxia / disorientation
Urinary incontinence
154
What toxin results in SLUDD signs, and what is its mechanism of action?
Organophosphate toxicity
It is an acetylcholinesterase inhibitor
155
What is the mutation associated with HCM in Maine Coon cats? What other breed has a similar mutation?
MyBPC3 (myosin binding protein C3)
Ragdoll
156
What diagnostic test can help distinguish between hypoalbuminemia secondary to a PLE v hepatic disease
Bile acids (elevated post-prandial = liver)
Additionally, measurement of alpha 1 protease inhibitors in feces can help support PLE.
157
What is the rationale behind treating cancer patients with metronomic chemotherapy?
Anti-angiogenesis
158
What is a common cause of regurgitation in German Shepherd puppies?
Persistent right aortic arch
159
What is the most common disease process to result in PH in dogs?
MMVD
160
What immunoglobulin is associated with upper respiratory mucosa?
IgA
161
Systemic hypertension can result in what CNS abnormalities?
Hyper-perfusion resulting in white matter edema, particularly in the occipital lobes, as well as ischemic infarcts.
162
What is the most common biochemical change associated with Addison’s disease?
Azotemia / elevated creatinine, hyponatremia and hyperkalemia
163
What is the most common gram negative bacteria associated with feline pyothorax?
Pasteurella
Comes from the oral cavity of cats, so likely associated with bite wounds
164
What bacteria is acid fast staining and which one is not? What are these bacteria often a cause of?
Nocardia is partially acid fast positive
Actinomyces is not.
They cause pyothorax, often associated with migrating foreign bodies.
165
What is the preferred way to monitor diabetic control in a fractious cat?
Continuous glucose monitor (CGM) like a Libre
166
What is the most side effect reported for oclacitinib?
What is the MOA of this drug?
What is the MOA of cytopoint (lokivetmab)?
Diarrhea
Janus kinase inhibitor
IL-31 monoclonal antibody
167
What value is elevated first with anti-coagulant rodenticide toxicity? What is the MOA?
PT
Inhibition of vitamin K dependent factors (2,7,9,10). 7 has the shortest half life, and is used up first. This leads to abnormalities in the extrinsic pathway first, as assessed by PT.
168
What is the value that is abnormal in hemophilia A? Due to deficiency in what?
Hemophilia B?
PTT (for both)
Hemophilia A = decreased 8
Hemophilia B = decreased 9
169
What is the treatment recommendation for Tritrichomonas faetus?
Ronidazole
170
What is the mechanism of action of leflonumide?
Inhibition of pyrimidine synthesis, specifically the dihydroorotate dehydrogenase (DHODH) enzyme.
171
What are two lab findings that are supportive of EPI on a GI panel?
Low TLI
Low cobalamin (due to lack of intrinsic factor secretion)
172
What is a bacteria that can be transmitted from horses to dogs?
Staphylococcus aureus
173
What lab abnormality would you expect to see in a psychogenic polydipsic patient treated with desmopressin?
Hyponatremia (the ADH activation in the nephron will result in free water retention and subsequent hyponatremia)
174
These two possible lab values would raise concern for pseudohyperkalemia:
Thrombocytosis
Hemolysis (not necessarily a lab value)
175
What type of helminths are able to be detected on Baermann fecal analysis?
Lungworms - most commonly aelurostrongylus abstrusus (cat) or angiostrongylus vasorum (dog)
176
What hormone directly causes free fatty acids to be released from adipocytes?
Glucagon - it signals hormone sensitive lipase to liberate triglycerides from adipocytes
177
True or false: bundle branch blocks are normal sinus rhythms
True - the beats are initiated in the sinus node and travel down the conducting system normally up until they get to the bundle branches.
178
What CBC abnormality does folic acid deficiency cause?
Macrocytosis due to defective DNA synthesis
179
What are the two functions of gastrin?
What molecule is required in large quantities for the second function listed?
Gastric mucosal growth and H+ release from parietal cells
ATP
180
What molecule is important for potentiation of antithrombin III? What does antithrombin III do?
Heparin
AT3 binds to and inactivates various clotting factors to include Xa and thrombin
181
How do amino acids form ketone bodies?
Two molecules of acetyl CoA condense to form acetoacetate.
182
What are some causes of an elevated anion gap metabolic acidosis?
Lactate (can be seen in exercise)
Ethylene glycol
Salicylic acid (aspirin)
Uremia
Ketosis
183
What is a major way that carbon dioxide is transported through the bloodstream?
As bicarbonate thanks to carbonic anhydrase
184
What are two ways that neutrophils can kill organisms?
NADPH oxidase that releases free radicals / reactive oxygen species. This can be termed the respiratory burst. They can also use lytic enzymes stored in cytoplasmic granules.
185
Lack of this molecule is responsible for leukocyte adhesion deficiency in cattle and dogs.
What does this molecule allow for? What is a common clinical presentation in these dogs?
CD18 - this allows for the neutrophil to bind to an antibody coated organism.
These patients often have recurrent infections and severely high neutrophilic leukocytoses.
186
What form of toxoplasma organisms cross the placenta?
Tachyzoites
187
What is the toxic component of castor bean? What major organ systems are affected?
Ricin
When inhaled, the lungs are clearly affected first.
When ingested, signs typically include vomiting/hematemesis, but may also cause hepatic and renal dysfunction.
188
What is the most common phase II hepatic reaction?
Glucuronidation
189
What is paradoxic aciduria?
What are common bloodwork changes?
Refers to the situation where you have a metabolic acidosis (high bicarbonate), but have acidic urine.
Commonly occurs in outflow tract obstructions where HCl and fluid are sequestered in the stomach (which results in metabolic alkalosis). The low circulating volume triggers aldosterone secretion, which leads to low K. The body then wants to try and save potassium, so the kidneys exchange H+ for K+ at the alpha intercalated cells, resulting in acuduria.
As such common lab changes include low potassium, chloride and high bicarbonate
190
What is a hallmark finding of lupus cytologically?
Neutrophil that has phagocytosed nuclear material; when found in joints, termed ‘ragocytes’.
191
How long do RBCs live for in dogs and cats?
Dogs - 110-120 days
Cats - 70-80 days
192
What fluid choice should be administered to a dehydrated hypercalcemic patient?
0.9% NaCl
193
What are two classic features of ciliary dyskinesia?
Recurrent respiratory tract infections and inability to sire
194
How does phenobarbital influence thyroid hormone concentrations?
Decreases both total and free T4; +/- increases TSH.
195
What is the most important feature for medical management of struvite urolithiasis in dogs?
Urine acidification via diet (this is the opposite of what you want for calcium oxalate urolithiasis).
If a UTI is contributing, this will need to be treated as well.
196
Bronchial collapse is associated with what kind of dyspnea - inspiratory or expiratory?
expiratory
197
What type of hypersensitivity reaction is associated with immune mediated thyroiditis?
Type II
198
What differential should be at the top of the list for a male intact dog with swollen, painful testifies? How do you test for this?
Brucella - patient-side agglutination test
199
What type of dysfunction (systolic v diastolic) is HCM associated with?
Diastolic - the heart is too stiff / thick to relax
200
What type of drug is phenoxybenzamine, and what is a common indication for its use?
Alpha antagonist (non-selective); medical management of pheochromocytomas
201
What is a negative prognostic indicator for pituitary macroadenomas following RT?
Worsening neurologic signs
202
Which is an indication to start anti-convulsant therapy?
A. 2 seizures in 12 months
B. 1 generalized seizure in an old dog
C. Cluster seizures
D. Ataxia lasting four hours following a seizure
Cluster seizures
203
What is one of the most accurate ways to assess for a dietary allergy?
Hypoallergenic diet trial
204
What is the mechanism of action of cyclosporine?
Calcineurin/NFAT inhibitor, which reduces the production of IL-2, and subsequent T cell activation.
205
What is the most important supportive treatment we can do for pancreatitis patients?
Aggressive intravenous fluid therapy
206
What hormone is released secondary ventricular stretch?
BNP
207
Where is bradykinin inactivated? By what enzyme? What is the normal function of this enzyme?
Lungs
ACE
Convert AT1 to AT2
208
What is a more sensitive means of detecting heart worm disease in cats?
Antibody test
209
What cardiac valve disease can predispose to infective endocarditis?
Subaortic stenosis
210
In a patient that is having a suspected cutaneous drug reaction, what lesion is ideal to biopsy?
Pustule
211
In a dog with an ACTH simulation test that is consistent with hypoadrenocorticism, what should a baseline ACTH be to diagnosis secondary hypoadrenocorticism?
Low
212
What electrolyte derangement can result in hemolytic anemia in patients being treated for DKA?
Low phosphorus
213
What do the kidneys do to phosphorus in secondary nutritional hyperparathyroidism?
Increased renal excretion (normal action of PTH is to get rid of phosphorus in the kidneys, so when there is a lot of PTH, phosphorus will be peed out).
214
Which thyroid hormone has the shortest latency period and is quick to reach maximum cellular activity?
T3
215
What is the following acid-base disturbance:
pH: 7.2
HCO3: 10
PCO2: 50
Mixed respiratory and metabolic acidosis (normal bicarbonate is 15-25)
216
What is the anion gap of this patient:
Na - 140
K - 5.4
Cl - 92
HCO3 - 8
140+5.4 = 154.4
92+8 = 100
Anion gap = 54.4 —> this is elevated
Be concerned for an elevation unmeasured anions like SKULE. Normal AG is 15-25.
217
What type of test should be used if a positive result could result in the euthanasia of the animal?
A highly specific test - reduces chances of false positives.
218
What is the source of Cryptosporidium hominis?
Humans
219
What is PFK deficiency and what breed of dog is over-represented?
Phosphofructokinase deficiency is an abnormality that can result in hemolytic anemias during exercise due to pH changes in the blood. Rhabdomyolysis and pigmenturia can occur as well because PFK is normally present in muscle.
220
What percentage of equine and canine patients hospitalized in the ICU develop nosocomial infections?
16%
221
What is the preferred way to treat an acute exacerbation of hepatic encephalopathy?
Cleansing enema
222
What is different about ALP in cats versus dogs?
Cats do not have an inducible ALP, so it is specific for cholestatic disease.
223
What cleaves ALP from its membrane in the liver?
Bile acids / salts and a random protein called phospholipase D
224
Where are natural killer cells formed?
Bone marrow (which makes sense - they are weird versions of lymphocytes, which all start in the bone marrow)
225
What is a main clinical sign of SLE?
Non-erosive polyarthritis
226
CpG and LPS are examples of what?
What is CpG?
They are PAMPs recognized by the innate immune system.
CpG (specifically unmethylated ones) are unique to bacterial DNA.
227
Which white blood cell has the shortest half-life in circulation?
Eosinophils (6 hours), followed by neutrophils (7-12 hours)
228
What is the function of miRNA?
MicroRNA is kind of like a feedback RNA that inhibits gene expression
229
What part of the cell does lupus attack?
Nucleus
230
What is the formula for RER?
RER = 70 x BW^0.75
RER = (30 x BW) + 70
231
What type of glomerular disease would not improve with prednisone?
Glomerular sclerosis
232
What type of glomerular disease would not improve with prednisone?
Glomerular sclerosis (scarring)
233
What test is most sensitive for detection of hyperthyroidism?
Nuclear scintigraphy
234
What is the most common type of T cell associated with inflammatory bowel disease?
CD3 positive
235
What is the most sensitive way of detecting leptospirosis within 5 days of illness?
Blood PCR
236
Which disinfectant is effective at killing bacterial spores?
Bleach
237
What hormones (2) can inhibit glucagon secretion?
Somatostatin
Insulin
238
Which liver value (at least in dogs) is most sensitive for cholestasis?
GGT
239
What is the mechanism of action for fluoroquinolone medications?
Inhibition of topoisomerase II (aka DNA gyrase) and topoisomerase IV
240
What are two electrolyte abnormalities that can result in nephrogenic diabetes insipidus?
Hypokalemia
Hypercalcemia
241
How does epinephrine influence GFR?
Reduces GFR via vasoconstriction
242
How would increased glomerular capillary oncotic pressure influence GFR?
Decreases it (the proteins hold fluid in the capillary and keep them from crossing into the ultrafiltrate)
243
The presence of what in the duodenum results in CCK secretion?
Amino acids, fatty acids, and high osmolarity (makes sense because CCK triggers the pancreas to secrete more enzymes in the pancreatic juices).
244
By what percentage does atrial fibrillation decrease ventricular filling?
20-25%
245
True or false: gastrin is the most important stimulant for parietal cell H+ secretion.
False - Ach and histamine are
246
What is the treatment for lead toxicity?
Calcium EDTA
247
What would be an indication that a patient would benefit from an iron supplementation?
Decreased saturation of transferrin (+/- increased amount of apotransferrin)
248
What form makes up the majority of iron in the body?
Hemoglobin
249
How does amphotericin B work? Why is it nephrotoxic? Why do lipid forms of the drug cause less nephrotoxicity?
Amphotericin B recognizes ergosterol in fungal cell membranes, and kills that way.
The drug can also bind to cholesterol in the kidney, causing damage there.
Lipid formulations have a higher volume of distribution, and can be released more slowly, decreasing how much the kidney is exposed to at one time.
250
What type of portal hypertension does portal vein atresia cause?
Pre-hepatic
251
What is the mechanism of action of doxycycline?
30S ribosomal subunit inhibition
252
How does hyperthyroidism increase GFR?
Decreased total peripheral resistance
253
What is the mechanism of action for clopidogrel?
Irreversible binding to ADP-receptor on platelets.
254
What is the most potent chemokine in the arachadonic acid cascade?
Leukotriene B4
255
How does nitric oxide influence platelet function?
Decreases platelet aggregation and adhesion
256
What makes glargine insulin long-lasting?
Forms crystals / microprecipitates in the subcutaneous tissues.
257
How does neostigmine result in GI prokinesis?
Acetylcholinesterase inhibition
258
What acid-base disturbance can cause exacerbation of hepatic encephalopathy?
Metabolic alkalosis — NH4+ is converted to NH3 (the extra H+ is being buffered) and the non-ionized NH3 can cross the BBB.
259
Most common signs of HE in cats:
Ptyalism, aggression, seizures
260
How can multiple myeloma result in decreased platelet function?
Hyperviscosity syndrome / hyperglobulinemia
261
What disease can be misdiagnosed as lymphoma / lymphocytic leukemia based on PARR?
Ehrlichia
262
What is the most common immune molecule associated with IMHA?
Broadly speaking, what can happen when IgM is present?
IgG is most common - this frequently results in extravascular hemolysis.
When IgM is present, intravascular hemolysis can occur — this relates to IgM’s ability to trigger complement more easily via the classical activation pathway.
263
What medication is contraindicated in patients with traumatic brain injury?
Methylprednisolone / corticosteroids
Shown in people to have worse outcomes — extrapolated to dogs
264
What is the most specific means of diagnosing feline asthma?
BAL that has >25% eosinophils
(normal cats may have up to 25% eosinophils on BAL so it needs to be above this)
265
What is the major side effect of using cisplatin in cats?
Pulmonary edema
266
What is the pathophysiology for botulinum toxin?
The toxin is ingested, and absorbed from the GIT. It travels in the bloodstream until it makes way to nicotinic cholinergic synapses at the NMJ. The toxin gets uptaken into axon terminal, where part of the toxin (light chain specifically) prevents SNARE proteins from allowing acetylcholine to be released into the NMJ.
267
What has the greatest effect on resistance?
Blood vessel (or airway) radius
Resistance is inversely proportional to radius, to the fourth power.
268
What is the ideal diet for a diabetic cat?
High protein, low carb
269
What enzyme in the adrenal cortex is stimulated by ACTH?
Cholesterol desmolase
270
What channels are responsible for SA node automaticity?
Funny / slow sodium channels, and slow calcium channels
271
What molecule is highly concentrated in pancreatic fluids, and how does it get there? What is the osmolarity of pancreatic fluid?
Bicarbonate, via exchange with chloride.
Iso-osmotic.
272
What is mesna?
A medication that can be given with cyclophosphamide or ifosfamide to prevent hemorrhagic cystitis.
273
What is a major goal to achieve within 6 hours when treating sepsis?
BP MAP >65
274
What drug should not be given in combination with theophylline? Why?
Enrofloxacin
Theophylline is metabolized by a CYP1A2 enzyme that is inhibited by fluoroquinolones, and when these two drugs are co-administered, theophylline toxicity can occur.
275
Why do patients with CKD develop PU/PD?
Solute overload in the ultrafiltrate results in an osmotic diuresis
276
What is unique about the neutrophils present in effusions associated with FIP?
Non-degenerate (as opposed to what would be expected in a septic effusion)
277
What is a tell-tale sign of a hemophagocytic histiocytic sarcoma?
Hypocholesterolemia
278
What organ system is most often affected by alfatoxicosis? What is the toxin produced by? How is it acquired?
Liver - jaundice, hepatopathy (ALT>ALP), and coagulopathy are common
Toxin is produced by Aspergillus flavors
Most commonly acquired via ingestion of contaminated food
279
What is the carrier for copper in the blood called?
Ceruloplasmin
280
What are four antibiotics that will cross the blood prostate barrier?
TMS
Chloramphenicol
Fluoroquinolones
Clindamycin
281
What are four possible side effects of TMS, and what breed of dog is at more risk for these complications?
Hypothyroidism, KCS, IMPA, and blood dyscracias
Dobermans
282
What is the most common cause of discospondylitis in dogs? Other common causes?
Staphylococcus
Streptococcus
E coli
Brucella
Aspergillosis
283
The most common bacterial pneumonia in cats?
Mycoplasma
284
What is the mechanism of action for orlistat?
It inhibits pancreatic lipases, preventing triglyceride breakdown in the GIT, thus limiting their absorption. It also promotes satiety.
285
What is the most common lab abnormality associated with Hepatozoon canis? Americanum?
H. canis — anemia
H. americanum — neutrophilic leukocytosis
286
What is the most common cause of necrolytic migratory erythema in dogs? People?
In dogs —> hepatic disease (can also be seen with phenobarbital - probably liver associated)
In people —> secondary to glucagonomas
287
What is the most common brain metastasis?
Hemangiosarcoma
288
How does diazoxide result in less insulin release and what disease is it commonly used in?
Diazoxide activates the ATP-K channel allowing it to stay open. This lets potassium leave the cell, hyperpolarizing it. This means that the VGCC don’t let calcium in, and then insulin vesicles aren’t triggered to be released.
Insulinomas
289
What is the likely diagnosis of a dog with weight loss / diarrhea and hypocobalaminemia?
What is this same dog had elevated folate levels instead?
Inflammatory bowel disease — commonly associated with low B12
Antibiotic responsive diarrhea — commonly associated with high folate levels
290
What is the most potent stimulator of aldosterone?
Hyperkalemia
291
What infectious disease diagnostic test requires the use of live organisms?
Leptospirosis MAT
292
What chemotherapy medication is used to treat patients with erythrocytosis?
Hydroxyurea
293
How much more potent is dexamethasone than prednisone?
7-10x
294
What is the most sensitive diagnostic test for Bartonella in dogs?
PCR +/- concurrent enrichment culture (and possibly up to 6-8 weeks in a media called BAPGM)
295
What are the two most sensitive diagnostics for MMM?
Temporalis muscle biopsy — chronic stage may reflect just fibrosis
2M antibody — may not be present in patients treated after 7-10 days
296
What is the stage of infection in cytauxzoonosis associated with vascular obstruction?
Schizonts (in monocytes)
297
What is a classic bloodwork finding associated with ethylene glycol toxicity?
Elevated osmole gap — the EG metabolites act as unmeasured osmoles
298
What is the diagnosis?
Adult female spayed dog with following vaginal cytology:
- parabasal cells / non-cornified nucleated epithelial cells
- both degenerative and non-degenerative neutrophils
- extracellular bacteria
Stump pyometra
299
What is the difference between relapse and re-infection in regards to UTI?
Both happen within 6 months
Relapse — same infectious organism
Reinfection — different infectious organism
300
MOA for carbon monoxide toxicity? Cyanide?
CO — binds with lots of affinity to hemoglobin so that oxygen can’t bind
Cyanide — disrupts electron transport chain via binding to cytochrome C, preventing ATP production
301
What is the MOA for strychnine toxicity?
Inhibition of glycine, allowing for neuronal dis-inhibition, resulting in tetanus.
Similar to tetanus from clostridial toxicity, strychnine inhibits the function of Renshaw cells in the spinal cord, which function to suppress alpha motor neurons via glycine.
302
What infectious organism is associated with tracheal nodules / masses? What is it treated with?
Oslerus osleri
Fenbendazole
303
Osmosis due to protein is related to what property?
Number
304
What is the most potent stimulus for H+ secretion in the kidney?
Elevated blood pCO2 levels
305
How does growth hormone influence carbohydrate, lipid and protein metabolism?
Decreases carbohydrate usage
Increases lipid metabolism
Increases protein anabolism
306
What amino acid stimulates insulin release?
Alanine
307
In what location are bile acids conjugated?
In the hepatocytes — remember conjugation is a phase II hepatic metabolic process, so it has to happen within the hepatocyte
308
What is the purpose / function of T tubules?
They take the action potential (excitation) and allow it to travel throughout the myofiber rapidly so that contraction can occur — promotes excitation-contraction coupling
309
What are J receptors and where are they located?
Full name = juxtacapillary receptors
They are located in the alveoli, and sense pressure within the pulmonary capillaries, and can also be stimulated by pulmonary infiltrates. They contribute to dyspnea and tachypnea responses in patients with congestive heart failure and pulmonary disease.
310
Which prostaglandin is most important in protection of gastric mucosa?
PGE2
311
What is a crucial pharmacokinetic value that is necessary to know in order to determine drug dose?
Volume of distribution of the drug
312
What is Slentrol / dirlotapide?
A weight loss drug for dogs. It causes fat to accumulate within enterocytes, preventing its absorption, and causing less lipoproteins to be released into the bloodstream.
313
What is the mechanism of action of ondansetron?
5HT3 receptor ANTAgonism
314
What is the MOA for gabapentin?
Inhibition of voltage gated calcium channels (very similar to pregabalin)
315
What determines the specificity of a PCR?
Primers
316
A PARR from a lymph node aspirate shows multiple bands — what is this consistent with?
Non-specific inflammatory disease
317
What medication acts on mTOR?
Sirolimus - aka rapamycin
318
What is the most consistent finding associated with a stress leukogram?
Lymphopenia
319
Explain the concept of Gompertzian growth.
Smaller tumors grow more quickly and are therefore more susceptible to chemotherapy.
320
How does hemolysis influence serum iron levels?
Increases them
321
What is the relationship of type A blood to type B blood?
Type A blood is dominant to B
322
What is the MOA of mitoxantrone?
Inhibition of topoisomerase II and DNA intercalation
323
Why can ephedrine be used to treat urinary incontinence?
It is a non-selective alpha and beta adrenergic receptor agonist, and can cause urethral sphincter tightening.
324
Reportedly, what percent of animals that have CVAs are hypertensive?
30%
325
What is the diagnostic test of choice for diagnosing cryptococcus?
Latex agglutination
326
What tick is the vector for Anaplasma phagocytophilum?
Ixodes
327
An FIV positive cat gives birth to kittens that test FIV positive as well. What is the best course of action?
Isolate the kittens and retest them in 6 months. The positive test result could be a result of MDAs or true infection, and at 6 months time, no more MDAs should be present to help make it more clear what a positive result means.
328
What cell does histoplasmosis infect, and what is a common cytologic means of diagnosis?
Macrophages, rectal scrape
329
What is the diagnosis and treatment in a young cat with an acute hemolytic anemia and epicellular RBC parasites?
Mycoplasma hemofelis
Doxycycline +/- pradofloxacin
330
What is kallikrein, what does it bind to, and what molecule does it make?
It is an inactive enzyme in blood/tissues that is activated by inflammation. It binds to neurokinin-1 receptor and produces bradykinins which result in vasodilation and increased vascular permeability.
331
Mutations in TLR4 will do what to risk of sepsis / gram negative infections?
Increase
332
What type of macrophages are M2, and what cytokines increase conversion to M2?
Anti-inflammatory
IL 4, 10 and 13
333
What two medications are indicated in the treatment of salmon poisoning disease?
Doxycycline and praziquantel
334
Phemphigus folieaceus is characterized by what type of lesions, especially the drug induced version?
Vesiculobullous lesions associated with the mouth (but can include haired skin and paw pads).
335
How does glucagon influence gastrointestinal motility / peristalsis?
Decreases it
336
What chemotherapeutic medication has a specific antidote?
Methotrexate
337
What is the function of leukotriene B4?
Increase neutrophil recruitment
338
What red blood cell morphologic feature can be seen in DM, hyperthyroidism, and lymphoma?
Heinz bodies
339
What is bilirubin bound to in the bloodstream?
Albumin
340
What treatment option for NP polyp is associated with the lowest rate of recurrence?
Ventral bulla osteotomy
341
What is a possible side effect of administering growth hormone to dogs?
Diabetes mellitus
342
What is the pathophysiologic mechanism for PU/PD in liver disease?
Decreased cortisol metabolism
343
Explain a T3 suppression test.
Normal cat - giving T3 should decrease TSH and T4.
344
True/false: blastomycosis is associated with hypercalcemia
True
345
When are cryptosporidial organisms infectious?
Immediately after being passed in feces
