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ACVIM Certifier > Seminal articles and consensus statements > Flashcards

Seminal articles and consensus statements Flashcards

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1
Q

what would be considered third line treatment for management of status epileptics?

A

anaesthetic drugs (1. ketamine 2. propofol 3. barbiturates 4. inhaled anaesthetic gas)

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2
Q

Define the critical change value for a biomarker?

A

Critical change value is the percentage (or concentration) that a biomarker must change between sequential measurements to be considered a clinically relevant alteration and not merely a reflection of biological or analytical variability.

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3
Q

what is the ideal sample size for calculating a RI for a quantitative biomarker?

A

n = >120

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4
Q

Canine fecal alpha1-proteinase inhibitor may be falsely reduced in which situations?

A

chronic GI protein loss (as will deplete systemic a1PI levels) (serum to fecal a1PI ratio can improve dx accuracy) , caution if increased in <6-12 months old animal, caution also with interpreting in steroid tx animal

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5
Q

fecal IgA concentrations may be increased in which breed of dog with chronic GI disease?

A

German Shepherd

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6
Q

what change in CRP may be considered clinically relevant?

A

a 2.7 fold increase or decrease

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7
Q

Seropositivity for which inflammatory biomarker may indicate renal and gastrointestinal protein loss in Soft Coated Wheaten Terriers?

A

pANCA (Perinuclear anti-neutrophilic cytoplasmic antibodies)

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8
Q

which breeds may have mast cell degranulation and associated fecal N-methylhistamine increases with chronic inflammatory enteropathy?

A

Norwegian Lundehunds and Soft Coated Wheaten Terriers

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9
Q

Calprotectin is a ligand for which toll-like receptor?

A

TLR 4

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10
Q

Which DAMP molecule is not impacted by steroid treatment and if greater than or equal to 490 ng/g can distinguish dogs requiring anti-inflammatory or immunosuppressive tx from those with food responsive enteropathy?

A

Calgranulin C (S100A12) (whereas calprotectin is affected by steroid tx)

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11
Q

genetic polymorphisms in which gene were detected in Boxer dogs with granulomatous colitis?

A

NCF2 gene

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12
Q

levels of which lymphocyte were reduced in duodenal biopsy specimens from dogs with chronic inflammatory enteropathy?

A

regulatory T cells

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13
Q

what duration of clinical signs is used to class feline upper respiratory tract disease as chronic?

A

> 10 days

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14
Q

what criteria are needed for intermediate vs high probability of pulmonary hypertension?

A

Intermediate: - echo signs at 2 anatomic sites regardless of TRV, or TRV 3.0-3.4/s but don’t have PH observed at >/=2 anatomic sites, or TRV >3.4m/s but don’t have PH at >/=1 anatomic site
High: TRV >3.4m/s with echo signs at >/=1 anatomic site, or TRV 3.0-3.4m/s with echo findings at >/=2 anatomic sites or TRV </=3.0 m/s but with echo findings at 3 anatomic sites

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15
Q

what is the simplified Bernoulli equation for converting TRV to pressure gradient?

A

pressure gradient mmHg 4x veolicty^2

mild PH = 30-50 mmhg
moderate 50-75
Severe >75

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16
Q

When surveyed, what percentage of North American dogs are DEA 1 +ve , Kai1 and Kai2 +ve?

A

59.6% DEA1+ , 94% Kai1+/Kai2 -ve , 5% Kai1-ve/kai2-ve, 1% kai1-ve/kai2 + , none were Kai1+/Kai2+
- Take home Kai1+/2-ve most common combination
-No relationship between kai1/2 and other blood types tested
- Plasma from DEA1 -ve/ kai1-ve and kai2-ve contained no detectable alloantibodies against any of these respective blood types

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17
Q

Which breeds in North America appear more likely to be Kai1+/Kai 2- and Kai1-ve/2+ve ?

A

Greyhounds more likely to be Kai 1+
Lhasa apso maybe more likely to be Kai 2+ (also in Uk Study, in Korea however mastiffs has 17% Kai 2+ frequency)

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18
Q

What breeds of dogs have been reported as more likely to be Dal -ve?

A

Dalmations, Doberman pinshcers, Shih Tzus

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19
Q

What is the mean age at time of diagnosis of chyloabdomen in dogs and cats ?

A

Cats 11.3 years , Dogs 6.9 years

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20
Q

What are the most common clinical signs in dogs and cats with chyloabdomen?

A

Lethargy and anorexia most common in both, less commonly abdominal distension. Chylothorax common comorbidity.

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21
Q

What was the most common underlying diagnosis in dogs and cats with chyloabdomen and how long do they survive?

A

Malignant neoplasia most common underlying diagnosis (45% cases combined cats and dogs), less commonly cardiac disease (24.5%), lymphangiectasia (15%), or pancreatitis (9%) . Neoplasias identified: carcinoma > haemangoisoarcoma, sarcoma of undetermined origin, lymphoid (lymphoma vs leukaemia). MST from dx of chloabdomen 31 days overall, 8 days if malignant neoplasia, 73 days for patients without neoplasia

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22
Q

What stain can be used to confirm chylous effusion?

A

Sudan staining to detect chylomicrons

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23
Q

Is there a sex predisposition to chyloabdomen?

A

Significantly higher proportion female dogs , no obvious sex predisposition in cats

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24
Q

No breed predisposition for chyloabdomen has been reported, in contrast what dog breed and what cat breed are recognised as over represented for chylothorax?

A

Dogs - Afghan Hound
Cats- Siamese

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25
How may the triglyceride concentration of cats and dogs differ in chyloabdomen?
Cats higher median abdominal fluid TG conc (1,404 mg/dL) compared with dogs (155 mg/dL)
26
What abdominal fluid criteria may be considered to diagnose a chyloabdomen?
At least 1 of following abdominal fluid criteria: - Total lipid concentration >4g/L Triglyceride concentration greater than serum triglyceride concentration detection of chylomicrons by Sudan stain updatek cytologic features consistent with chylous effusion (e.g. modified transudate with a predominance of noninflammatory mononuclear cells, typically lymphocytes) -> NB limitation of study on chyloabdomen was above inclusion criteria- possibility that included patients without chyloabdomen or missed patients that did have
27
What type of Hepatic encephalopathy is associated iwht ALF?
type A
28
what percentage of dogs with ALF have signs of HE? What percentage have increased ammonia?
signs of HE = 57% increased NH3 = 63%
29
what causes of ALF have been reported most commonly in dogs?
63% no identifiable cause, but toxin exposure may be suspected, 37% cause identified (27% neoplasia, 8% leapt, 2% schema)
30
what is the definition of ALF in dogs?
development acute clinical signs and severe hepatocellular injury with concurrent hyperbilirubinaemia and coagulopathy (PT >1.5x RI). HE is NOT a required diagnostic finding (due to difficulties identifying early stage HE in dogs/ cats)
31
what percentage of dogs with ALF have spontaneous haemorrhage ? What percentage have evidence of thrombosis?
Haemorrhage - >50% Thrombosis - 8%
32
what neoplasia is most responsible for ALF in dogs?
85% neoplastic cases were round cell (lymphoma , poorly differentiated round cell neoplasia, MCT) , carcinoma also seen
33
what percentage of dogs with ALF survive to discharge? What are good px indicators?
14.3% survive to discharge High serum ALT at presentation and >50% decrease over several days good px indicators (speculation that survivors had more viable hepatocytes with subsequent greater ALT leakage or due to the fact that toxic aetiologies that inhibit ALT were more likely in non-survivors (e.g. aflatoxins, microcystins)
34
what complications are seen in association with canine ALF?
Complications included ascites (20/49, 41%), bleeding tendencies (14/49, 29%), pancreatitis (12/49, 24%), and acute tubular necrosis (11/49, 22%).
35
Which species of borrelia are most prevalent in USA and Europe and what species of tick are responsible for spread?
Borellia burgdorferi spp (at least 30 subtypes/ strains) responsible for Lyme dz in USA dogs In Europe co-infections with Bb plus other Bb-senso late strains can occur Other Bb-sl species causing human Lyme dz don't appear to affect dogs Vector - Ixodes scapulars in Northeastern/ mid Atlantic , upper mid western states and adjacent areas of Canada I. pacificus = pacific states and canada I. ricinus in Europe
36
How does Borrellia species transmission occur?
Most transmitted transstadially within tick, some in relapsing fever croup (e.g. B. miyamotoi) transmitted transovarially
37
Describe the life-cycle of Ixodes and how is this relevant to geographical persistence and spread of borrelia?
2 year, 3-state (larva, nymph and adult) life cycle feeding on variety of hosts. One blood meal occurs per state. Uninfected tick larvae hatch to feed on Borrelia infected reservoir hosts , principally mice/ squirrels/ shrews/ birds (I. scapulars) and lizards (i. Pacific's). In endemic areas, prevalence of borellia in nymphal/ adult ticks can reach 50%. Borrellia infection often occurs in warmer months due to questiong behaviour of ticks. Deer important for spread.
38
What presentation has been described in Boxer puppies with Borrelia positive immunohistochemistry?
Fatal myocarditis
39
which breed of dog in Europe are more often borrelia seropositive?
Bernese Mountain dog (and often co-infected with A.phagocytophilum)
40
Antibodies against what antigens indicate natural exposure to borellia (because they are not present in any vaccines)? What antibodies may vaccination induce?
Natural exposure- Abs against C6 (4DX and quantitative), Variable major protein like sequence expressed (VlsE) and OspF Vaccination - OspC , OspA
41
how should Lyme arthritis be treated?
4 weeks antibiotics (doxycycline preferred)
42
what borrelia testing is advised for healthy dogs?
recommended to screen all healthy dogs that live in, live near or travel to Bb endemic areas in North America for Bb antibodies. Recommended to screen all bb-seropositive dogs for proteinuria NB vast majority nonclinical non proteinic Bb seropositive dogs never become unwell and therefore routine antimicrobial tx not recommended
43
how can borrelia be prevented?
tick control! No clear consensus on vaccination - healthy seronegative dogs in endemic areas may be vaccinated, healthy non clinical non proteinuirc seropositive dogs may be vaccinated if risk of reinfection is high. Not recommended to vaccinate sick or proteinuric dogs
44
define volume-reposnsive vs intrinsic AKI?
intrinsic AKI refers to structural damage to the renal parenchyma, volume-responsive AKI is characterised by a transient reduction of renal function, which can be reversed after short-term fluid administration Volume responsive AKI = increase in urine production above 1ml/kg over 6 hours of adequate ivft, or a decrease in sCr concentrations to baseline over 48hrs intrinsic AKI = persistent azotaemia for longer than 48hours, inappropriate oligo/anuria despite appropriate fluid therapy once any volume deficit had been restored and euvolaemia achieved, or both
45
what diagnostic differences may be seen in dogs with intrinsic AKI vs volume-responsive AKI?
Intrinsic AKI - sig increased SBP, AKI grade, sCr, urea, magnesium, phosphorus, tail, anion gap, FE of electrolytes and UPC and sig decreased blood pH, iCa, USG, uCr and UCr/sCr compared with dogs with volume responsive AKI and control dogs Dogs with vol-r Aki had sig higher lactate concentration and uUA/uCr than dogs with intrinsic AKI and controls
46
how may fractional excretion of electrolytes differ between intrinsic and volume-responsive AKI?
- Cut off values of FENa and UCr/Scr in line with human recommendations may be used for diagnosing AKI; volume responsive AKI is low (<1%) FENa and higher FE of electrolytes in intrinsic AKI FeNa was NOT different between volume-responsive AKI and control dogs - Fractional excretion of urea was NOT different between intrinsic and volume-r AKI and control dogs - Sig increases in blood lactate concentration and uUA/Ucr documented in v-r AKI vs intrinsic and healthy dogs -
47
sepsis induced AKI occurs in what percentage of dogs with abdominal sepsis? What impact does this have on mortality? What offers best opportunities of improved patient outcome?
12% of dogs worse survival (only 14% dogs with sepsis that have AKI survive to discharge) early recognition best chance of improved outcome
48
what are the RIFLE criteria to classify AKI? (Risk of Renal dysfunction, injury to kidney, failure or loss of kidney function and end-stage kidney dz) What is mortality of dogs fulfilling different RIFLE criteria/
RISK - serum creat increase x1.5, UOP <0.5ml/kg/hr for 6hr INJURY- sCr increase x2, UOP <0.5ml/kg/hr for 12 hr FAILURE- sCr x3 or >0.5mg/dL (44.21 umol/L) if baseline serum creat >4.0mg/dL (354 umol/l) , UOP <0.3ml/kg/hr for 24 hr or anuria for 12hr LOSS- complete loss function >4 weeks END STAGE - end stage renal dz RIFLE-R dogs had 24% mortality, RIFLE-I dogs had 41% , RIFLE-F 79% (and F dogs had MST 3 days vs R 9 days)
49
what histological changes are expected in sepsis-induced AKI?
only mild to moderate patchy tubular changes with little evidence necrosis despite marked reduction in kidney function (contrasting marked histopath changes expected with other forms AKI)
50
how is the tubuloglomerular feedback system implicated in epithelial dysfunction and reduced GFR in AKI?
tubuloglomerular feedback mechanism activated in kidney -> tubular dysfunction will result in a lack of NaCl reabsorption in PT. This will be detected as increase in Na and Cl delivery to the macula densa cells in the DT. Through tubuloglomerular feedback mechanism, this increased tubular NaCl will result in widespread vasoconstriction of afferent arteriole and a subsequent drop in GFR that ultimately gives rise to clinical manifestations of AKI, decreased UOP and increased sCr. Disruption of tight junctions also implicated in epithelial dysfunction.
51
which urinary biomarker may be able to identify AKI 12 hours before changes in serum creatinine (or serum levels of this biomarker) occurred?
NGAL
52
what fluids should be avoided in AKI patients?
colloids hydroxyethyl starches Fluids containing supra physiological conc of chloride (e.g. 0.9% NaCl)
53
which vasopressor is associated with an increased frequency of adverse events and no benefit to the kidney? Which vasopressor should be considered first line for septic patients (with AKI) ?
dopamine Norepinephrine first line
54
Why has N-acetylcysteine been theoretically proposed as a treatment in sepsis induced AKI?
Re-generates glutathione stores and known to be potent scavenger of ROS, also enhances NO availability , promoting vasodilation BUT no evidence to support use of NAC in AKI at present ...
55
how do intermittent haemodialysis and CRRT compare in terms of hospital and ICU mortality and renal recovery ?
No prospective veterinary studies but human literature suggests no difference
56
which novel biomarkers in AKI may aid differentiation of patient that would benefit from early RRT?
tissue-inhibitor or metalloproteinases-2 AND insulin-like growth factor-binding protein 7
57
when should immunosuppression be considered in a patient with glomerular dz?
severe , persistent or pgorssive dz with evidence of active immune pathogenesis on biopsy - when biopsy not available consider if source proteinuria clearly glomerular and drugs not otherwise contraindicated, breed/ age doesn't suggest familial nephropathy, amyloidosis deemed unlikely, creat >265 or progressive increasing or albumin <20
58
how long should dogs receive immunosuppressive therapy for glomerular dz before a change of tx considered?
8-12 weeks, then consider alternative drug, however if after 3-4 months a therapeutic response not achieved, consider discontinuing immunosuppressive tx. stable IRIS CKD 1/2 and glomerular dz. reevaluate 3-15d after a change in therapy, unstable iris sag 3/4 or glomerular dz within 3-5d of change in therapy Partial response 0 UPCR <0.5, creat <125, alb >25. Parital response - >50% reduction in UPCR, >25% reduction creat and >50% improvement albumin
59
what treatment trial should be pursued in any dog failing to respond to standard USMI therapy that has a urination pattern consistent with possible detrusor instability?
Trial oxybutynin
60
what is normal post voiding residual bladder volume? how can US be used to estimate bladder volume?
normal PVRV 0.2-1ml/kg, >3ml/kg abnormal , 1-3ml/kg interpret on case by case basis v= lxwxh x 0.52
61
what is the most common clinical sign in cats with chronic enteropathy?
weight loss
62
what IHC marker distinguishes low grade intestinal T cell lymphoma in cats?
CD3 positivity- in 63-74%
63
high expression of what marker of up regulation of signal transduction as an oncogenic marker is seen in LGITL cats?
Stat 5 (LGITL - 100% expression CD3, variable expression of STAT5 (0-44%), low expression ki67 and STAT3 and absent expression CD56)
64
what IHC marker indicates M-phase (cellular mitosis) ?
Ki67
65
what are IHC NK cell markers?
granzyme B , CD56
66
what are the chemotherapy excretion times in dogs for carboplatin, cyclophosphamide, doxorubicin, vinblastine and vincristine? What default position should be taken on handling excreta of patient that have received chemo?
Carbo - urine, faeces, saliva- 21 d Cyclophosphamide - urine - 1-4 d Doxo - urine - 21 d Vinblastine- urine - 7 d Vincristine - urine 3 days - Handle excreta as contaminated for minimum 48-72 hours post administration for IV and perhaps as long as 7d after PO
67
which bacteria were increased in the faecal microbiome of cats with GI lymphoma compared to IBD?
- Fusobacterium spp. (in ileal and colonic adherent mucus and combined colonic compartments - Bactericides sp. in ileal adherent mucus and 3 combined ileal compartments - There were significant correlations between fusobacterium spp. totals and CD11b+ cell and NF-kB expression
68
what is classed as B2 MMVD?
LA: Ao >/=1.6, LVIDDN >/= 1.7, breed adjusted VHS >10.5
69
what changes in iron status may be observed in cats with CKD?
TIBC lower in CKD vs healthy cats CKD cats with anaemia have lower percent transferrin saturation (TSAT) than CKD cats without anaemia No sig differences in ferritin concentration, iron concentration or TIBC between anaemic/ non anaemic CKD cats and no difference in Fe conc, ferritin conc or TSAT between healthy and CKD
70
where are apical sodium bile acid transporter mRNA and protein expressed in healthy dogs? how do these findings change in dogs with CIE?
mRNA expressed in enterocytes throughout intestinal (highest levels in ileum) , protein expressed in ileum, cecum and colon CIE - decreased expression of ASBT protein in the ileum which negatively correlated with histopath score
71
how to primary bile acids in faeces vary in CIE dogs?
higher (alongside a higher fecal dysbiosis index) (NB overall fecal bile acids not increased, but proportion 1ry is higher)
72
what faecal dysbiosis index changes are expected in cats with CKD?
significantly decreased fecal bacterial diversity and richness (e.coli qpcr however showed no sig difference in bacteria count between control and cod cats)
73
what uraemic toxin is increased in serum of cats with CKD?
Indoxyl sulfate (with no sig difference between stage 2 and 3/4 cats) P-cresol sulphate levels were NOT sig different between CKD and control cats Indoxyl sulfate - indoles produced by metabolism of dietary tryptophan by tryptophanase in intestinal bacteria such as e.coli, proteus and bactericides Cresol is generated from the partial breakdown of tyrosine and phenylalanine by many intestinal obligate or facultative anaerobes including genera bactericides, lactobacillus, enterobacter, bifidobacterium and clostridium

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