Flashcards in Vet Prep/ Soft tissue Deck (182)
A 1-year old female spayed Doberman Pinscher has presented after being hit by a car. Initial chest radiographs show mild contusions, and the patient appears to be otherwise stable. A right mid-shaft long oblique femoral fracture has been identified. Routine pre-operative blood work is unremarkable. A buccal mucosal bleeding test (BMBT) is elevated at 6 minutes. What will you administer prior to surgery?
A dairyman's favorite cow was bred by a new bull a few weeks ago and now his cow has pyometra. What agent is most likely responsible for causing the cow's pyometra?
The correct answer is tritrichomonas foetus. This organism is commonly associated with a post-coital pyometra in addition to causing early embryonic death. Campylobacter is a cause of early embryonic death but does not usually result in pyometra. Brucella will result in late term abortion. Leptospirosis is a cause of mid- to late-gestation abortions and not post-coital pyometras.
You perform a low-dose dexamethasone suppression test on a dog you suspect has Cushing's syndrome. The 4-hour blood cortisol level and 8-hour blood cortisol level are approximately equally elevated above the normal range. What can you conclude from this information?
The correct answer is you should run a high-dose dexamethasone suppression test. Elevated blood cortisol concentration 4 hours and 8 hours post low-dose dexamethasone administration is diagnostic for hyperadrenocorticism, but it does not allow differentiation between PDH and a cortisol secreting adrenal tumor. Dexamethasone is more rapidly metabolized in dogs with either type of hyperadrenocorticism (approximately 4 hours to metabolize as opposed to 30 hours in normal dogs). In PDH animals, the 4-hour post-cortisol concentration may sometimes be suppressed, whereas cortisol from adrenal tumors will not be suppressed after administration of a low dose of dexamethasone. A high-dose dexamethasone test will suppress a larger percentage of PDH patients (up to 75% will be suppressed, showing a decrease in cortisol after 4 hours). Less reliable tests to differentiate PDH from an adrenal tumor include endogenous plasma ACTH concentration or abdominal ultrasound.
You are examining a 7-year old Thoroughbred gelding for a 5-day history of anorexia and jaundice. Which of the following enzymes would you consider to be liver specific in the horse?
Sorbitol Dehydrogenase (SDH) and Gamma Glutamyl Transferase (GGT)
A dog presents to your clinic for fever and lymphadenopathy. You perform an aspirate and see large, bipolar staining coccobacilli. The owner mentions that he saw his dog eating a rat a few days ago. What is causing the dog's illness?
The correct answer is Yersinia pestis. In order to make this determination remember that Yersinia pestis is usually transmitted to cats and dogs as a result of ingesting infected rodents or via bites from the prey's fleas. Dog and cat fleas are poor vectors of Plague. Dogs usually recover and you may lance the "buboes" and flush it, but dispose of organic material properly.
You are starting insulin therapy for a newly diagnosed diabetic feline patient. Blood glucose is 520 mg/dl (60-120 mg/dl). Urinalysis shows 3+ glucose and is negative for ketones with a trace of protein. Which of the following tests should this patient and all diabetic patients receive upon initial diagnosis?
All newly diagnosed diabetic patients should have their urine cultured. Diabetics are prone to getting urinary tract infections due to the chronic presence of glucose in their urine. Any underlying infection can lead to insulin resistance and make regulation of diabetes difficult to achieve.
Blood pressure and ECG are good tests for all patients in general but aren't necessarily tests that are directly related to diabetes regulation.
A thyroid level should be checked in all older cats, for general health screening, but hyperthyroidism is not associated with diabetes mellitus. If a patient has diabetes which is difficult to control, concurrent hyperthyroidism should be ruled out.
Fructosamine level is helpful in trying to determine if a cat actually has diabetes if their glucose level is elevated and also as a follow up to determine regulation. Cats that have markedly elevated glucose levels, glucosuria, and clinical symptoms of diabetes do not necessarily need to have a fructosamine checked at the time of diagnosis.
You have encountered white muscle disease in a large commercial flock of sheep, and wish to examine the selenium status of the flock. You decide to collect samples. What samples should be collected in order to accurately assess the selenium status of the flock?
Whole blood from 20 random sheep to determine selenium levels
A relative calls you to ask how she can stop her 4-year old Cockapoo from begging for food at the table. You advise her not to pay any attention to the dog when it is showing this behavior. What behavioral principle is this?
Extinction of operant conditioning
Negative reinforcement occurs when a behavior is followed by the removal of an aversive stimulus thereby increasing that behavior's frequency. An example is a loud noise continuously sounding until a lever is pressed, upon which the loud noise is removed. This will encourage the behavior of pressing the lever.
Negative punishment, also called punishment by contingent withdrawal, occurs when a behavior is followed by the removal of a favorable stimulus, such as taking away a child's toy following an undesired behavior, resulting in a decrease in that behavior.
Avoidance learning is when a behavior results in the cessation of an aversive stimulus. For example, holding your ears to shield them from a loud, high-pitched sound helps avoid the aversive stimulation of that obnoxious sound.
Noncontingent reinforcement is the delivery of reinforcing stimuli regardless of the animal's behavior. This causes that behavior to decrease because it is not required in order to receive the reward.
You finish a spay procedure on a young kitten and she regurgitates upon recovery after her endotracheal tube cuff was deflated. You wipe out her mouth and she appears to recover uneventfully. The surgery otherwise went well. Two days later she presents with a temperature of 103.4 F (39.7 C), she is a little lethargic, and she has a mild increased respiratory effort. You suspect she may have aspirated and now has pneumonia post-operatively. You perform chest radiographs. Which type of lung pattern is most typical of aspiration pneumonia?
Pneumonia is most commonly characterized by an increase of pulmonary densities with a patchy or lobar pattern. Aspiration usually involves the right middle and cranial lung lobes.
One study indicated that the aspiration pneumonia distribution patterns depend on patient position at the time of aspiration. In ventrodorsal, dorsoventral and standing dorsoventral positions, the right cranial, middle, and left cranial lung lobes are prone to aspiration pneumonia.
Pleural effusion is fluid around the lungs which is not a pattern for pneumonia.
Caudodorsal pulmonary edema, also known as neurogenic pulmonary edema, is characterized clinically by a rapid onset of respiratory difficulty after a central nervous system insult. The four major causes recognized include head trauma, seizures, electrocution, and upper airway obstruction.
Bronchiolar pattern in cats is most typical of airway disease such as asthma; perihylar lymphadenopathy is more typical of fungal disease or neoplasia.
Immune-mediated hemolytic anemia is classically associated with which type of hypersensitivity reaction?
ype I (aka immediate) hypersensitivity reactions occur when re-exposure of an antigen results in an allergic reaction. The antigen is presented and causes B cell production of IgE antibodies.
Type II (aka cytotoxic) occurs when an antigen on a cell surface binds with an antibody and is then recognized by the body as being foreign. The antigen on the cell may have been a normal feature of the cell or it may have been acquired, such as a drug binding to the cell. Macrophages or dendritic cells then recognize the cell and "present the antigen" which then causes B cell proliferation and production of IgG and IgM antibodies. The antibodies bind to the cell and activate the complement cascade which results in cell lysis/destruction.
Type III (aka immune complex) occurs when there are more antigens than there are antibodies. The antigens float around in the circulation and multiple antigens may bind one antibody, thus forming an immune complex. Large complexes can be cleared by macrophages, but smaller ones may evade the macrophages.
Type IV (delayed type hypersensitivity) takes several days to occur and rather than being antibody-mediated, it is actually cell-mediated. Cytotoxic CD8+ T cells and CD4+ helper T cells recognize antigen that is in a complex with major histocompatibility complex 1 or 2. This results in proliferation and activation of the cells. Activated CD8+ T cells then destroy the antigen containing cells while activated macrophages release hydrolytic enzymes.
What is the holding layer of the stomach?
the submucosa. Use monofilament, synthetic, absorbable
Where should you incise the stomach?
An avascular area away from the pylorus
How should the stomach be closed?
Two layer - mucosa and submucosa with a simple appositional pattern, simple or continuous fine.
Then second layer : muscularis and serosa with an inverting pattern.
What is the normal size of the fundus? how can you tell if the stomach is distended?
Normal fundus 6 icsp suspect pathology
Which way does the stomach usually rotate in GDV?
90 to 360 degrees
Pylorus moves ventrally and to left,
Fundus moves to right.
How do you confirm gdv?
cannot identify pylorus on a right lateral, fundus distended.
What is an incisional gastropexy?
Antrum anchored to the body wall, which prevents pylorus moving. incise seromuscular layer of pylorus and transverse abdominus muscle and suture incision edges together.
What are the clinical signs of intestinal foreign bodies?
Vomiting, loss of appetite, abdominal discomfort, poss diarrhoea, poss melena.
Where should you incise the intestine?
Antimesenteric surface. relatively avascular. Not over FB. - distally in healthy bowel.
What is the holding layer of the intestine?
What is the common cause of intussuception?
in young animals - common, spontaneous, link to enteritis/worm burden.
In mature animals - uncommon, usually secondary to other pathology such as masses or peritonitis.
What is the common site for intussuception?
Jejunocolic at ileocaecocolic junction common.
What are the most common bacteria types found in the colon?
Gram negative anaerobes. Perioperative antibiotics indicated.
Which sort of patient can a subtotal colectomy be recommended for?
Extremely successful for management of feline megacolon. removes 90-95% of the colon & removes the ileocaecocolic junction. DOGS DO NOT TOLERATE THIS SURGERY. Post operative diarrhoea is inevitable. manageable within 12 weks usually.
What signalment is usually present with apocrine gland adenocarcinomas?
Where should you perform a cystotomy?
Ventral - readily accessible, visualise the trigone well, no increased risk of leakage. Prior to incision, perform cystocentesis to reduce spillage.
what breeds is urethral prolapse more common in ?
Young male dogs, sexually intact, brachycephalip breeds, tx- reset prolapse and castrate.
What is the most common cause of congenital urinary incontinence in dogs?
What are the causes of urge incontinence?
Unsuppressible urination as bladder fills - due to inflammation, reduce bladder volume or polyuria, e.g cystitis, urolithiasis, neoplasia, systemic causes of polyuria.
What is sphincter mechanism incontinence? Which patients does this affect?
Majority of patients are neutered female dogs. it responds to oestrogen supplementation. Many affected patients are obese. Early spay more common. Common in dobermans, setters, rottweilers. continent for most of the day but urine passively leaks when lying or sleeping. continuous dribbling of urine is uncommon. May have concurrent UTI - exclude. A -adrenergic agonists used as tx.
What is juvenile smi?
Sphincter mechanism incompetence seen in female entire bitches, before first oestrus. it is often associated with ectopic ureters. but 50% resolve after first oestrus. Treat concurrent UTI.
What is colposuspension ?
Repositions the bladder neck forwards, incraeses pressure at bladder neck. used to treat SMI. This is performed even in patients that do not have intra pelvic bladder with effect, the mechanism of action is not fully understood. The cranial vagina is anchored to prepubic tendon.
what is the typical presentation with ectopic ureters?
Females > males. Retrievers, poodles, huskies. typically incontinent since birth. occasional adult onset presentations. there is continual dribbling of urine. may have urine scald. if unilateral may be able to pass a stream of urine. if bilateral may have no bladder filling.
What are the signs of prostatic disease?
Alteration in faecal shape
What signalment is prostatic neoplasia common in? what is the prognosis?
Aggressive, locally invasive, early metastasis.
Why should you give antibiotics when doing liver surgery?
Anaerobic (clostridial) residual population, may proliferate in ischaemic liver tissue.
What are the possible systemic effects with portosystemic shunts?
stunting, failure to thrive, hypoalbuminaemia, hepatic encephalopathy, dullness, aggression, failure to house train, seizures, PUPD, urate crystalluria, Liver dysfunction on biochemistry and high postprandial bile acids.
What type of shunt are small breed dogs predisposed to?
What type of shunt are large breed dogs predisposed to?
What are the possible complications with a Total ear canal ablation and lateral bulla osteotomy?
Facial nerve damage, vestibular disease, horners syndrome, deafness, altered ear carriage, para aural abscess,
What is a cholesteatoma?
An epidermoid cyst lined by keratinised epithelium containing keratin debris.
What suture material should you use for ovarian pedicles?
synthetic, absorbable, e.g PDS
What are the land marks for flank ovariohysterectomy in cats?
Wing of ilium, greater trochanter, spay site - triangle
What bacteria is usually involved in a pyometra?
What does blood in the urine stream reflect?
Blood at the start of urination may relflect urethral, vaginal, penile or preputial disease, whereas blood at the end may reflect renal, ureteric or bladder disease, blood throughout the stream may be present with upper or lower urinary tract disorders. Dogs with prostatic disease may drip blood independent of urination.
Which breeds are predisposed to polycystic kidney disease?
What are the signs of an acute renal infection?
PUPD, haematuria, lethargy, vomiting, anorexia, renal pain, pyrexia
What is a good empirical choice of antibiotic for pyelonephritis?
Amoxicillin-clavulanate - it is bactericidal, concentrates in urine and has a broad spectrum of efficacy.
What does PLE lead to? What is the name of these three signs together?
significant proteinuria will also progressively lead to hypoalbuminaemia and hypercholesterolaemia. This is known as the nephrotic syndrome and these patients may be hypercoagulable due to loss of antithrombin III in the urine.
Which breeds are predisposed to amyloidosis?
Sharpei, abysinnian siamese and oritental cats. In cats the amyloid tends to be deposited within the medulla so the degree of proteinuria may not be so extensive.
What is fanconi syndrome?
A primary tubular disorder - may be congenital in the basenji (most commonly affected dog), may also be acquire with infections such as leptospirosis. Renal tubular reabsorption is affected resulting in a loss of variable amounts of glucose, amino acids, bicarbonate and electrolytes in the urine. Fanconi syndrome may be suspected in a PUPD patient with glucosuria but not hyperglycaemia.
What is primary renal glucosuria?
May be congenital or acquired secondary to tubular damage. diagnosis is based on identifying persistent glucosuria in the absence of hyperglycaemia or loss of other substances in the urine.
What is renal tubular acidosis?
May be congenital or acquired.
Proximal renal tubular acidosis arises when the proximal tubules cannot reabsorb bicarbonate ions and is often part of fanconis syndrome. This results in mild acidaemia due to compenstatory ccid secretion by the distal renal tuules and a urine with a ph of 5.5-6.0.
Distal renal tubular acidosis arises when the distal tubules cannot secrete hydrogen ions. as this is a more significant factor in acid base homeostasis the metabolic acidosis arising is usally marked and the urine ph > 6.0
What are the common causes of AKI in veterinary patients?
Ischaemia during anaesthesia, hypotension, hyperviscosity
Infarction - thrombi and emboli
Toxins - ethylene glycl, lilies, grapes, raisings, heavy metals, organic compounds, haemoglobin, myoglobin, envenomation, melamine.
Infectious diseases - leptospirosis, pyeonephritis, borrelia burgdorferi, feline infectious peritonitis
Nsaids, aminoglycosides, amphotericin B, cisplatin, radiographic contrast agents, sulphonamides, tetracyclines, ACe inhibitors.
Rodenticides (calciferol containing), psoriasis creams, neoplasia all cause hypercalcaemia.
What are the clinical signs of AKI?
short history of signs such as anorexia, nausea, lethargy, vomiting, diarrhoea, weakness, altered mentation. PUPD not always present if patient is anuric/olgiuric. Uraemic breath and oral ulceration may be detected. Renal palpation may reveal painful & enlarged kidneys.
What does haematology/biochem show with aKI?
Anaemia more suggestive of chronic kidney disease
Phosphorus elevated. If calcium also elevated - suspiscious of vitamin D toxicity.
Potassium may be elevated
Frequently acidotic - inability of renal tubules to excrete hydrogen ions.
Glucosuria in the absence of hyperglycaemia is supportive of renal tubular damage, as is the presence of casts on urine sediment.
What can be given to a patient that is hyperkalaemic whilst waiting for fluid therapy to take effect?
Calcium gluconate may be given to stabilise the cardiac mebrane whilst therapies ot lower potassium take effect. fluid therapy will dilute hte potassium to a certain extent, and insulin and dextrose saline can be used to stimulate intracellular shift of potassium. sodium bicarbonate can also be given to encourage this or address severe acidaemia.
What UPC would classify as proteinuric in dogs and cats?
cats >0.4 (borderline 0.2-0.4)
Dogs >0.5 (0.2-0.5 borderline)
What management can be used to slow progression of chronic kidney disease?
Protein restiction - low/normal may be adequate for most patients.
Increased fat - calories if not willing to eat
Alkalinisation - potassium citrate or sodium bicarb.
Fatty acids - omega 3 and 6 fatty acids in dogs.
Atioxidants- oxidant damage to protein lipids and dna may play a role - so anti oxidants such as vitamin E , carotenoids or flavanoids may prove beneficial.
Sodium restriction generally not advocated as there is little evidence it contributes to hypertension.
Potassium levels are usually kept normal as patients may be hyperkalaemic or hypokalaemic. supplement if needed.
Use of a renal diet advocated from iris stage II onwards.
What can be used to reduce phosphate levels in CKD?
Phosphate binders in the diet which act within the GI tract to reduce absorption of phosphate - aluminium salts, calcium salts, sevelamer hydrochloride, lanthanum carbonate.
How can proteinuria be reduced in CKD?
Dilation of the efferent renal arteriole which reduces glomerular hypertension, reduction of angiotensin II which has an effect on systemic hypertension, may reduce pdocyte hypertorphy and reduce renal fibrosis, reduction of aldosterone which may reduce renal fibrosis, may increase appetite and feeling of well being, may cause an increase in azotaemia as a result of reduction in GFR. Proteinuria has been shown to be deleterious and associated with a poorer outcome as it may axercerbate tubulo interstitial damage.
What are the best treatments for systemic hypertension in CKD?
ACE inhibitors in dogs
Calcium channel blocker amlodipine besylate being used in cats. (can be combined with an ACE inhibitor)
Why do patients with CKD become anaemic?
Decreased erythropoietin production by kidneys
Increased blood loss form GI bleeding - uraemic gastritis
decreased life expectancy of circulating RBCs
Suppression of bone marrow by uraemic toxins such as PTH
Decreased precursor availability form anorexia
Options for treatment include erythropoietin, darbopoietin and blood transfusion.
What is the composition of struvite uroliths?
Magnesium ammonium phosphate hexahydrate.
List the most common urolith types in order.
Dogs - struvite, calcium oxalate, urate, silica, cysteine.
Cats - calcium oxalate, struvite, urate - the rest v uncommon.
What are the clinical signs of urolithiasis?
In the urethra - stranguria, dysuria, anura, abdominal discomfort, uraemia.
In the bladder - signs similar to UTI such as haemturia, dysuria and pollakiuria.
List the typical urolith radiopacity, in order of decreasing radiodensity -
Most radio dense and obvious on a radiograph > Struvite, calcium phosphate, oxalate, cystine, urate.
which types of stones typically respond to dissolution?
Struvite and urate.
Calcium oalate, calcium phosphate and silica are resistant to dissolution.
Why do dogs get struvite uroliths?
Struvite calculi usually follow infection with urease producing organisms such as staphylococcus, proteus or ureaplasma. urease is an enzyme that breaks down urea, causing the release of ammonium and bicarbonate ions into the urine. supersaturation with ammonium ions promots struvite formation, while bicarbonate ions alkalinise the urine, which further enhances the presence of alkaline urine. Attempted dissolution may be indicated in stable patients. Female dogs with radiodense uroliths, uti and alkalinuria usually have struvite urolithias.s Tx - antibiotics, dietary modification that reduces urine saturation of magnesium, and oral urinary acidifiers.
Why do calcium oxalate uroliths occur?
Urine must be supersaturated with calcium. Factors that may affect supersaturation of calcium include hypercalcaemia, and possibly a diet containing high protein, high calcium and a low vitamin B6. Diuresis > decreased urine concentration decreases the risk of Ca oxalate urolithiasis in people - e.g cats on high moisture diets have less risk. Nephrocalcin is a natural inhibitor of calcium oxalate crystal growth. Other potential inhibitors include citrate, glycosaminoglycals, tamm horsfall proteins. Treatment is usually by surgery. Prevention of reoccurence includes treatment of underlying hypercalcaemia., increasing water intake, lower protein.
Which animals are predisposed to urate uroliths?
they form because of increased excretion of urates or uric acid in the urine. dalmation dogs and bulldogs have a higher frequency of urate stone formation than other breeds. Breeds that are predisposed to portosystemic shunts are also predisposed.
Why do urate uroliths occur?
In normal animals, purines convert to hypoxanthine, which converts to xanthine which converts to uric acid which converts to allantoin which is a soluble end product excreted in urine. in dalmation dogs uric acid is not converted to allantoic resulting in urine that is oversaturated with uric acid. Other risk factors include increased renal excretion of ammonium, low urine ph, urinary tract infections with urease producing bacteria and other bacteria or mycoplasma. Animals with portosystemic shunts may develop ammonium urate uroliths because of impaired metabolism of uric acid and ammonia.
What is the treatment for urate uroliths?
Medical dissolution can be attempted in cases which do not have liver disease, using a low purine diet, xanthine oxidase inhibitor, alkalinization of urine, treatment of UTI and dirnking more. Average takes 8-12 weeks. the urine should be alkalinized with oral sodium bicarbonate or potassium citrate to maintain a urine ph of approx 7.
How does allopurinol work?
It is an xanthine oxidase inhibitor - thereby decreases the production of uric acid by inhibiting conversion of hypoxanthine to xanthine and xanthine to uric acid. As prolonged administration of high doses of allopurinol may result in xanthine uroliths it is used with dietary therapy with the option of treating infrequent recurrent episodes of urate uroliths with dissolution protcols.
Why do cystine uroliths occur?
they occur in dogs and cats with cystinuria, an inborn error of metabolism characterized by abnormal transport of cystine, a non essential sulfer containing amino acid. Cystine is relatively insoluble in acid urine but becomes more soluble in alkaline urine so urolith formation enhanced by acid urine ph, high concentration urine and infrequent micturition. They are usually radiolucent to slightly radiopaque. Breeds predisposed include dachshunds, mastiff, newfoundland. Medical dissolution involves a combination of 2MPG and diet to reduce urinary excretion of cystine and promote formation of alkaline urine and reduce urine concentration.
What is periuria?
Urinating in inappropriate places.
What are the common causes of bacterial cystitis?
gram negative bacteria of faecal origin such as E coli, proteus and klebsiella are te most common causes of bacterial cystitis in the dog. 25% of cases will be caused by gram positive cocci such as staphylococcus and streptococcus.
Which antibiotic Should be used as first choice for an acute bacterial cystitis?
Gram negative infections will respond to TMPS while gram positive infections usually respond to amoxicillin or ampicillin. Bacteriocidal antibiotics are preferable to bacteriostat antibiotics since patients with bacterial cystitis cannot always mobilise sufficient leukocytes into urine to effectively augment antibiotic effect. Persistent or recurrent cystitis after appropriate therapy is uncommon and suggests a persistent focus for infectio e.g prostatitis, pyelonephritis, calculus or neoplasia or a predisposing systemic disorder..
What is the most common bladder tumour in the dog?
Transitional cell carcinoma, usually involving the bladder trigone. usually aggressively invades the adjacent urethra and ureters.
How can bladder tumours be treated?
Typically refractory to treatment. Aggresive invasion. Palliation of clinical signs and reduction in tumour size may be achieved with oral piroxicam.
What is Tardak?
Delmadione - it will temprarily decrease the prostate. Can cause squamous metaplasia. Not recommended as castration is better tx.
What are the most common organisms cultured from infected prostates?
E coli, proteus, pseudomonas, staphs and streps.
Which antibiotics are advised for prostatitis?
TMPS or enrofloxacin, these drugs cross blood prostate barrier and concentrate in the acidic prostatic fluid.
What are the clinical signs of a sertoli cell tumour?
Attractiveness to other male dogs
bilateral flank hair loss
Which tumour types have the greatest metastatic potential?
Seminomas and sertoli cell tumours. Metastasis is usualy to regional draining lymph nodes then to liver, lungs, spleen, kidney.
What are the most common neoplasms in intact female dogs?
Mammary gland tumours. 50% are malignant, 50% are benign.
Which LN should be removed with mastectomy?
The superficial inguinal LN is always removed with gland 5 since it lies nearly within the substance of the fat associated with the gland, but the axillary node is removed only if it is enlarged or there is cytological evidence of metastases.
Which factors are NOT associated with prognosis in mammary tumours?
Age, type of surgery, number of tumours, glands involved.
What percentage of mammary masses are malignant in cats?
90% are malignant, 20% benign.
What is benign fibroepithelial hyperplasia?
Enlargement of the mammary glands resembling neoplasia, but seen in young cats after a silent oestrus or continuously calling, one or more gland will be involved. ovariohysterectomy is the treatment of choice.
What is the chemotherapy treatment for TCC in dos?
Mitoxantrone plus a COX2 inhibitor.
What type of tumours affect the kidney?
renal carcinomas tend to affect older, male dogs. Nephroblastoma tends to occur in young dogs of either sex. both are highly metastatic.
Renal lymphoma is a well recognised form of lymphoma in cats.
What are the primary & secondary disorders in brachycephalic airway syndrome?
Elongated soft palate
Everted laryngeal saccules
What is arytenoid lateralisation?
Sutures from cricoid + arytenoid cartilages pull the arytenoid cartilage laterally and permanently open one side of the glottis.
What are the three openings of the diaphragm?
What signs can be seen with a peritoneal- pericardial congenital diaphragmatic hernia?
Often clinically silent, or Gi signs, rarely cardiac tamponade, liver lobe torsion. Concurrent abnormalities include; cranial abdominal hernias, swirling hair pattern over sternum, fusion defects of sternum.
Where should thoracocentesis be performed?
6th-8th intercostal space.
What are the indications for a thorocostomy tube placement?
Continuous suction required
You diagnose a dog with a large ventricular septal defect with advanced sequelae to the abnormality. Which of the following is the most likely radiographic appearance of this dog's thorax?
The correct answer is left atrial and left ventricular enlargement with pulmonary hyperperfusion. In dogs with a VSD, the shunt occurs during systole when both ventricles are contracting so blood is shunted from the left ventricle almost directly into the pulmonary artery. The right ventricle acts as a conduit between the left ventricle and pulmonary artery and is less commonly affected by the shunted blood. The excess blood flow is found in the pulmonary vasculature, left atrium, and left ventricle, thus enlarging these structures.
Which tumour is commonly seen in intact older male dogs?
You ask your technician to give a 1 ml/kg dose of lidocaine to a dog that is having ventricular premature complexes. You realize after it is too late that she miscalculated the dose and gave 10 times what you asked for. What is the most common early sign of lidocaine toxicity in dogs?
In dogs, toxicity of lidocaine is manifest primarily as CNS signs. Drowsiness or agitation may progress to muscle twitching and convulsions at higher doses. This occurs before respiratory or cardiac depression. Hypotension may develop if an IV bolus is given too rapidly.
Cats are more sensitive to lidocaine toxicity and may show cardiac suppression and CNS excitation.
A 3 year-old spayed female Rhodesian Ridgeback presents for mild pruritus and skin lesions. Upon examination you notice diffuse papules and occasional pustules along the dorsal trunk. You conclude that the patient has folliculitis. Which of the following infectious agents is least likely to be causing this patients skin lesions?
Bacteria, dermatophytes, and most species of Demodex can infect the hair follicle causing a folliculitis. Sarcoptes scabiei, which is a non-seasonal, intensely pruritic, transmissible mite, affects the stratum corneum. The female mite burrows through the stratum corneum and lays eggs in the tunnel behind her. Therefore, Sarcoptes is less likely to cause a folliculitis. Additionally, intense pruritus would be expected with a Sarcoptic mange infection, unlike the patient in this case. Furthermore, the patient's distribution is not consistent with Sarcoptes, which typically affect the elbows, hocks, ears, and abdomen.
You are examining the eyes of a dog with all the signs of Horner's syndrome. After instilling topical hydroxyamphetamine, there is no change. You then instill topical phenylephrine and in 5 minutes, the eye returns to normal. What can you conclude about this dog's Horner's?
The answer is that he has a post-ganglionic lesion. Hydroxyamphetamine acts by encouraging release of norepinephrine from the neuromuscular junction. If there is a pre-ganglionic lesion, NE will still be released by the postsynaptic neuron and signs will resolve. If there is a post-ganglionic lesion, there will be no NE to release. Also, with a post-ganglionic lesion, denervation hypersensitivity to NE occurs. As a result, adding phenylephrine topically can cause a rapid response. With pre-ganglionic lesions, the response usually takes greater than 20 minutes.
When performing surgery on the intestinal tract, which forceps are most appropriate for clamping of the intestines?
The correct answer is Doyen forceps. They are the least traumatic of the answer choices and provide good clamping without severely disrupting blood supply.
A 7-year old male castrated Doberman Pinscher presents for lethargy and anorexia. Your physical exam reveals a 3/6 left systolic heart murmur and a rectal temperature of 103.5F (39.7 C). One of your differential diagnoses for this dog is infective endocarditis. Which area of the heart is most commonly affected in a dog with infective endocarditis?
The correct answer is mitral and aortic valves. Dogs with endocarditis are most commonly affected on the mitral and aortic valves. The tricuspid and pulmonary valves are rarely affected in dogs and cats, but are the more common sites of infection in large animal species.
Which is contraindicated in cats with chronic feline bronchial disease (feline asthma)?
The correct answer is atropine. Atropine is contraindicated because it thickens bronchial secretions and encourages mucous plugging of the airway. Theophylline is a bronchodilator used to treat asthma. Corticosteroids are used to reduce airway inflammation in feline asthma. Doxycycline is sometimes given to cats with feline bronchial disease to treat suspected Mycoplasma infections. Another drug that is contraindicated in cats is any beta-blocker because stimulation of the beta-2 receptors in the smooth muscle of the bronchioles causes bronchodilation; blocking these receptors with a beta-blocker causes bronchoconstriction.
A 2-year old MN DSH presents for anorexia and vomiting of 2 days duration. Physical examination reveals the cat is dehydrated, but otherwise no abnormalities are noted.
Bloodwork shows the following: BUN 55 mg/dl (19-34 mg/dl), creatinine 3.8 mg/dl (0.9-2.2 mg/dl), sodium 135 mEq/L (146-156 mEq/L), potassium 3.1 mEq/L (3.7-6.1 mEq/L), chloride 85 mEq/L (115-130 mEq/L), TCO2 38 (13-21 mEq/L), HCT 60% (30-45 %). Urinalysis: USG 1.058 (>1.035), negative sediment.
You started the cat on 0.9% NaCl IV to treat the dehydration. Based on this history and blood results, what is your top differential diagnosis?
Because of this cat's history and blood results, an upper GI obstruction is highly suspected. Hypochloremic metabolic alkalosis is a classic finding in a pet with an upper GI obstruction and should be ruled out first, especially in a young cat with these clinical signs.
A 12-year old cat with an unkempt haircoat and palpable thyroid slip presents with a history of weight loss. Appetite has been normal to increased. Bloodwork is unremarkable and total T4 level is 3.8 ug/dL (normal 0.8-4.0). Although the value is within the reference range, you still suspect hyperthyroidism. Which other test could best support the diagnosis?
An elevated free T4 by equilibrium dialysis is a way to support the diagnosis of occult hyperthyroidism. In a small subset of cats, the free T4 is elevated due to non-thyroidal illness. Therefore, hyperthyroidism should not be diagnosed on a free T4 measurement alone. Most older cats have a thyroid level that is in the lower end of the normal range. The T4 in this cat is in the high end of the normal range. In combination with the exam findings and clinical signs, this raises suspicion for hyperthyroidism.
Taurine deficiency in cats causes what abnormality in the eye?
The answer is central retinal degeneration. Cats with taurine deficiency can develop feline central retinal degeneration (FCRD) in addition to cardiomyopathy. This is because photoreceptors contain large amounts of taurine, and cats cannot synthesize it. The classic lesion is an elliptical area of tapetal hyperreflectivity starting in the area centralis dorsolateral to the optic disk that progresses to a horizontal band and eventually can involve the entire fundus.
Which chemotherapeutic drugs cause fatal pulmonary edema in cats?
The correct answer is cisplatin. The famed statement, "cis-plat splats cats" is quite appropriate. 5-fluorouracil is also contraindicated for use in cats, but it is neurotoxic. Carboplatin, vincristine and doxorubicin are all used in cats.
Most cats have type A blood. This makes transfusion of cats with type B blood potentially problematic. Which feline breeds are most likely to have type B blood?
Besides the domestic short and long haired breeds, Tonkinese, Oriental Shorthairs and Siamese are typically blood type A.
Common B blood type breeds include British Shorthairs, Devon and Cornish Rex, Ragdolls, Scottish Fold, Persians, and Himalayans.
What breathing pattern is the hallmark of feline asthma?
Asthma causes expiratory dyspnea, or a marked abdominal push seen on expiration with normal inspiration. This occurs as a result of collapse of the lower airways during expiration. This occurs in asthmatics because negative intrathoracic pressure (exerted during expiration) can more easily cause collapse of the thickened and weak bronchial walls. This traps air inside the alveoli. During the next inspiratory cycle, there is decreased fresh air exchange and increasing hypoxemia.
Which dogs are prone to histiocytic ulcerative colitis?
Boxers, french bulldogs.
How is masticatory muscle myositis diagnosed?
Antibody titer to 2M fiblre, muscle biopsy of temporalis or masseter.
What is cricopharyngeal achalasia/asynchrony?
Usually congenital, lack of coordination of contraction of pharynx with food bolus and relaxation of upper oesophageal sphincter at the cricopharyngeus muscle. Genetic basis in golden retrievers.
What can be used to treat Gastrooesophageal reflux with megaoesophagus?
Why may a collie with dermatomyositis be regurgitating?
Due to acquired megaoesphagus due to underlying myopathy.
What is a hiatal hernia?
A congenital abnormality of the diaphragm that allows prolapse of the cardiac region of the stomach through the diaphragm into the thoracic cavity, leading to esophageal reflux.
What is the most common area for obstruction in the intestine with a foreign body?
What bloodwork is supportive of a gastric outflow obstruction?
Hypochloraemic metabolic alkalosis.
What can be a secondary complication with parvovirus enteritis?
younger animals may develop myocarditis.
In utero infections can cause cerebellar hypoplasia in cats. May develop bone marrow suppression and neutropenia.
How is parvovirus diagnosed?
ELISA for CPV2 in the faeces.
How is campylobacter diarrhoea diagnosed?
May see commas or seagull shaped organisms on direct faecal smear but could be normal inhabitant, PCR of faeces also can be performed.
What is the best treatment for Campylobacter?
How is giardia diagnosed? what is the treatment?
ELISA for faeces for Giardia proteins. Trophozoites may be visible on Zinc sulfate floatation. Metronidazole is often effective. Fenbendazole and albendazole are also effective.
What are the clinical signs of trichomoniasis infection ?
Typically cats, especially young in group housing, gives large bowel diarrhoea without other systemic signs, may be self limiting over several months. Trophozoites may be seen on direct faecal smear.
What is the treatment for coccidiosis in dogs and cats?
Isospora inested - faecal oral route - and infective oocysts destroy epithelium. Mild to severe large bowel diarrhoea. oocyst may be detected via faecal floatation. Sulfadimethoxine or TMPS for 10-20 days is tx.
What is trichuris vulpis?
Causes diarrhoea. Can mimic hypoadrenocorticism if severe.
Which roundworms affect dogs and cats? what are the treatments?
Toxocara canis - dog
Toxocara cati - cat
Toxascaris leonina - both
Infectious via faecal oral route. May also be tarnsmammary (T Cati) or transplacental (T canis).
Pyrantel is effective and safe in young patients. Puppies and kittens should be dewormed at 2,4,6,8,12 and 16 weeks of age.
What is ancylostoma?
A hookworm. transmitted via faecal oral route occasionally via skin. ATtach to small intestinal mucosa and ingest blood or mucosa.
Wht is the most common Tapeworm in dogs and cats?
Dipylidium caninum - fleas and lice are the intermediate host. Praziquantel and other anthelmintics effective.
What is the pathophysiology involved in pancreatitis?
Whatever the inciting cause > the colocalisation of the zymogen enzymes with lysosomal enzymes within the acinar cells follows, which permits trypsinogen to be converted to active trypsin, which in turn is then able to self activate and activate the other exocrine pancreatic enzymes.
Which breeds are predisosed to pancreatitis?
Schauzers, yorkshire terriers. 8yo mean age.
What is the most specific test for acute pancreatitis?
Pancreatic lipase (PLI)
What is the best test for exocrine pancreatic insufficiency?
What is triaditis in cats?
What is the treatment of Pancreatitis in dogs?
Supplement food with pancreatic enzymes
Fluid therapy e.g hartmanns
Anti emetics to reduce vomiting
Analgesics to relieve pain, do not use NSAIDs.
Anti oxidants - SAMe, vitamin E and sibylin.
In dogs, chronic pancreatitis may respond to the use of a low fat diet.
What is the most common cause of EPI in dogs & cats?
immune mediated destruction - dogs
Cats - chronic pancreatitis
Rubiosis iridis as seen in this cat is a sign of what process in the eye?
The correct answer is anterior uveitis. Rubiosis iridis along with other signs such as aqueous flare, hyphema, hypopyon, keratic precipitates, and decreased intraocular pressure are all suggestive of anterior uveitis which can be caused by a number of infectious, immune-mediated, traumatic, and idiopathic causes.
At what level does clinical jaundice occur?
How may ascites occur with liver disease?
Hypoalbuminaemiae associated with abnormal liver disease leads to a true transudate. cirrhosis of the liver results in portal hypertension and ascites associate with a modified transudate. Gall bladder rupture with bile peritonitis.
What are the clinical signs of hepatic encephalopathy?
Seizures, fly catching, blindness, star gazing, aggression., vacantness
What is ALT?
It is found free within cytoplasm of hepatocytes.
Considered to be liver specific.
Values represent damage in the last 24 hours.
Values rise when cells become damaged.
What is AST?
Not liver specific and also found in skeletal muscle. Not free within cytoplasm of hepatocytes.
Elevations in AST indicate severity of damage to hepatocytes.
What is AP?
Synthesised in the hepatocyte/bile caniculi membrane.
Increased circulating values are associated with synthesis of the enzyme not release. Synthesis is switched on by bile stasis and secondary bile acids formation. There is also a bone iso enzyme and a corticosteroid iso enzyme. Half life of AP is much shorter in cats than dogs.
What is GGT?
Gamma glutamyl transferase
Not liver specific
Found in muscle cells as well as liver
Synthesis is switched on a in similar manner to AP
Used more in cats where it is a relatively sensitive method of assessing cholestasis.
Why is bilirubin elevated in liver disease?
When RBC are broken down by RE system in liver and spleen> heme is released which is broken down to liberate iron protein and bilirubin. unconjugated bilirubin is transported to the liver bound to albumin and presented to hepatocytes for conjugation to glucuronic acid. Conjugated bilirubin enters the bile, is stored in the gall bladder and excreted in the duodenum. In the gut bilirubin is conerted to stercobilin. Presence of urobilinogen indicates bile flow into intestine. Canine kidneys can conjugate and excrete bilirubin, this does NOT occur in cats. bilirubin in the urine of cats is highly significant.
What are the liver FUNCTION tests?
Bile acids - measurement of serum bile acids - recycling involves enterohepatic recirculation.
Ammonia - circulating ammonia is derived from the gut and removed on first pass through the liver, where it is converted to urea and excreted in the kidneys. the highest levels of ammonia occur in portosystemic shunts and cirrhosis.
Proteins - the liver manufactures albumin and some globulin. low albumin is a good indicator of disease.
Glucose - in advanced liver disease the ability to store glycogen and release glucose fails. blood glucose may decrease.
Clotting - most clotting factors are made in the liver, if liver function seriously disturbed, PT and aPTT become prolonged.
Schistiocytes may be observed in chronic liver disease. Patients with advanced liver disease may develop a non regnerative anaemia.
What is ursodeoxycholic acid?
A synthetic hydrophilic bile acid which is used to restore bile flow and reduce the hepatotoxic hydrophobic bile acids which are frequently present in cholestasis.
Why do uroliths occur in dogs with portosystemic shunts?
Increased urinary excretion of ammonia and uric acid, dogs and cats may develop uroliths > uric acid cannot be converted to allantoin and is excreted in increasing amounts in the urine as urates which may form crystals and calculi in the urinary system.
What is chronic hepatitis?
underlying cause usually unidentified but may be infectious or toxic insult that sets up
chronic inflammation, or may in some cases be primarily autoimmune. Inflammation is usually
mixed, most often lymphocytic-plasmacytic. Chronic inflammation leads to fibrosis, which can
cause portal hypertension and lead to the development of acquired portosystemic shunts
(which can occur with any liver disease that causes portal hypertension).
How is copper storage hepatitis diagnosed?
Diagnosis: Bloodwork/liver function changes will be identical to chronic hepatitis. Biopsy with copper quantification is needed to differentiate. Distribution of copper in this disease is usually centrilobular (around central vein); if copper accumulates secondary to chronic hepatitis it is typically milder and periportal.
Which are common causes of drug induced hepatopathy?
Common offenders include
paracetamol, Phenobarbital, xylitol, aflatoxin, lomustine (CCNU).
What is vacuolar hepatopathy?
Glycogen accumulates in hepatocytes which leads to cell swelling and cholestasis. It is
often secondary to corticosteroid or other drug therapy but is recognized as a primary disorder
in some breeds
What is cholangitis?
Bacterial or unidentified pathogen causes biliary tract inflammation/infection which is
usually neutrophilic. There may be a recent history of enteritis or pancreatitis.
What are the clinical signs of Hepatic lipidosis in cats?
Signs can include jaundice, vomiting, diarrhea, hepatomegaly, as well as signs of
hepatic encephalopathy. HE in cats is usually milder and commonly includes ptyalism and
depression. There may be signs of underlying disease that led to period of anorexia.
Rubiosis iridis as seen in this cat is a sign of what process in the eye?
The correct answer is anterior uveitis. Rubiosis iridis along with other signs such as aqueous flare, hyphema, hypopyon, keratic precipitates, and decreased intraocular pressure are all suggestive of anterior uveitis which can be caused by a number of infectious, immune-mediated, traumatic, and idiopathic causes.
What happens to Cobalamin and Folate in gastrointestinal disease?
Cobalamin - vit b12 - is deficient in many animals affected with chronic GI disease. it is absorbed from the Ileal part of the small intestine and inflammation there decreases absorption. Clbalamin is needed for GI epithelial turn over and repair. Serum folate - another B vitamin, may be elevated if excessive bacteria in the intestine are synthesizing it but can be deficient if it isn't well absorbed. Other B vitamins can be lost with the water lost in diarrhoea and supplementation may be helpful. Fat soluable vitamins A, D, E and K may be lost in animals with fat malabsorption.
Which drugs can be used to induce emesis?
Xylazine - induces vomiting especially in cats but also dogs after i/m
Piecacuanha - local irritant, not terribly reliable
Apomorphine - emetic action predominant over other opiod effect, acts on D2 reeptors in CRTZ, can be given by any route.
How does maropitant work?
It is a neurokinin 1 receptor antagonist and blocks the effects of substance P. it acts in the final common pathway in emetic centre so is a broad spectrum anti emetic, it works for motion sickness, GI irritation, pancreatitis, chemotherapy induced.
How does metoclopramide work?
It is both centrally and peripherally acting. It centrally inhibits D2 and 5HT3 receptors in CRTz. peripherally inhibits D2 receptors and induces the release of local ACh. It results in increased oesophageal sphincter tone, increased gastric contractions, decreased pyloric sphincter tone, increased peristalsis of the upper intestine. IT is CONTRAINDICATED in GI obstruction.
How do phenothiazines work as anti emetics?
Broad spectrum anti emetics. Low doses block dopamine and histamine receptors. Higher doses have anti muscarinic effects also. Sedation and hypotension are side effects.
How do cimetidine, ranitidine and famotidine work? and what is their use?
They are anti ulcer drugs and work at H2 receptor antagonists. They decrease gastric acid and pepsin production. Ranitidine also has prokinetic activity.
How does omeprazole work?
It is a proton pump inhibitor, more potent than the h2 blcokers, it irreversibly inhibits the pottassium ATPase pump int he luminal surface of the parietal cell. It is a basic drug that requires enteric coated formulation. On absorption the drug is ion trapped in the parietal cels. The enzyme is permanently inhibited so Hcl production only resumes when new enzyme molecules have been formed.
How does misoprostol work?
It is a synthetic analgoue of PGE1. it acts locally - absorbed drug is rapidly metabolised. it decreases cAMP in the parietal cell. it increases bicarbonate and mucous production and enhances mucosal blod flow and mucosal epithelialisation - so has anti ulcer and cytoprotective agent.
How do antacids work?
e.g aluminium hydroxide. They inactivate HCl. they bind pepsin and bile salts, bind intestinal phosphate and have a more prolonged antacid effect than some.
How does sucralfate work
A dissacharide aluminum hydroxide product, it binds to positively charged elements of exposed epithelial cells at sites of ulceration - seals the ulcer, and prevents leakage of protein and electrolyte, binds epidermal growth factor and requires an acid environment to work, binds to bile acids and pepsin and increases local blood flow perhaps by increasing prostaglandin or NO locally.
What is the difference between emollient, bulk and osmotic laxatives.?
Emollient laxatives act locally and lubricate and soften the faecal mass - includes mineral oils and soft parrafins.
Bulk laxatives - hydrophilic and absorb water increasing faecal bulk and water content and stimulating peristaltic movement. e.g sterculia, isphaghula and bran. Adequate water intake is crucial.
Osmotic laxatives - examples include magnesium sulfate( epsom salts), sodium sulfate and lactulose. these solutions draw water into the intestine causing bowel distension and peristalsis. water availability is crucial in the case of lactulose, intestinal pH is reduced and ammonia producing gut flora are reduced.
Phosphate and sodium citrate are also used as osmotic laxatives, administered as enema preparations.
Stimulant laxatives - should never be used if obstruction is suspected, examples include bisacodyl and phenophthalein. They are diphenylmethane stimulants. They appear to sitmulate colonc smooth muscle and the myenteric plexus.
What is cisapride used for and how does it work?
Acts primarily as an agonist at 5HT4 receptors in the GI tract, it increases lower oesphageal sphincter pressure, gastric emptying , SI motility and colonic motility, more potent than metoclopramide. Withdrawn from UK and US human market due to toxicity.
Which drugs can be used to treat diarrhoea/ as spasmolytics?
antimuscarinics - Atropine sulphate, propantheline and hyoscine (buscopan)
Opioids - diphenoxylate Hcl, codeine and loperamide. Increase segmental contractions and decrease peristalsis.
Diphenoxylate combined with atropine available (lomotil).
Which drus can be used as appetite stimulants?
Diazepam most effective in cats. Inhibits satiety centre and GABAminergic effects.
Cyprohepatidine - anti serotonin effects.
How does silibinin (milk thistle) work?
thought to have an antioxidant, anti inflammatory anti fibrotic effect and promote regeneration.
How does penicillamine work?
It is a chelating agent, used in copper hepatotoxicosis as it binds copper. should be given on an empty stomach.
Fiona is a 14 year-old female spayed domestic long-haired cat that was referred to your hospital for work up of hypercalcemia. At home Fiona has had a decreased appetite, weight loss, and is not grooming herself. On physical exam, Fiona had an unkempt coat and generalized cachexia. Her superficial cervical lymph nodes were prominent and both kidneys palpated larger than normal. Thoracic radiographs showed sternal and hillar lymphadenopathy. What is the most likely adverse event of the first treatment option for this patient?
This cat is most likely dealing with hypercalcemia of malignancy; given the exam findings so far, we would suspect lymphoma as the underlying cause of her generalized lymphadenopathy. Patients with primary hyperparathyroidism usually have little to no clinical signs. The first treatment option for cats with lymphadenopathy and hypercalcemia is an L-asparaginase trial. The most common side effect of L-asparaginase is an allergic reaction; for that reason, antihistamines are often given upon administration.
Feline odontoclastic resorptive lesions are most likely to occur in which of the following teeth?
Although feline odontoclastic resorptive lesions can occur in any tooth, they are most frequently found in the first premolars, 307 and 407 in feline patients. So far, there is still no explanation for why these teeth are more vulnerable to this process.
Where in the GI tract is folate absorbed?
The correct answer is jejunum. Folate is predominantly absorbed in the jejunum, in contrast to most other vitamins, which are absorbed predominantly in the duodenum (except for Vitamin B12 aka cobalamin, which is absorbed in the ileum).
Which inhalant anesthetic agent is partially metabolized by the liver?
The correct answer is halothane. About 2/3 of halothane is exhaled unchanged. The other 1/3 or so is metabolized by the P-450 enzymes of the liver. By way of comparison, isoflurane is less than 0.2% metabolized.
What breed of dog is most predisposed to development of histiocytic neoplasia?
The correct answer is Bernese Mountain Dogs. These dogs are by far, the most overrepresented breed for developing histiocytic neoplasia.
The systemic inflammatory response syndrome (SIRS) is commonly observed in critically ill animals and is associated with fever, tachycardia, and leukopenia (among other abnormal parameters). Which cytokine is most typically associated with SIRS?
Interleukin 1 is one of the major up-stream instigators of the inflammatory response, regardless of species. Through activation of other inflammatory cells, IL-1 causes tremendous amplification of the inflammatory response.
In the treatment of an aural hematoma in a dog what is the best way to close the dead space created after drainage?
The correct answer is placement of mattress sutures parallel to blood vessels. This minimizes the possibility of occluding blood vessels.
A dog presents to your clinic for coughing and fever a week after going hunting. You work the dog up, perform bronchoscopy and remove a plant awn from the lungs. What bacterial infection is this dog predisposed to?
The correct answer is Actinomyces. This is a filamentous, branching, gram positive bacteria that is a normal inhabitant of the mouth and oropharynx. It is commonly associated with grass awn migration. These are usually contaminated in the oropharynx and then migrate through the body from the respiratory or GI tracts. Many times it takes months to years to make a diagnosis. Nocardia is a ubiquitous soil saprophyte found everywhere and is usually introduced via the respiratory tract.