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Flashcards in VetPrep Deck (52):
1

appetite stimulants

cycloheptadine, diazepam, mirtazipine, oxazepam

2

bandage for coxofemoral joint luxation

ehmer sling

3

5yo Dog hx chewing on tennis balls and frisbees. oral exam had brown, worn-down incisors, canines, and premolars. Otherwise healthy.
Why are they discolored?

formation of tertiary dentin, which stains easily.

4

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. desmopressin acetate
b. vitamin k
c. whole blood
d. 1,25 dihydrocholecalciferol

a. desmopressin acetate

The correct answer is desmopressin acetate (DDAVP). Administration of desmopressin results in release of von Willebrand factor, which will help this patient with clotting. Given this dog's breed and elevated BMBT there is a very strong likelihood she is afflicted with von Willebrand's disease. In Dobermans this results in an inability to form a clot. This can be life threatening if the dog is taken to surgery.

A whole blood transfusion does not provide an adequate source of von Willebrand factor but may be necessary if the patient's bleeding cannot be controlled despite appropriate pre-operative measures. 1,25 dihydrocholecalciferol is the active form of vitamin D which aids intestinal resorption of calcium. The BMBT does not assess factors 2, 7, 9, or 10 and therefore vitamin K is not indicated.

5

6mo labrador limping and not gaining weight. In an outdoor kennel with other hunting dogs. QAR, BCS 3/9. Pale MM, CRT 2s. Front and LH paw pads chewed at frequently, visibly ulcerated.
Diagnostic test?
[a. cbc/chem b. Rads c. Biopsy d. skin scrape e. fecal float f. PCV/TP]

e. fecal float
hookworms cause anemia, enteritis, coughing during larval migration, and dermatitis. Any young dog that is failing to thrive/pale mm should be tested for intestinal parasites. Hookworm dermatitis (Ancyclostomiasis) is typically seen in conditions with poor sanitation.

6

HBC
HCO3-12 mmol/L (17-24 mmol/L)
Total CO2-14 mmol/L (14-26 mmol/L)
Lactate-2.3 mmol/L (0.5-2.0mmol/L).

Assessment? [a. resp acidosis b. resp alkalosis c. met alkalosis d. met acidosis]

d. Metabolic Acidosis

low bicarbonate and total CO2 level is consistent with a metabolic acidosis.
Lactate above 2.0 mmol/L implies that there is anaerobic metabolism occurring in this patient as a result of inadequate tissue perfusion, perhaps due to bleeding and trauma.

Nothing can be said about respiratory acidosis or alkalosis because no PaCO2 or pH is provided.

7

A 6-month old Labrador Retriever presents for regurgitation. The dog is otherwise happy and doing well, according to the owner. A chest rads = megaesophagus. What therapeutic intervention is most important in the management of this dog's condition?
[a. terbutaline b. small frequent meals c. tensilon (edrophonium) d. strict cage rest e. glucocorticoids]

b. small, frequent elevated feedings.

megaesophagus. Causes of include congenital(It is 6months), vascular ring anomaly, endocrinopathy, secondary to neuromuscular disease such as myasthenia gravis, or secondary to esophagitis. Affected animals should be fed a high-calorie diet, in small frequent feedings, from an elevated or upright position to utilize gravity in emptying the flaccid esophagus. Pulmonary infections due to aspiration pneumonia should be identified and treated appropriately. Anti-cholinesterases can be tried, especially in cases where myasthenia gravis is the underlying cause, but edrophonium is too short-acting to be prescribed for chronic use, so you would probably choose pyridostigmine. Terbutaline is a bronchodilator and is not indicated in this case. Strict rest would not be particularly helpful in this case.

8


A 2-year old male castrated Bull Mastiff with a history of travel in the west coast presents to your clinic for a chronic cough and a recent development of lameness of his right hind limb. On physical exam you notice a draining lesion over the lame region of the right hind limb. You perform chest radiographs and see a diffuse bronchointerstitial pattern which is nodular in some regions. You also identify hilar lymphadenopathy. You suspect that you know what you are dealing with and perform a broncho-alveolar lavage for cytology. Just as you suspected, you see spherules. What is your diagnosis?
[blastomycosis, aspergillosis, cryptococcus, histoplasmosis, coccidiomycosis]

The correct answer is Coccidioidomycosis. The travel history and clinical signs are consistent with this answer. Additionally, finding spherules on cytology is pathognomonic for Coccidioidomycosis. Prolonged antifungal treatment will be necessary. Fluconazole is the treatment of choice. Ketoconazole and itraconazole are good choices. With blastomycosis you see broad based budding of the yeast. With Cryptococcus neoformans you will see narrow-based budding.

9


A dog presents for an acute onset of right hind limb lameness. On physical exam you note the limb to be slightly externally rotated and shorter than the contralateral limb. You suspect a coxofemoral luxation. What is the most likely direction of luxation?

craniodorsal

10

What is a potential side effect of administering diethylstilbesterol in an incontinent bitch?
[a. hemolysis, b. hemorrhagic diarrhea, c. KCS, d. bone marrow suppression]

The correct answer is bone marrow suppression. This is a hormone, and like many other hormones, can result in bone marrow suppression. This is one of the reasons veterinarians choose to use phenylpropanolamine for urinary incontinence. This drug is a weak alpha agonist and works on the muscles of the urethral which results in increased sphincter tone. KCS is more likely to occur with sulfa containing drugs. Most drugs can cause some sort of diarrhea as a side effect, but rarely will it be hemorrhagic.

11

Which of the following are effects of non-steroidal anti-inflammatory drugs that are non-selective COX inhibitors?
a. reduction swelling, neutrophil inhibition
b. GI ulcer, inhib platelet, analgesia
c. inhib inflam, dest platelets, red. fever
d. GI ulcer, platelet destruction, inhib neutrophils

B
Non-selective COX inhibitor side effects include GI ulcers, inhibition of platelet function, renal damage, and reduction of fever. NSAIDs reduce inflammation and pain by blocking the COX-1 and COX-2 pathways.

12

Two months ago, you prescribed one of your feline patients a course of pradofloxacin (Veraflox), a fluoroquinolone antibiotic, to treat an abscess. The owner of the cat also owns a small dog who now has pyoderma with Staphylococcus susceptible to fluoroquinolones. She asks you if she can use the remaining pradofloxacin for her dog that she has left over from her cat. What should you tell her?

Pradofloxacin (Veraflox) is an orally administered, liquid fluoroquinolone antibiotic that was FDA approved in 2012 for use in cats to treat skin infections (wounds and abscesses) caused by Pasteurella multocida, Streptococcus canis, Staphylococcus aureus, Staphylococcus felis, and Staphylococcus pseudointermedius. The drug is not for use in dogs and it has been shown to cause bone marrow suppression resulting in severe thrombocytopenia and neutropenia.

Enrofloxacin has been associated with retinal degeneration in cats, particularly at high doses and is used with caution for this reason.

13

What is the most likely complication associated with the post-anesthetic recovery of the dog in the photograph receiving Clotrimazole? (gel applied IN with Qtips)
[a. bacterial rhinitis b. asp pneumonia c. laryngeal inflammation d. seizure

c. The correct answer is laryngeal inflammation. Seizure is a possible sequela if the cribriform plate is compromised. If this were the case, the complication would likely be fatal. With severe swelling, the administration of corticosteroids and re-intubation is indicated. Sometimes these dogs may need to be intubated for days.

14

By far, the most likely diagnosis is intervertebral disc disease (IVDD) based on the history and myelogram showing a collapsed intervertebral space at T12-13 and an extradural compressive lesion originating from the same site.

Most important aspect of MEDICAL MANAGEMENT of this condition?

IVDD can be managed by surgical decompression or non-surgically. The most important aspect of non-surgical management of IVDD is STRICT cage rest, usually for a full 8 weeks.

Exercise should be avoided during the period of cage rest. Steroids, analgesics, and/or muscle relaxants may be useful additions to the management of these dogs.

15

Medical management of pyometra?

PGF2a
Although ovariohysterectomy is the treatment of choice for dogs with pyometra because it is curative and preventative for recurrence, medical management of pyometra can be considered in dogs of appropriate breeding age that are reproductively valuable and free of life threatening complications including septicemia, endotoxemia, or organ dysfunction. Options include prostaglandins to induce regression of corpora lutea, which relaxes the cervix and stimulates myometrial contractions, promoting expulsion of the uterine contents. Additional options include dopamine agonists (such as cabergoline and bromocriptine), which act to inhibit prolactin production from the pituitary gland. Patients should be monitored frequently during and after medical management of pyometra and should improve within 2-4 days. Successfully treated bitches should be bred during their next cycle after treatment.

16


A 5-year old female Golden Retriever presents for lethargy, dark runny stool, and dehydration. Bloodwork from yesterday showed markedly elevated plasma endogenous ACTH levels, K+ = 6.2 (3.9-5.1 mEq/L), Na+ = 135 (142-152 mEq/L), BUN = 62 mg/dl (8-28 mg/dl). Long-term maintenance therapy for this patient should most likely include:
A. physiologic pred
B. Min,glucocorticoid, NaCl
C. fluids and daily IV dexamethasone sodium phosphate
D. Mineralocorticoid only

B
The correct answer is mineralocorticoid, glucocorticoid, and NaCl supplementation. This dog has hypoadrenocorticism which is usually a deficiency in both glucocorticoids and mineralocorticoids. Elevated endogenous plasma ACTH concentrations with hypoadrenocorticism means the disease is due to primary adrenocortical insufficiency and failure to produce both types of corticosteroids (as opposed to secondary adrenocortical insufficiency, when the pituitary does not produce sufficient ACTH). Maintenance treatment of this disease includes supplementation with mineralocorticoids (e.g. Fludrocortisone acetate), glucocorticoids (e.g. Prednisone), and sodium chloride in the diet. IV fluids and dexamethasone sodium phosphate is used in an acute crisis.

17

A 6-month old male intact Weimaraner presents for the right forelimb swelling seen in the picture. He is also pyrexic at 104 F (40 C) and reluctant to walk. His litter-mate had the same clinical signs which resolved with a course of prednisone. What should you ask the owners to support the diagnosis you suspect?
a. hx of trauma?
b. contact with snakes/spiders/wildlife?
c. travel hx?
d. vaccinated recently?

D.
This puppy likely has hypertrophic osteodystrophy (HOD). Weimaraners are predisposed and litter-mates will commonly be affected. Although the exact cause is unknown, the leading hypothesis is recent vaccination leading to hyper-reactivity of the immune system. In a study of 53 Weimaraners with HOD, all had been vaccinated within the past 30 days.

18

Which is important in managing struvite urolithiasis?
a. inc. dietary protein
b. USG <1.020
c. urine pH 8-8.5
d. inc. Mg in diet

B
The correct answer is maintaining urine specific gravity <1.020. An important principle in management of any patient with urolithiasis is to maintain dilute urine so that solutes do not concentrate to the degree that they form precipitates that lead to stone formation. Struvite stones (magnesium ammonium phosphate) tend to form in alkaline urine so ideal urine pH for struvite stone formers is usually around 6.5. Other principles of management are to decrease urea in the urine, often done by moderate protein restriction and to decrease the minerals involved (magnesium and phosphate). Finally, a key element in struvite stone formation is the presence of a urinary tract infection, particularly with urease-producing microbes, most notably staphylococcus and proteus. Monitoring, preventing, and treating UTIs is an important aspect of management of these patients.

19

Clinical finding in lymphangiectasia?
a. hypercholesterol
b. lymphocytosis
c. hypercalcemia
d. panhypoproteinemia

d
The correct answer is panhypoproteinemia. Lymphangiectasia is a classic example of a protein-losing enteropathy. It is characterized by dilation and dysfunction of intestinal lymphatics and leakage of protein-rich lymph into the intestinal lumen. As a result, protein, cholesterol, and lymphocytes are all lost. Calcium is also frequently low due to either low albumin or vitamin D and calcium malabsorption.

20

T or F
Treatment of localized Demodex in young dogs is usually unnecessary. It usually clears up on its own.

True

21

progressive muscle loss on the right side of the face. Differential?

Trigeminal or Facial neuropathy.

The correct answer is right trigeminal neuropathy. Hopefully, you were able to identify the presence of significant muscle atrophy of the right masseter and temporalis musculature. The nerve innervating these muscles is the trigeminal nerve. Recall that the trigeminal nerve (cranial nerve V) has primarily a sensory function, with the exception of innervating the muscles of mastication. The facial nerve (CN VII) innervates the muscles of facial expression and is the main motor nerve innervating the face but is not responsible for the muscles that are atrophied in this case. Masticatory muscle myositis is an autoimmune condition that chronically leads to atrophy of the same muscle group, but what differentiates this case is that the signs are unilateral. Idiopathic polyradiculoneuritis is the medical term for a condition sometimes referred to as Coonhound paralysis, which is a condition that diffusely affects all motor nerves.

22

VPCs tx?
a. oral mexiletine and recheck
b. IV furosemide
c. no tx
d. bolus lidocaine

There are several general guidelines/recommendations regarding treatment of ventricular premature contractions which is what is shown on the ECG strip. These include a heart rate of over 180 bpm, pulse deficits, clinical signs, and VPCs for over 20 seconds in duration. In this case, the heart rate is visible on the recording and clearly not elevated. The patient's physical exam findings are not suggestive of an immediate problem secondary to the arrhythmia. There are many dogs with intermittent VPCs that are not of clinical importance. However, it is recommended that the patient be evaluated regularly and ideally have a consultation with a cardiologist to ensure the progression of heart disease is being minimized.

Furosemide is not indicated as there is not an indication that the patient is fluid overloaded or in fulminant heart failure.

Mexiletine is a Class IB anti-arrhythmic and is not necessary given the lack of severity in the ECG findings.

23

Most common cause of pyometra in dogs over 8 years old?
a. trauma
b. ovarian neoplasia
c. pregnancy
d. cystic endometrial hyperplasia

D. The correct answer is cystic endometrial hyperplasia (CEH). Older intact females develop CEH from repeated exposure to progesterone. Progressive thickening occurs and glands become hypertrophied. This sets up the uterus for development of pyometra.

24

Signs of chocolate toxicity?

The toxic principle of chocolate is methylxanthines (specifically theobromine and caffeine). Methylxanthines can cause CNS excitation tachycardia, and vasoconstriction. Signs include vomiting, diarrhea, hyperactivity, polyuria, polydipsia, lethargy, tachycardia, cardiac arrhythmias, seizures, and death.

25


Mitral regurgitation in dogs eventually results in which of the following?

a. Concentric hypertrophy of the left atrium and eccentric hypertrophy of the left ventricle
b. Eccentric hypertrophy of the left atrium and concentric hypertrophy of the left ventricle
c. Eccentric hypertrophy of the left atrium and left ventricle Correct Answer
d. Concentric hypertrophy of the left atrium and left ventricle

C. The correct answer is eccentric hypertrophy of the left atrium and left ventricle. Mitral regurgitation is the process of blood flowing back from the left ventricle to the left atrium due to a defect in the valve. The excess blood flow causes volume overload of the left atrium leading to eccentric hypertrophy or dilation of the chamber. The excess blood volume will then return to the left ventricle during the next diastole, resulting in dilation and eccentric hypertrophy of the left ventricle as well. Concentric hypertrophy occurs in cardiac chambers when they are pressure overloaded, such as in the case of pulmonic stenosis or aortic stenosis.

26

4y MN Pit bull, may have gotten rodenticide 2 hours ago. induce emesis = green vomit.
What do you recommend next?
a. just monitor
b. vitamin k 6 wk
c. check serum Ca
d. hospitalize and treat any neuro signs
e. vit e and selenium

The bright green vomit confirms the owner's suspicion of rodenticide ingestion because many rat poisons contain a bright green dye. Dogs that ingest these products may have bright green vomit or stool. Brodifacoum is a vitamin K antagonist commonly used in rodenticides. Ingestion of this compound causes hemorrhaging after several days due to a lack of production of new clotting factors. Treatment for this condition requires vitamin K1 administration for 4-6 weeks.

27

clinical signs of ancyclostoma in dogs and humans?

dogs - anemia
humans - cutaneous larval migrans

28


You are examining a dog for lameness and on radiographs; you find hypertrophic osteopathy of the metacarpal bones. What is the likely cause of this lesion?
a. Ca def
b. bone tumor
c. pulmonary neoplasia
d. vit d def

c. The correct answer is pulmonary neoplasia. Hypertrophic osteopathy is visible as periosteal proliferation in the diaphyses of affected bones. Usually the metacarpal and metatarsal bones are affected first, and it may progress to the long bones. Lameness, pain, and swelling are usually evident. Joints are unaffected. The cause is usually primary or metastatic pulmonary neoplasia, although other diseases in the thorax including bronchopneumonia, Spirocerca infection, or congestive heart failure, may also be associated. Less commonly, abdominal neoplasia may be seen with this condition.

29

primary goal in treating diabetic ketoacidotic dog?

The correct answer is correction of acidosis, electrolyte abnormalities, and hyperosmolality. Initial treatment of DKA patients is aimed at correcting acidosis by administering bicarbonate (if the total bicarbonate is markedly low), correcting electrolyte abnormalities with IV fluids, potassium and phosphorus supplementation, and correction of hyperosmolality. Regulating blood glucose, getting the animal to eat, controlling obesity and concurrent disease should be addressed after immediate life-threatening issues are resolved.

30

2 month female maltese. L heart base grade 5 murmur. Enlarged L heart and pulmonary vasculature.

diagnosis?

The correct answer is patent ductus arteriosus. PDAs results from the failure of ductus closure after birth resulting in a shunt (usually left-to-right) from the aorta to the pulmonary artery. The shunting causes excess volume in the pulmonary arteries, veins, left atrium, left ventricle, and aortic arch. The signalment of the dog and described clinical features and diagnostic findings are classic for PDA. In addition to the enlarged left heart and pulmonary vasculature, there is also usually an aneurysmal bulge of the aorta near the PDA on the DV view. The bounding pulses result from a widened pulse pressure (difference between systolic and diastolic pressure) because of the run-off of blood from the aorta to the pulmonary artery. PDAs are the most common congenital heart defect in dogs. The most common congenital heart defect in other domestic species is ventricular septal defect.

31


What test should be run to monitor the efficacy of treatment for an Addisonian dog being treated with supplemental mineralocorticoids and glucocorticoids?

The correct answer is serum sodium and potassium. Addisonian patients deficient in mineralocorticoids will usually exhibit the classic findings of hyponatremia and hyperkalemia. Monitoring serum sodium and potassium concentration while treating with exogenous mineralocorticoids is the best way to determine if the level and frequency of dosage is adequate for the patient.

An ACTH stimulation test can be used to monitor the efficacy of treatment of a patient with Cushing's disease, but does nothing for an Addisonian.

32


A 6 year previously healthy old dog presents in acute respiratory distress. On physical exam, you auscult a split second heart sound. You take neck and thoracic radiographs which appear normal. What is the most likely cause of this dog's dyspnea?

The correct answer is PTE. PTE should be immediately suspected in any dog with profound dyspnea and unremarkable radiographs. The split second heart sound is heard due to pulmonary hypertension from the PTE. This is not congestive heart failure because the heart is not enlarged, and there is no pulmonary edema on the radiographs. Aspiration pneumonia is less likely because of the history and normal lung films. With pneumothorax, you would expect decreased dorsal lung sound and consistent radiographic changes.

33

A 4-year old male castrated Schnauzer presents after being rescued from a house fire. On presentation, the dog has a respiratory rate of 45 breaths per minute with increased inspiratory effort and moderate distress. The dog's mucous membranes are bright red. lateral rad shows interstitial pulmonary pattern.

What is the likely cause of the bright red color of the dog's mucous membranes?

The bright red mucous membranes in a dog suspected of having smoke inhalation are concerning for carbon monoxide toxicity. Carbon monoxide displaces oxygen on hemoglobin molecules, forming carboxyhemoglobin complexes, which leads to tissue hypoxia.

The dog should be supplemented with 100% oxygen which reduces the half-life of the carboxyhemoglobin complexes from 4 hours on room air to 30 minutes. Other treatments for smoke inhalation include humidifying the air to promote mucociliary clearance and to prevent drying injuries to the airways.

34

When measuring Vitamin B12 (Cobalamin) and Folate levels in a dog with suspected small intestinal bacterial overgrowth, which finding is most supportive of this diagnosis?

The correct answer is increased folate, decreased cobalamin. The reason for this is that bacteria synthesize folate leading to decreased absorption of cobalamin.

35

Which of the following is most suggestive of pyelonephritis?
a. bacterial or WBC casts in urine
b. pain on abd palpation
c. small irregular kidneys
d. bact/WBCs in urine

A. The correct answer is bacterial or white blood cell casts in urine. Bacterial or white blood cell casts are highly suggestive of a past or present bacterial infection in the kidneys. Bacteria or white blood cells in the urine may be due to cystitis. Small, irregular kidneys may be due to any chronic pathology in the kidneys. Pain on abdominal palpation can be caused by pain from any abdominal organ or structures adjacent to the abdomen. Other signs associated with pyelonephritis include fever, anorexia, depression, and vomiting. A nephropyelogram may show blunted, dilated calices and dilated, tortuous ureters. Renal biopsy and culture would give the definitive diagnosis of pyelonephritis.

36


A 6-month old male German Shepherd Dog presents for castration. A 4/6 left systolic murmur is heard best over the apex of the heart. Thoracic radiographs reveal a moderately enlarged left atrium. What is the most likely diagnosis?

The correct answer is mitral valve dysplasia. This abnormality is a congenital anomaly of the mitral valve. The valve leaflets may be thickened, fused, fibrosed, etc. The chordae tendinae or the papillary muscles attaching to the mitral valve may be irregular as well. German Shepherd Dogs, Great Danes, and other large breed dogs are predisposed to this disease. Myxomatous mitral valve degeneration occurs in older dogs, but would otherwise result in similar physical exam and radiographic findings as those described. Tricuspid dysplasia results in an enlarged right heart, and the murmur would be heard best on the right side of the dog. Aortic stenosis results in concentric hypertrophy of the left heart, which may or may not be detectable on radiographs. Also, the murmur is heard best at the left heart base with aortic stenosis.

37


A 10-year old Shih Tzu presents for collapse. A diagnostic work up shows a mass on the right kidney, which was subsequently removed and biopsied as renal carcinoma. Which one of the following can be associated with renal carcinoma?
a. hyperestrogen
b. hyperCa
c. Hyperadrenocorticism
d. thrombocytopathy
e. polycythemia

E. Renal carcinomas have been associated with erythropoietin secretion, causing elevations in hematocrit as a paraneoplastic syndrome.

Hypercalcemia is associated with anal sac adenocarcinomas, lymphomas and other tumors.
Thrombocytopathy can be seen with hemangiosarcoma and multiple myeloma.
Hyperestrogenism can be seen with Sertoli cell tumors.
Hyperadrenocorticism is caused by functional adrenal or pituitary tumors.

38

Approved medical tx for oral(metastatic) melanoma?
a. doxorubicin
b. ONCEPT vax
c. Palladia
d. vincristine
e. mitoxantrone

The ONCEPT vaccine, also commonly referred to as the "melanoma vaccine" was given a conditional product license in 2007 and was USDA approved in 2010 as a therapeutic vaccine for cancer treatment.

Palladia is a receptor tyrosine kinase inhibitor approved for use in mast cell tumors in dogs. Doxorubicin, vincristine and mitoxantrone are human chemotherapy drugs commonly used off-label in veterinary oncology but not routinely for melanoma.

39

A 2-year old Siberian Husky presents for crusting and scaling of his foot pads, periorbitally, and along his mucocutaneous junctions. Based on the breed and clinical signs, which supplement should be added to this dog's diet?
a. vit e
b. Zn
c. Ca
d. Cu

The correct answer is zinc. Huskies are predisposed to zinc-responsive dermatosis in which individuals have a higher requirement for zinc in their diets due to a defect in absorption of the element. Clinical signs include crusting and scaling of foot pads, elbows, eyes, and mucocutaneous junctions.

40


A 6-year old female Saint Bernard presents for an acute onset of restlessness, retching, and hypersalivation. On physical exam you notice abdominal distension, tachycardia, a prolonged capillary refill time, and pale mucous membranes. What is your most likely diagnosis?

GDV
The correct answer is gastric dilatation and volvulus. To answer this question correctly, you need to pay attention to the signalment. In this case, you have a deep-chested large breed dog. These dogs are predisposed to GDVs. Additionally, the history of acute onset and clinical signs are consistent with GDV. You can immediately eliminate parvovirus by looking at the age of the dog. For the most part, parvovirus is a disease of puppies. Gastric foreign body and pancreatitis are good differentials; however, the abdominal distension seen on physical exam should help you lean towards GDV. Surgical treatment would involve a gastropexy to anchor the stomach in place so that a GDV does not recur.

41


Which of these is a major potential adverse side effect of the chemotherapeutic drug cyclophosphamide in a dog?

The correct answer is cystitis. In addition to the usual side effects of chemotherapeutic drugs such as myelosuppression and GI side effects, a major concern with cyclophosphamide administration is causing sterile hemorrhagic cystitis due to a breakdown product of the drug called acrolein. To reduce this risk, animals should be encouraged to drink lots of water or be given fluids and encouraged to urinate frequently to prevent the toxic compound from sitting in the bladder for a long time. The drug that causes cardiotoxicity is doxorubicin. The drug that causes ileus is vincristine. The drug that causes anaphylaxis is L-asparaginase. The drug that causes nephrotoxicity is cisplatin.

42


Which of these is least likely to cause respiratory distress and an increase in respiratory rate in animals that are victims of smoke inhalation (as in smoke from a fire, not a cigarette)?
a. Co2
b. thermal damage to bronchi
c. laryngeal edema
d. CO

The correct answer is thermal damage to the bronchi. Carbon monoxide inhalation is an important component of smoke inhalation morbidity as it leads to carboxyhemoglobin formation and displacement of oxygen. Carbon dioxide inhalation at high levels leads to severe acidosis, which leads to an increase in respiratory rate. Damage to the larynx from the heat causes edema and swelling, contributing to upper airway obstruction. The heat damage does not usually reach the level of the bronchi or lower airways. Smoke also can inhibit pulmonary macrophage function, and skin burns can worsen pulmonary status.

43


A new client from North Carolina comes to your practice to bring in her 5 year-old male neutered hound dog, Bart, and her 10 year-old male neutered domestic short hair, Spaz, for examination. Spaz has been doing fine and just needs his yearly preventative care, but Bart has been lethargic with weight loss and intermittent lameness. On physical exam, you note that the dog has a thin body condition score of 3/9, generalized lymphadenopathy and a fever of 104.2 F (40.1 C). The cat seems completely normal and healthy enough for vaccinations. During your attempt to vaccinate Spaz, he gets very agitated and scratches the owner on the arm. She notes that Spaz is kind of a difficult cat and that he has scratched her many times before; after one incident, the owner needed antibiotics for an infection that spread to her armpit from one of the cat's scratches. She mentions that she probably should have told you that Spaz can be difficult prior to the exam. Given the dog's (and owner's) clinical signs and travel history, what disease might you suspect at this time?
a. toxoplasmosis
b. lyme
c. bartonella
d. ehrlichia
e. babesia

Bartonella henselae is the bacterium that causes cat-scratch disease. In cat-scratch disease, the owner is infected with the bacteria from flea feces when the cat bites or scratches the owner. Commonly, the bacteria cause fever, malaise, weight loss and lymphadenopathy. Often, cats show no clinical signs. Dogs can be exposed via tick or flea vector and show signs similar to humans, including possible endocarditis. With the dog and cat being from a southern state, both animals were at risk of exposure from Bartonella species.

44


A 4-year old male castrated Basenji presents for polyuria, polydipsia, and weight loss. Blood work shows P=2.5 (2.9-5.3 mg/dl), K= 3.1 (3.9-5.1 mEq/L), total CO2= 12 (17-25 mmol/L). The remainder of the blood work is within normal limits. Urinalysis shows 3+ glucose. Which of the following is your most likely differential diagnosis?
a. pyo
b. DM
c. pyelonephritis
d. Fanconi syndrome

The correct answer is Fanconi syndrome. Fanconi syndrome is an inherited disease in Basenjis. The disease involves renal tubular defects causing an abnormal loss of electrolytes and solutes leading to hypophosphatemia, hypokalemia, and metabolic acidosis. DM is less likely because serum glucose is normal. The lab abnormalities present in this dog are not consistent with pyelonephritis. Pyometra is not a viable choice as the signalment describes a male.

45


A 7-year old male castrated cat presents to you for difficulty eating. On examination, you see that there are dental lesions on the buccal surfaces of several premolar and first molar teeth. The cat shows signs of discomfort when you palpate around these teeth and the surrounding gingiva appears inflamed. You suspect that the cat has odontoclastic resorptive lesions. You perform dental radiographs which show evidence of endodontic necrosis. Which of the following is the most appropriate treatment recommendation?

As described in this case, feline odontoclastic resorptive lesions commonly affects cats with increasing incidence as cats age. One or more lesions are found in about 50% of the domestic cat population over 5 years old. Lesions are often seen at the buccal surfaces of premolars and the first molar teeth at the gingival margin. Canine teeth can also be affected but usually lesions occur in the roots and the crown may appear normal.

There have been many theories about the cause of these lesions including a relationship to plaque-induced inflammation, microfractures of the cemental surface, and mineral deficiencies but most of these theories are no longer supported. It is now believed that abnormal formation or mineralization of cementum results in cemental resorption. There may be a relationship to high levels of vitamin D.

For treatment, there are reports of using alendronate, a bisphosphonate which inhibits demineralization of bone. Also, laser therapy has been used. However, neither of these treatments are currently accepted as standard care of this disease and extraction is the only current treatment that offers permanent prevention of pain to the patient. Restorative dental procedures are retained without recurrence in <25% of cats in 2-3 years.

In cases where lesions are entirely confined to the crown with no deep periodontal pockets and no radiographic evidence of endodontal necrosis, one can consider retaining the root. However, in the case described, complete extraction is the most appropriate recommendation. Because the incidence of lesions increases with age, it is likely that the cat in this case will develop lesions in other teeth in the future. Excessive Vitamin D should be avoided but other recommendations for prevention are controversial. Diligent dental care is certainly recommended.

46

When performing an enterotomy in a cat, it is best to cut ________.
a. lat to antimesenteric border
b. on mesenteric border
c. On antimesenteric border
d. lateral to mesenteric border

C. On the antimesenteric border.

47

You just began working in the intensive care unit and you notice a Cornish Rex exhibiting fever, restlessness, vomiting, urticaria, and hemoglobinuria. What do you think is happening?
a. blood transfusion rxn
b. diabetic ketoacidosis
c. disseminated IV coagulation
d. cyclosporine reaction

A. The correct answer is blood transfusion reaction. This is the perfect random question. The fun fact to remember is that Cornish rex, British short hair, and Devon rex cats are predisposed to having Type B blood type. Type B cats have anti A antibodies and tend to have acute transfusion reactions as compared with type A cats. Also, realize that the clinical signs being exhibited are those of anaphylaxis and that will help you narrow down the choices.

48


A 13-year-old female spayed domestic short hair cat presents for a geriatric screening. The owner reports that the cat is polyuric, polydipsic, and slightly lethargic recently. Physical exam reveals a nodule in the region of the thyroid gland and a thin body condition. Blood work is run with the following findings (normal ranges are within parentheses): T4 2.7 mg/dL (2.3-4.7 ug/dL), blood urea nitrogen 34 mg/dL (10-32 mg/dL), creatinine 2.1 mg/dL (0.5-2.2 mg/dL), total calcium 16 mg/dL (8-11 mg/dL), phosphorus 2.5 mg/dL (3.5-8.1 mg/dL). An ionized calcium is 1.8 mmol/L (1.12-1.32 mmol/L). A urinalysis shows a urine specific gravity of 1.010 and numerous calcium oxalate crystals. An ultrasound of the neck confirms a nodule within the region of the thyroid. What do you tell the owner?
a. lymphoma, stage
b. hyper PTH, sx
c. hyperT, methimazole
d. renal failure, fluids
e. UTI, abx

B. The symptoms, physical exam findings, and blood work results are most consistent with primary hyperparathyroidism, which is most commonly caused by a parathyroid gland tumor. The elevated calcium causes the signs of PU/PD. Cats will commonly not show significant clinical signs and may be diagnosed incidentally on routine blood work evaluation.

This cat's clinical signs of PU/PD and slight lethargy are non-specific, but classic for primary hyperparathyroidism along with the blood work shown in the question, which depicts borderline or mild azotemia, high total and ionized calcium levels, and a low phosphorus.

49


Which insulin is most similar in composition to feline insulin?

Feline insulin is closest in its amino acid sequence to bovine insulin, differing by only one amino acid in the A-chain. Canine insulin however is identical to porcine insulin in its amino acid sequence. It is quite dissimilar from feline insulin, differing by four amino acids. Feline and human insulin sequences differ by four amino acids.

Although feline insulin is closest in sequence to bovine insulin, some cats can be managed quite well on other forms of insulin. Insulin glargine (Lantus), an engineered human insulin, is the current recommended insulin for cats. ProZinc (a protamine zinc recombinant human insulin) is also an option and has been FDA approved for use in diabetic cats. PZI (bovine zinc insulin) is no longer manufactured.

50


An owner calls concerned that her 2 month-old kitten vomited a worm. You just saw the kitten for an exam the week before and gave a dose of Pyrantel during the appointment. According to the owner, the worm looks like a piece of spaghetti. What course of action do you take for the most likely diagnosis?

You would recommend to examine the worm and perform a fecal flotation for definitive diagnosis of the worm and to diagnose concurrent parasites. Most likely, based on the history and description, this patient is dealing with a Toxocara infection. Toxocara cati can be transmitted from queen to kitten via transmammary infection. Environmental control is also extremely important as grooming is a common source of egg ingestion. Due to the life cycle of roundworms, it is important to continue to treat every 2-3 weeks until the patient is 3-4 months old. It is unlikely that a one-time treatment of Pyrantel will resolve the issue.

51

This 8-week old domestic short hair cat presented with an acute onset of severe chemosis as seen in the photo. The cat is systemically healthy otherwise with no oral or corneal lesions. Which of the following diseases most commonly causes severe chemosis in the absence of other systemic signs?

The correct answer is Chlamydophila felis. The key is to note the severe chemosis which is characteristic of chlamydophila infections. This upper respiratory tract pathogen does not cause oral ulcers in cats. Herpes virus will cause ocular, dendritic ulcers, and less commonly cause oral ulcers, and is commonly associated with systemic disease. Calicivirus also causes more systemic disease and can cause oral ulcers. Mycoplasma is not associated with such severe chemosis.

52


An 8-month old male neutered domestic shorthair presents for ptyalism and decreased appetite. His temperature is normal. He has received his first set of vaccines from the Humane Society prior to adoption by this owner. Humane Society records indicate he was treated recently for upper respiratory symptoms. Upon oral examination you note severe gingivitis and stomatitis and multiple lingual ulcerations. FeLV and FIV testing were negative prior to adoption. Which of the following causes is suspected and which is the best treatment option listed?

Calicivirus is a common virus that can cause upper respiratory symptoms as well as oral ulcerations and stomatitis in cats. The stomatitis is often associated with concurrent bacterial infection of the mouth. An antibiotic such as clindamycin, doxycycline liquid, or amoxicillin-clavulanic acid (Clavamox) should be administered. Sucralfate in a slurry can help to coat the ulcerations for quicker healing. An analgesic, such as buprenorphine, should also be considered. An esophagostomy tube may be useful in severe cases when the cat will not eat on his own despite initial therapy.

A recent study found that 88% of cats with stomatitis were shedding both feline calicivirus and feline herpes virus-1, making these two viruses highly suspicious in playing a role in feline stomatitis.

Feline immunodeficiency virus (FIV) and feline leukemia virus (FeLV) do not appear to play as much of a role in this disease. Immunosuppression from these viruses make concurrent infection with calicivirus and herpesvirus more common.

A cause-effect relationship between Bartonella and feline stomatitis has not been proven but has been suspected in some cases. Doxycycline tablets should be avoided in cats due to risk of esophageal stricture.

There has been some controversy regarding the use of corticosteroids for stomatitis. Mostly, they have been used in cases of lymphocytic plasmacytic stomatitis that do not respond to other therapies and as a last resort. In general, the use of corticosteroids for stomatitis is not widely accepted.