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Flashcards in VetPrep Deck (120):
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.

53

Treatment for giardia

fenbendazole or metronidazole

54

Treatment for Polycystic kidneys

The image shows polycystic kidneys. This is an inherited disease that most commonly affects Persian cats. Other breeds such as Himalayans and British shorthairs are occasionally affected as well. The responsible gene is autosomal dominant. The homozygous form is lethal in utero and all affected living cats are heterozygotes.

The disease is diagnosed most reliably by ultrasound and treatment is similar to that of other causes of chronic renal disease with fluids, a low protein diet, gastric protectants (such as famotidine), maropitant, and appetite stimulants.

Cyclophosphamide, doxorubicin, vincristine, and prednisone are treatments for lymphoma, which can also affect kidneys bilaterally, but generally the lesions would not be cystic in appearance such as those in the picture.

Typically, the cysts are diffuse throughout both kidneys so surgical excision is not an option.

55


A 4-month old kitten arrives at your clinic with a 3-day history of anorexia, lethargy, vomiting, and diarrhea. On physical exam the cat is 5% dehydrated and has a temperature of 103.9F (39.9 C). What is your primary differential?
a. FB
b. FIP
c. FIV
d. Panleuk

The correct answer is feline panleukopenia virus. These clinical signs most closely correlate with panleukopenia. One must piece together the signalment, history, and clinical findings. Usually a cat with a foreign body will not have diarrhea and a fever. It is unlikely for a 4-month old kitten to have FIV due to maternal antibody protection. It is also unlikely for FIP to present in such a manner. With the wet form of FIP, you may see dyspnea due to pleural effusion and abdominal distention due to ascites. With the dry form of FIP it will depend on the organ that is affected. You may see a hepatopathy, splenomegaly, renal failure, etc.

56

White cats or cats with areas of white fur on the face or ears are predisposed to developing ___________ from UV light. These lesions are usually ulcerative and appear around the nose, ears, or eyelids.

Squamous cell carcinoma

57

Which of these chemotherapeutic drugs cause fatal pulmonary edema in cats?
a. vincristine
b. doxorubicin
c. carboplatin
d. 5-fluoruracil
e. cisplatin

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.

58

Treatment of Pemphigus
a. triamcinolone
b. itraconazole
c. prednisone
d. chlorambucil

B. itraconazole
In cats, the most commonly affected area is the head. Specifically, the pinnae, nasal planum, chin, or periocular region are involved. A smaller percentage of cats will also have lesions on their feet. Approximately 90% of cats with pemphigus foliaceus will have lesions in multiple sites, with over 75% having the head or face involved. Over 90% of cases will also have bilaterally symmetrical lesions. Although the condition is pustular in nature, these are usually not observed on clinical presentation; instead, crusts are seen as evidence of ruptured pustules. The condition is thought to be immune-mediated in nature with potentially a genetic component. Drug induced pemphigus foliaceus has been reported with the use of itraconazole. Interestingly, there is a case report of ampicillin inducing pemphigus foliaceus in a cat as well. All the other medications have been used for the treatment of this condition. A large retrospective study of 57 cats performed in 2003 documented that patients were more likely to respond with triamcinolone, as compared to prednisone or chlorambucil.

59

What is the most appropriate way to initially manage a cat with pyothorax from a cat bite wound from several weeks ago after thoracocentesis?

The correct answer is to place a thoracostomy tube, lavage three times daily with LRS, appropriate systemic antibiotic for 6 weeks. If the cause of the pyothorax is identifiable, such as a foxtail, attempts should be made to treat that cause. In this instance, the initial wound is probably no longer visible or treatable. Aggressive management of these patients is necessary. Placement of a thoracostomy tube with continuous suction or intermittent aspiration is necessary. Lavage 2-4 times per day for 1 hour with an isotonic fluid should be performed. There is no advantage to adding antibiotics to the lavage fluid, although heparin is beneficial. Systemic antibiotics based on culture and sensitivity should be administered for a minimum of 4-6 weeks. If there is no improvement in 3-4 days, surgery is indicated to explore for abscesses, foreign bodies, etc. Pyothorax is an accumulation of pus in the pleural space. The fluid is classified as an exudate and the cells usually consist of neutrophils. If it is a bacterial pyothorax such as that from a cat bite, the neutrophils will be degenerate. Fungi and agents such as Actinomyces and Nocardia often cause exudates of non-degenerate neutrophils and macrophages. Reactive mesothelial cells are often seen in the effusion as well.

60


A 10-year-old female spayed DSH presents to you after the pet-sitter found her with the following wound (ulcerative wound on L abdomen and chest). She is strictly indoors and the pet-sitter notes that she has otherwise been normal. She is the only animal in the house. She was previously diagnosed with diabetes mellitus and has been receiving her insulin on a consistent schedule but she continues to be polyuric and polydipsic. Her haircoat is unkempt and her abdomen is slightly pendulous. A CBC was unremarkable. Chemistry panel showed hyperglycemia and her urine specific gravity was 1.040. An abdominal ultrasound was performed. Which ultrasonographic finding is consistent with the likely underlying disease process?
a. hypoechoic pancreas and hyperechoic mesentery
b. bilateral adrenal atrophy
c. normal to enlarged adrenal glands
d. hyperechoic liver and moderate hepatomegaly

The clinical signs, patient's medical history, and lack of overt trauma is highly suggestive of skin fragility syndrome. Typically, these patients appear to have a normal looking coat from a distance but when palpated or manipulated one must be very careful, particularly when scruffing the patient.

Skin fragility syndrome in cats is commonly associated with poorly regulated diabetes mellitus due to hyperadrenocorticism. Cushing's disease can cause insulin resistance. Clinical signs are similar to those seen in dogs (pendulous abdomen, polyuria, polydipsia, polyphagia, lethargy, and muscle wasting). The hyperadrenocorticism can be iatrogenic, adrenal dependent or pituitary dependent. In cats, approximately 80% have a pituitary tumor while 20% have an adrenal tumor. ACTH stimulation test is not recommended in cats due to poor sensitivity. The low dose dexamethasone suppression test is recommended to confirm hyperadrenocorticism. Urine cortisol-creatinine ratio can be used as a screening tool. The UCCR has a high sensitivity so a negative test makes Cushing's highly unlikely.

Abdominal ultrasound can be used to support your diagnosis. With pituitary dependent Cushing's (which constitutes 80% of cats), you would expect normal to hypertrophied/enlarged adrenal glands. The excessive ACTH secreted from the pituitary gland produces an excessive amount of cortisol and adrenal hypertrophy.

Bilateral adrenal atrophy can be seen with hypoadrenocorticism. A hypoechoic pancreas and hyperechoic mesentery is highly suggestive of pancreatitis which is not associated with fragile skin in cats. A hyperechoic liver and moderate hepatomegaly can be suggestive of hepatic disease such as hepatic lipidosis or lymphoma which would not result in fragile skin either.

61

A 1-year old female stray domestic short hair cat was presented for pruritus. Your physical exam revealed a generalized miliary dermatitis and dark brown flecks in the fur. Which of the following findings are most consistent with the most likely diagnosis?
a. yeast on impression smear
b. anemia, eos, tapeworm
c. mites on ear swab, eos, anemia
d. mites on skin scrape, eos, enemia

B.
The correct answer is anemia, peripheral eosinophilia, tapeworm infestation. The cat has flea allergy dermatitis, which often manifests as a miliary dermatitis. Anemia occurs when there is a large burden of fleas feeding on the cat, peripheral eosinophilia is seen with allergies or parasite infestations, and tapeworms are transmitted by the ingestion of fleas carrying tapeworm eggs. The brown flecks in the fur found on physical exam are flea dirt, which are the feces of fleas after ingesting blood. (We know this a somewhat vague question, but we feel you need to get accustomed to these types of questions.

62

You see an 8-month old kitten with the effusive form of feline infectious peritonitis and perform euthanasia. The kitten was having severe diarrhea around the house when it became ill. The owner has a 2 year old cat at home and wants to know what this cat's prognosis is since it has been exposed to the sick kitten. Currently this cat is clinically healthy. What do you tell her?
a. rec coronavirus titer
b. PCR feces to see if virus is shedding
c. highly contagious, may show symptoms w/in 2wk
d. not contagious
e. start L-lysine to suppress infection

D. Feline infectious peritonitis is not a contagious disease. It is a disease that is caused by a mutation of feline enteric coronavirus. It is unknown why in some patients this virus mutates and causes the FIP syndrome. It is most likely to occur in young or immunocompromised cats. Her other cat is not necessarily going to get FIP just from exposure. In fact, the majority of the cat population has been exposed to the feline enteric coronavirus.

Because most cats in the general population have been exposed, it makes interpretation of coronavirus titers difficult. The titers can be elevated due to prior exposure and not from FIP. The titers can only be interpreted in lieu of clinical signs, blood results, etc.
L-lysine is an anti-viral medication that may have some benefit for suppression of herpes virus but would not be a prevention or treatment choice for coronavirus.

The coronavirus is shed in the cat's feces during active infection with coronavirus. Some infected cats do not shed the virus. The virus attacks the intestinal tract and causes GI upset. PCR on the feces would detect coronavirus, but does not distinguish between the enteric coronavirus and the mutated FIP form of the virus.

63

You perform thoracocentesis on a cat with pleural effusion. The fluid has a hazy gold color and a protein content of 7 g/dl and 7,000 cells/uL. These cells are primarily non-degenerative neutrophils with lesser numbers of other white blood cells and mesothelial cells. What is the most appropriate interpretation of these findings?
a. chylous
b. neoplasia
c. FIP
d. exudate, pyothorax

c. The correct answer is that this effusion is strongly suggestive of FIP. FIP causes a classic straw or gold colored effusion with high protein content (about equal to serum protein) and moderate cell counts. An exudate would tend to have somewhat higher cell counts and lower protein. The protein content is not consistent with chyle or neoplasia.

64

A woman brings her two cats into your clinic. She is worried because she has a young daughter who loves to play with her cats but she is concerned about Bartonella transmission resulting in cat scratch disease. You perform culture, PCR, and Western Blot on her cats, and those tests are negative. Which of these measures would be the most important way to decrease the chance of her cats acquiring Bartonella from another cat?
a. spay (std)
b. heartworm meds
c. prevent bites/scratches from other cats
d. strict flea control
e. frequently clean litterbox

d. While transmission of Bartonella from cats to humans is primarily via scratches and occasionally bites, the same is not true for cat-to-cat transmission. Arthropod vectors are the main mode of transmission, particularly the cat flea, Ctenocephalides felis. Direct transmission from cat-to-cat or vertically from queen to kitten in a flea-free environment is very unlikely.

65

Treatment for hypertrophic cardiomyopathy in cats (as depicted in the pathologic image) is aimed at which of the following?

improve systolic v. diastolic function?
via inc. or dec. HR?

The correct answer is improving diastolic filling by decreasing heart rate. The primary problem with HCM is thickening of the wall of the left ventricle, impairing diastolic filling. There is usually no problem with contractility and systolic function. Slowing the heart rate provides for longer diastolic filling, allowing the left ventricle to fill more effectively. Decreasing the heart rate also decreases the severity of systolic anterior motion of the mitral valve.

For this reason, the medications used most frequently to slow the heart rate are:

1) Beta- blockers (i.e. atenolol: 6.25-12.5 mg/cat orally qD-BID, or metoprolol: 0.5-1 mg/kg TID)
2) Calcium channel blockers: diltiazem: 1-2 mg/kg TID (PO) or 7.5 mg per cat TID

For cases with severe left atrial enlargement or cats in heart failure, also consider:

3) ACE inhibitors (i.e. enalapril or benazepril: 0.25-0.5 mg/kg once daily)
4) Diuretics: furosemide (Lasix): 1-2 mg/kg BID-TID
5) Preventing thromboembolic disease with aspirin or clopidogrel (Plavix).

Also, always keep in mind that you want to identify and treat possible underlying hypertension or hyperthyroidism that could be contributing to the disease.

66


A 2-year old male neutered cat presents to you depressed, hypersalivating, and ataxic with muscle tremors. The owner reports that a pyrethrin-based spot-on formulation for flea control belonging to their Golden Retriever was accidentally applied on the cat earlier today. Which of the following drugs will you use to treat the cat's clinical signs?
a. atropine
b. 2-pam
c. ace
d. amoxicillin
e. methocarbamol

Pyrethrins alter the activity of the sodium ion channels of nerves, which prolongs the period of sodium conductance. This increases the length of depolarization resulting in repetitive nerve firing. Cats are particularly sensitive to pyrethrin-containing products and can develop clinical signs within hours after administration. Affected animals should be bathed to remove remaining product. Minor clinical signs such as hypersalivation and ear twitching are usually self-limiting and do not require treatment. Control of marked tremors or seizures can be achieved with methocarbamol (Robaxin).

67

A 12-year old male neutered domestic short hair cat presents for ongoing evaluation of diabetes mellitus. The cat was diagnosed 6 months ago and has continued to be markedly polyuric, polydipsic, polyphagic, and has been gaining weight. The cat is currently receiving 10 units of glargine insulin every 12 hours. On physical exam, the cat weighs 15 pounds (6.8 kg) and has an enlarged head, abdomen, and paws. What imaging modality would be most appropriate to try and prove what you suspect is causing the uncontrolled diabetes and weight gain in this cat?

This cat has the signs and symptoms of acromegaly. Acromegaly is caused by excessive growth hormone release from the pars distalis from a tumor in the pituitary gland. Excessive growth hormone causes a defect in the insulin receptors on target cells causing insulin resistant diabetes mellitus. The enlarged head, paws, abdomen, and weight gain despite uncontrolled diabetes is due to the anabolic effects of the growth hormone.

Treatment for this condition includes radiation therapy to the pituitary tumor, high doses of insulin to try and control the diabetes, and somatostatin analogs (octreotide) to try and inhibit the release of growth hormone from the tumor. Surgical excision has been used as a form of treatment in people with pituitary tumors, but this has only been rarely reported in cats.

68

Which of the following is NOT a common post-operative complication of thyroidectomy for hyperthyroidism in cats?
a. lar par
b. esophageal stricture
c. hypocalcemia
d. horners syndrome
e. hypothyroidism

The correct answer is esophageal stricture. Esophageal stricture is not a common post-op complication of thyroidectomy. Hypocalcemia can occur due to damage or excision of the parathyroid glands. Horner's syndrome occurs when the sympathetic trunk running through the neck is damaged. Laryngeal paralysis occurs with damage to the recurrent laryngeal nerve running through the neck. Hypothyroidism can occur secondary to removal of the affected thyroid gland or glands.

69

Mousie, a 3-year old FS DLH, has been vomiting once daily for the past week. Clinically, she otherwise acts normally. Bloodwork and radiographs are within normal limits. The owners have seen chunks of hair in her vomit. She is currently on no medications and is eating Fancy Feast. Which of the following would you recommend?
a. metoclopramide
b. lactulose
c. pred
d. laxatone
e. maropitant

This young long-haired cat is apparently having a hairball problem. Frequent brushing, a higher quality diet, and a hairball treatment such as Laxatone (petroleum/mineral oil gel) should be recommended for this cat.

Lactulose is a stool softener often used to help with constipation.

Metoclopramide is an anti-emetic and promotility agent and may be beneficial for hairballs if a high quality diet and laxatone fail to correct the problem.

Maropitant (Cerenia) is a central and peripheral acting anti-emetic approved for the use in dogs.

Prednisolone is a corticosteroid which could be used for treatment of underlying inflammatory conditions.

70


Krissy, a 10-year old female spayed Himalayan, has had chronic constipation problems over the last year and has been diagnosed with megacolon. Today she presents for vomiting and straining to defecate. She is currently taking Lactulose to help with her bowel movements. You palpate hard feces in the colon. You give her an enema and manually evacuate most of the hard stools. Which of the following medications could also be used to help treat and try to prevent this problem in the future?
a. metronidazole
b. cisapride
c. omeprazole
d. sulfasalazine
e. prednisolone

b. There are five main treatment objectives for cats with megacolon. These include adequate hydration status, removal of impacted feces, laxative therapy, promotility agents for the colon, and dietary fiber.

This cat may benefit from Cisapride, which is a benzamide prokinetic drug. Due to the chronic stretching of the colon from the feces impactions, the colon can no longer move the feces out of the body in a normal way. This medication has anecdotally been shown to help cats evacuate feces more efficiently, especially in mild or moderate cases. Some cats may also benefit from a fiber source such as psyllium or canned pumpkin.

If the constipation problems continue despite the above mentioned treatments, colectomy should be considered.

Prednisolone is used sometimes in treating inflammatory bowel disease, but for megacolon is not indicated. Metronidazole and Sulfasalazine are antibiotics sometimes used for diarrhea or inflammatory bowel disease.

Omeprazole is a proton pump inhibitor used for prevention of gastric ulcers and upper GI disease and would not be helpful for megacolon.

71


Which of the following is caused by taurine deficiency in cats?
a. iris atrophy
b. retinal degeneration
c. anterior uveitis
d. glaucoma
e. cataracts

The correct answer is retinal degeneration. Taurine deficiency in cats causes retinal degeneration as well as dilated cardiomyopathy. Since most commercial cat diets have adequate taurine supplementation, it is now rare to see this occurrence unless the cat is on a home-cooked diet.

72


A 6-month old domestic short hair cat presents for its first physical exam. Cardiac auscultation reveals a grade IV/VI holosystolic murmur on the right thorax. Thoracic radiographs were unremarkable and echocardiography showed a small turbulent jet flowing through the ventricular septum from the left ventricle to the right ventricle. Which of the following do you tell the owner?

The correct answer is the prognosis is very good with small ventricular septal defects and no treatment is needed. The prognosis of small VSDs is very good. Some will close by themselves within the first year of life. It is unlikely that a small VSD will cause any significant problems such as heart failure, though follow-up evaluation is warranted to monitor cardiac size and function. Large VSDs carry a guarded prognosis and require cardiac bypass for surgical correction or novel device closure via transcatheter techniques; neither of which are commonly employed in animals. Small VSDs cause a relatively more turbulent jet of blood through the small defect, causing a louder murmur than a large VSD.

73

Rubiosis iridis as seen in this cat is a sign of what process in the eye?
a. Ant uveitis
b. glaucoma
c. lens luxation
d. iris atrophy
e. Chorioretinitis

a. Anterior uveitis
Along with other signs such as aqueous flare, hyphema, hypopyon, keratic precipitates, dec. intraocular pressure.
*Caused by infection, immune-mediated, traumatic, idiopathic

74

A 1-year-old male neutered cat is transferred to you in the morning after seeing an emergency service for electrical cord bite trauma. You anesthetize the cat to address numerous oral burns and ulcers and note frothy pink fluid accumulating in the endotracheal tube (see image). What is the likely cause of this?
a. tracheal tear
b. congestive heart failure secondary to electric cord bite
c. pleural effusion
d. tube in esophagus
e. non-cardiogenic pulmonary edema

E. non-cardio pulmonary edema
Electrical cord trauma commonly causes burns and ulcerations of the mouth, lips, and tongue. Due to the effect of electrical current on capillaries, non-cardiogenic pulmonary edema is an important complication to expect and monitor for. Although electrical cord bites can cause cardiac arrest, congestive heart failure would not be an expected complication.

75


A 3-year old indoor/outdoor domestic short hair cat presents with a history of lethargy and decreased appetite. T= 103.1 F/ 39.5 C, P= 200 bpm, R= 36. On exam you note a swelling over the bridge of the nose and on fundic exam see some dark circular lesions in the retinas. The disease you suspect in this cat may have been transmitted by which of the following?

a. inhalation of spores from pigeon droppings
b. ingestion of oocysts from raw meat
c. puncture wound from contaminated soil
d. scratch from another cat

Cryptococcus is a genus of encapsulated yeast that is often associated with or found in pigeon droppings and eucalyptus trees. The spores are most often inhaled from the environment where these are present. Cats with cryptococcus will often develop a swelling over the bridge of the nose and lesions in the retinas.

Sporothrix is a fungus found in the soil ("rose grower's disease") and is introduced into the body via a puncture from a thorn or through an open wound or cut when exposed to contaminated soil.

Toxoplasmosis may be transmitted through ingestion of raw meat.

76

A 1-year-old female indoor cat from Florida was presented for an after-hours emergency examination. Approximately, 72 hours after spending the night locked out on the family's screened-in porch, the cat developed acute severe facial pruritus and was presented for the lesions (ulcerated nasal planum). Similar lesions were seen on the ear tips and paws; only thinly haired areas with dark hair were affected. The cat was otherwise healthy. Skin scrapings were negative. Impression smears of the nose revealed inflammatory exudates comprised of approximately 75% eosinophils and lesser numbers of neutrophils, lymphocytes, and mast cells.

Which of the following is the best diagnostic or treatment plan?

a. aggressive flea control
b. dietary trial with novel protein source
c. confine indoors for 5-7 days
d. intradermal skin testing
e. bacterial culture of lesions

c. confine indoor.
The history, onset, clinical appearance, as well as the cytologic and histologic findings are most consistent with insect bite hypersensitivity. There are other reasonable but less likely differentials including pemphigus foliaceus, food allergy or atopy, and dermatophytosis.

The best way to rule in/out the most likely diagnosis is to confine the cat indoors and see if the lesions resolve as none of the other differentials would be expected to respond. It would be premature to institute skin testing for allergies or a dietary trial for food allergy. Aggressive flea control is not a bad idea, but the lesion distribution is less likely for flea allergy dermatitis. Cats are very sensitive to several pesticides. Bacterial culture would likely result in growth of normal superficial bacteria and not indicate the underlying pathology.

It also may be necessary to initiate an anti-pruritic therapy to reduce further self-trauma by the cat.

77

You are called out on a house-call to see the 3-year-old male Labrador Retriever shown in the photo below. He presents for bilateral periocular edema (see photo) and facial pruritus. This has been a recurrent problem for the last 4 months. The owners reported the dog would be normal for several days, and then acutely develop the periocular swelling and itching. These episodes always happened while the dog was inside the house.
The previous episodes would last for several hours, and then the edema would resolve en route to the veterinary clinic. After each episode, the dog had some residual periocular or facial pruritus for 1-2 days.

You perform conjunctival swabs and aspirates of the edematous area which reveal large numbers of eosinophils.

What is the most likely underlying cause of the dogs signs?
a. bacterial infection
b. Neoplasia
c. autoimmune
d. parasitism
e. hypersensitivity

Edema as you see here is a common clinical sign of a type I hypersensitivity reaction or allergy. The intermittent nature of the episodes suggests some type of allergic reaction, most likely infrequent contact with a potent allergen to which the dog has become sensitized. An underlying allergic etiology is further supported by the presence of eosinophils.

Identifying the underlying allergy in cases like this one can be challenging, and a thorough history and investigation of the dog's environment is warranted.

The other answer choices presented are less consistent with the recurrent and sudden clinical signs that are repeatedly observed.

78


A 4-month old intact male Collie presents for severe dermatitis along his nose and ears (see image). The areas are sensitive on palpation but not pruritic. No other areas are affected. Skin scraping and cytology are negative for mites or bacteria. Fungal culture is negative. Anti-nuclear antibody tests are ordered and are also negative. How do you educate the owner based on your presumptive diagnosis?
a. familial, cyclic, will regress
b. not curable, discuss euthanasia
c. biopsy and culture, long term tx needed
d. long term immunosuppressives

Familial dermatomyositis is a familial disease seen in Collies, Shetland sheepdogs, and other collie breeds. Diagnosis can be made with skin or muscle biopsies, but can be difficult as the clinical and histopathologic signs can wax and wane. Inciting causes can include vaccinations, sunlight, viral infections, or drugs. Some cases; however, will come and go without obvious inciting causes. Some cases can become severe enough to include muscle atrophy; megaesophagus has also been seen with this disease.

Treatments are often symptomatic and supportive and include Vitamin E supplements, Omega 3 fish oils, treatments for any secondary bacterial infections, and pentoxifylline. Prednisone can also be used to get more severe cases under control. Avoiding prolonged sun exposure can also help.

Educating the owner on the fact that signs will reoccur despite treatment can alleviate some owner frustrations. Often times signs will regress with or without treatments. Educate owners on neutering animals to prevent propagation of diseased animals.

79

tx cat hcm?
a. nitroglycerin paste
b. furosemide
c. atenolol
d. spironolactone
e. digoxin

This case describes typical findings for a cat with hypertrophic cardiomyopathy (HCM). Nitroglycerin, oxygen, spironolactone, and furosemide are indicated for cats with heart FAILURE from HCM, which this cat does not have.
Use of a beta-blocker such as atenolol is advocated by some cardiologists, particularly when left ventricular outflow obstruction exists. Atenolol alleviates the obstruction by reducing heart rate, LV contractility, and also reduces myocardial oxygen demands. Diltiazem and antithrombotics may also be considered.

Digoxin is used to slow atrioventricular conduction in the setting of supraventricular tachyarrhythmias or for systolic dysfunction. As the cat does not have a supraventricular tachyarrhythmia and has normal fractional shortening, digoxin is not indicated for this cat.

80


A 10 year old female spayed Labrador retriever mix presents for regurgitation and weight loss. Thoracic radiographs show an 8 cm cranial mediastinal mass and a gas filled esophagus. What is the most likely diagnosis of the mediastinal mass?

a. Thymoma
b. Chemodectoma
c. Lymphoma
d. Thyroid carcinoma

a. The megaesophagus is caused by myasthenia gravis, which is occasionally seen with thymomas. Treatment of choice for thymomas is surgical excision. The myasthenia gravis typically resolves after removal of the thymoma. Although lymphoma is a reasonable differential for a mediastinal mass, the concurrent megaesophagus is more consistent with the scenario above.

Chemodectomas are heart base masses. An ectopic thyroid carcinoma could occur in the mediastinum but is rare and would be unlikely associated with megaesophagus.

81

EPI in cats v. dogs

The correct answer is pancreatic acinar atrophy. This is an idiopathic condition where the exocrine cells of the pancreas atrophy with minimal inflammation. Chronic pancreatitis is a much more common cause of EPI in cats than dogs. For this reason, dogs with EPI do not usually have concurrent diabetes mellitus because the endocrine cells are spared, whereas cats often do have concurrent DM. Neoplasia and infection are rare causes of EPI.

82

Brodifocum toxicity

Vitamin K Antagonist
CS: hemorrhaging
Tx: induce emesis (confirmation if green dye seen in vomitus or diarrhea), activated charcoal, rinse conjunctiva
Vitamin K1 supplementation for 4-6 weeks

83

A man presents his middle aged female spayed indoor/outdoor cat for having difficulty breathing. Her gums are pink but she has moderate tachypnea and temperature is 104.1 F (40.1 C). The lung sounds are quiet. You perform a thoracocentesis and retrieve a pleural effusion that is white with a yellow tinge. It has a foul odor when you empty the syringe. What treatment do you advise?

A. Drain the effusion via thoracocentesis and start furosemide for congestive heart failure
B. Place a chest tube to drain and lavage chest and administer IV antibiotics
C. Culture the fluid and start antibiotics, the fluid will resorb after the infection is treated
D. Euthanasia due to the cat likely having FIP and the prognosis is grave
E. Drain the fluid via thoracocentesis, start a low fat diet and benzopyrone (Rutin)

This cat has pyothorax which is an accumulation of pus within the pleural cavity. In cats, the most common cause is a bite wound that introduces bacteria into the chest cavity. It can also be seen with migrating foreign body, or extension of pneumonia into the pleural space. At minimum, hospitalization with chest tube, drainage and lavage of the pleural space, and antibiotics are needed. Sometimes surgical exploration is required.

While this cat could have FIP, the foul odor and presence of bacteria indicate a suppurative infection which is not typical for FIP.

Congestive heart failure can present as pleural effusion in cats, but fever and this type of effusion are not typical of heart failure.

Culturing the fluid is important. However, the fluid will not resorb and the fluid must be removed and the pleural space lavaged.

A low fat diet and Rutin are treatments for pleural effusion caused by chylothorax which is an accumulation of lymphatic fluid within the pleural space.

84

Which of these fungal pathogens grow in pigeon feces and has the potential of being a serious zoonotic problem?

Cryptococcus
Aspergillus
Coccidioides
Histoplasma
Sporothrix

The correct answer is Cryptococcus. Cryptococcus neoformans grows exceptionally well in pigeon feces. Blastomyces is also found in bird feces. Histoplasma can grow in bird feces but is not as much of a zoonotic concern.

85

A 10-year old feline domestic short hair presents to you in respiratory distress. A chest radiograph reveals rounded lung lobes and a significant bilateral pleural effusion. A sample of this fluid is milky white with an elevated triglyceride:cholesterol ratio. What is your immediate treatment choice for this cat?

a. Tap both sides of the chest to evacuate as much fluid as possible
b. Discuss the poor prognosis with the owners and offer euthanasia
c. Tap one side of the chest only to reduce likelihood of complications with tapping
d. Hospitalize this cat and place it in an oxygenated cage for medical treatment

a. The radiographs describe significantly rounded lung lobes which suggests that the fluid has caused some fibrosing pleuritis. Sheets of fibrous connective tissue often times will cause pocketing of fluid on the right and left sides of the chest. Thus, it is important to tap both sides of the chest to adequately drain enough fluid to relieve dyspnea. The immediate life-saving procedure will be to remove the fluid that is causing the respiratory distress. Chylothorax is usually idiopathic in origin and rarely may resolve spontaneously in 1-2 months. Most cases ultimately require surgery which is usually a combination of ligation of the thoracic duct and a sub-total pericardiectomy.

86

In which of these conditions would you expect to find hypocalcemia in a cat?

T-cell lymphoma
Primary hyperparathyroidism
Hypervitaminosis D
Eclampsia

d. The correct answer is eclampsia. This occurs when serum calcium drops during parturition or lactation such that these functions cannot be supported. The other answer choices are causes of hypercalcemia.

87

What is the treatment of choice for traumatic proptosis of the eye as shown in this image?

a. Tarsorrhaphy
b. Conjunctival flap
c. Push globe back into orbit with sterile blunt instrument
d. Phacoemulsification
e. Exenteration

a. The answer is tarsorrhaphy. Tarsorrhaphy is the treatment of choice for proptosis. In this procedure, the eyelids are pulled in front of the proptosed globe rather than pushing the eye in and then temporarily suturing the lids shut. Exenteration is a procedure used to remove eyes with neoplasia that is infiltrating into the surrounding structures. A conjunctival flap is a procedure usually used to help healing of complicated corneal ulcers. Phacoemulsification is the procedure used to remove cataracts.

88

Rubiosis iridis as seen in this cat is a sign of what process in the eye?

Iris atrophy
Chorioretinitis
Lens luxation
Glaucoma
Anterior uveitis

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.

89

Which of the following is true about canine hypothyroidism?

a. It is often congenital
b. It is often caused by immune mediated lymphocytic thyroiditis
c. It can be caused by deficiency of thyrotropin-releasing hormone (TRH) by the hypothalamus
d. It is rarely caused by idiopathic atrophy of the thyroid parenchyma

b. About half of all cases of primary canine hypothyroidism are caused by immune mediated lymphocytic thyroiditis. Antithyroglobulin antibodies are present in about 35-50% of hypothyroid dogs. Idiopathic atrophy of the thyroid follicles is another common cause of the disease. Deficiency of TRH (tertiary hypothyroidism) from the hypothalamus has not been documented in dogs. Congenital hypothyroidism (cretinism) is rare in dogs.

90

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?

a. He has a pre-ganglionic lesion
b. The Horner's is idiopathic in origin
c. The Horner's has only been present for less than 24 hours
d. He has a post-ganglionic lesion Correct Answer
e. The Horner's has been present for a long time

d. 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.

91

Clinical signs of Iris atrophy

- It leads to scalloping of the iris margin and sometimes a moth-eaten stroma.
- absent or incomplete PLRs, dyscoria, or anisocoria.

92

Which of the following is not a likely cause for hemorrhagic pericardial effusion in the dog?

a. Hemangiosarcoma
b. Congestive heart failure
c. Chemodectoma
d. Idiopathic hemorrhagic effusion
e. Left atrial rupture due to chronic mitral regurgitation

The correct answer is congestive heart failure. CHF usually results in a modified transudate pericardial effusion. Idiopathic hemorrhagic effusion and neoplasia are the most common causes for hemopericardium. Rupture of the left atrium due to chronic mitral regurgitation or trauma is another albeit more rare, cause.

93

The 2-year-old Doberman Pinscher shown in the photo presents for hair loss of unknown etiology. Previous diagnostic tests were normal or negative and included skin scrapings, dermatophyte culture, complete blood count, urinalysis, serum chemistry panel, thyroid hormone evaluation, low-dose dexamethasone suppression test, and surgical neutering. Dermatological examination reveals a thin hair coat, nodular-like hair follicles, comedones, bacterial pyoderma, and scaling (see image). All of the other littermates are similarly affected. What is the most likely primary condition

a. Pemphigus vulgaris
b. Hypothyroidism
c. Color dilution alopecia
d. Hyperadrenocorticism
e. Systemic lupus erythematosis

Color dilution alopecia is a genetic disorder of the hair coat commonly associated with a blue or fawn coat color as is the case for the blue Doberman shown in the photo. The cause is unknown, but it is believed to be due, in part, to a defect in the coat color genes. Affected dogs are born with normal hair coats and, as they mature, they develop hair loss on the dorsum, recurrent bacterial infections, generalized thinning of the hair coat, secondary seborrhea, and cystic or dilated hair follicles.

The keys to answering this question are to recognize the color of the Doberman in the photo and concurrent alopecia and skin lesions. The information that all of the littermates are affected should have given you further reason to consider a genetic cause. The endocrine conditions (hypothyroidism and hyperadrenocorticism) are less likely due to the dog's young age and having multiple affected littermates. In addition, previous diagnostic screening tests for those conditions were reported to be negative. The lesions are not consistent with pemphigus vulgaris and systemic lupus.

There is no effective treatment for the genetic disorder and affected dogs will continue to lose hair. Many are alopecic by 2-3 years of age. Control of the secondary pyoderma is important. Diagnosis can be confirmed by histopathology which shows melanin clumping in the epidermal and follicular basal cells, macromelanosomes in the hair shafts or hair bulbs, and follicular dysplasia. The melanin clumping and macromelanosomes are key histologic findings for diagnosis of this disease.

94

Which of these is not a proper treatment for glaucoma (primary or secondary) in a dog?

a. Oral methazolamide (carbonic anhydrase inhibitor)
b. Topical mannitol
c. Topical latanoprost (prostaglandin analog)
d. IV mannitol
e. Topical dorzolamide (carbonic anhydrase inhibitor)

The answer is topical mannitol. Carbonic anhydrase inhibitors act by decreasing aqueous production which is partially dependent on the conversion of carbon dioxide to bicarbonate. It can be used topically or systemically. Latanoprost (Xalatan) is a prostaglandin analog frequently used topically in the treatment of glaucoma. IV mannitol works to decrease IOP through its properties as an osmotic attractant. It is not used topically.

95

A 4-year old male castrated cat presents to you with the primary complaint of lethargy. The cat's mucous membranes appear pale on physical examination. You perform bloodwork and find a hematocrit of 18% (30-45%). The anemia is regenerative with 3% reticulocytes (0-0.6%). You are concerned about Mycoplasma infection; which of the following tests would be most useful in ruling in or out such an infection?

a. Coombs' test
b. PCR for Mycoplasma spp
c. New methylene blue staining Your Answer
d. Coagulation tests
e. Bone marrow cytology or biopsy

b. The PCR test for Mycoplasma can be used to detect circulating DNA from Mycoplasma haemofelis and Mycoplasma haemominutum (previously known as Hemobartonella felis). Therefore, it is useful for determining if there is an active infection. In some cases, a fresh blood smear may allow detection of the organisms, but they frequently detach from RBCs when blood is placed in EDTA anticoagulant.

Since the anemia is regenerative, it is unlikely that you will need to perform a bone marrow evaluation. New methylene blue staining for reticulocytes or Heinz bodies will not rule in/out Mycoplasma, although increased numbers of Heinz bodies would be associated with other causes of anemia.

96

Which of these is not a sign of Horner's syndrome in dogs?

3rd eyelid protrusion
Enophthalmos
Ptosis
Mydriasis

The answer is mydriasis. Horner's syndrome is denervation of the sympathetic fibers going to the eye. As such, you observe the opposite of what you would see in a fight or flight response. The signs of Horner's are miosis, ptosis, 3rd eyelid protrusion, and enophthalmos.

97

Idiopathic Trigeminal Neuritis

A syndrome seen in dogs with peracute onset of a dropped jaw and inability to close the mouth.
● No other sensory deficits or other cranial nerve deficits are present.
● Dogs are typically normally alert and responsive without difficulty swallowing food
that is placed on the back of the tongue.
● Should be distinguished from these differentials (usually based on speed of onset and lack
of other signs):
a. Mandibular fracture
b. Rabies
c. Neoplasia of mandibular nerve
d. Masticatory muscle myositis
● Treated with supportive care with fluids and hand feeding of soft food a prognosis is excellent, with
most dogs regaining function within 1-2 weeks and returning to normal within 3-4 weeks

98

Idiopathic facial n. paralysis

● Acute onset of several signs.
a. Inability to blink (lack of menace or palpebral response).
b. Drooping lip and ear.
c. Drooling from one side of the mouth.
d. Dry eye.
● Facial sensation is normal.

99

The image of the eye below is from a canine patient diagnosed with keratoconjunctivitis sicca (KCS). This condition causes a decrease in tear production which then results in the classic changes observed in this image. Which of the following is not an etiology of the disease?

a. Immune mediated
b. Penicillin toxicity
c. Long-term atropine administration
d. Sulfonamide toxicity

b. In canine patients, the most common cause of KCS is immune mediated. This is why these patients are treated with cyclosporine, a t-cell modulator. Penicillins have not been documented to result in KCS. Sulfonamide containing antibiotics, such as TMS have been shown to cause KCS in some patients. Long-term atropine administration has also been shown to result in KCS. Atropine is a parasympatholytic and will result in decreased tear production. Etodolac has also been associated with KCS in dogs. The corneal pigmentation seen is a nonspecific response to chronic irritation or inflammation. There is also evidence of corneal vascularization which occurs as part of the inflammatory and healing response.

100


When performing surgery on a patient with compromised liver function what is a test that should be performed prior to surgery?

Bile acids
Coagulation panel
PIVKA
White blood cell count
Blood urea nitrogen

The correct answer is coagulation panel. If you have compromised liver function, the liver may not be able to produce enough coagulation factors; thus a surgical procedure would bring the risk that the animal could bleed to death.

101

4 components of nephrotic syndrome?

The four components of nephrotic syndrome are proteinuria, hypoproteinemia, hypercholesterolemia, and ascites or edema. This syndrome occurs with protein-losing nephropathies such as glomerulonephritis or amyloidosis. Hypercoagulability is not a component of nephrotic syndrome, although it can occur with protein-losing nephropathies due to the loss of antithrombin III.

102


A 7-year old female spayed Golden Retriever that you suspect has Addison's disease has bloody diarrhea, inappetance, and is dehydrated. What should be your next step?

a. Start aggressive IV fluid therapy and run a chemistry panel
b. Give IV dexamethasone and subcutaneous fluids
c. Give Lysodren
d. Run a chemistry panel and perform an abdominal ultrasound.

a. The correct answer is start aggressive IV fluid therapy and run a chemistry panel.

Addisonian patients often present in hypovolemic shock, so the first step to treating this dog is to restore vascular volume with IV fluids and to run a chemistry panel to check the extent of electrolyte abnormalities (hyponatremia, hyperkalemia, and elevated BUN). IV dexamethasone would not take precedence over restoring vascular volume, and subcutaneous fluid treatment is not aggressive enough for treatment of hypovolemia. Abdominal ultrasound would not be a priority in this case but could eventually be helpful in ruling in/out other differentials.

Lysodren is used for treating hyperadrenocorticism. One possible complication of Lysodren treatment is to make a dog Addisonian, which often causes the animal to present with the signs described as in the question.

103

You diagnose a deep pyoderma. She is started on a limited ingredient diet, chlorhexidine shampoo, and you need to send oral antibiotics. Which of the following treatments would be appropriate?

c. cephalexin for 8 weeks.
Deep pyodermas involve tissues deeper than the epidermis, including the dermis and even subcutis. The skin may heal on the surface before the deeper infection is resolved; making clinical cure difficult to assess. In general, deep infections can require 6-8 weeks of antibiotic treatment (and even 12 weeks for severe cases) for resolution.

Deep pyoderma can be secondary to allergies, skin fold anomalies, endocrine disorders, immune mediated skin diseases, bacterial and/or fungal skin infections, or migrating foreign bodies. Determining the underlying etiology will help with resolution and minimize chances of treatment failure and re-occurrence.

Diagnostics should include skin scraping and impressions, culturing for bacteria and fungi, biopsy, and blood work. Treatments typically include antimicrobials that have demonstrated effectiveness, antifungals if needed, and frequent topical treatments with chlorhexidine shampoo and removal of the dead tissue and debris.

Incidentally, the German Shepherds are predisposed to severe deep pyodermas that can be difficult to treat. Discussing this with your client will help give them realistic expectations for treatment. German Shepherds are at a higher risk of developing dry eye from Trimethoprim-sulfa; therefore, it is not recommended for this condition due to the length of time required to treat a deep pyoderma.

104


Which of these is the most important treatment for salmon poisoning?

Praziquantel
Oxytetracycline
Fenbendazole
Ivermectin

The correct answer is oxytetracycline. Because the signs are caused by a rickettsial organism, Neorickettsia helminthoeca, treatment is with a tetracycline-type of drug. Praziquantel is usually given to eliminate the fluke even though it does not usually cause any clinical signs in order to prevent contamination of other waterways.

105

Which of the following is true about diltiazem?

a. Diltiazem slows the heart by inhibiting the influx of calcium into the myocardial cells.
b. Diltiazem speeds up the heart because it is a beta adrenergic agonist.
c. Diltiazem slows the heart by antagonizing beta adrenergic receptors.
d. Diltiazem speeds up the heart rate by increasing the influx of calcium into the myocardial cells.

The correct answer is diltiazem slows the heart by inhibiting the influx of calcium into the myocardial cells. Diltiazem is a calcium channel blocker used to slow the heart to treat supraventricular tachycardias, hypertrophic cardiomyopathy, and hypertension.

106

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?

Peripheral neuropathy
Profound bradycardia
Anaphylaxis
Central nervous system depression
Apnea

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.

107

An 8-month male intact English bulldog presents after his owner noted bleeding from the penis. He took a look and describes seeing a small mushroom-like mass at the tip of the penis. The owner states that the dog has always been healthy and that the only thing unusual about the situation is that the dog masturbates on his favorite stuffed animal on a daily basis. On your physical exam, you confirm a urethral prolapse. What is the best treatment option?

a. Penile amputation and prescrotal urethrostomy with concurrent castration
b. Penile amputation and perineal urethrostomy with concurrent castration
c. Apply sugar to the urethral prolapse, start patient on prednisone, and castrate in one week
d. Urethropexy with concurrent castration

d. Urethral prolapse is a relatively rare condition in dogs; however, it is most often seen in young male English bulldogs. Although the etiology is unknown, it is suspected that sexual excitement, masturbation, genitourinary infection, and calculi may play a role. Additionally, a genetic component is likely present, since English bulldogs are over-represented; therefore, concurrent castration is always recommended and thought to decrease the incidence of recurrence.

There are several treatment options for urethral prolapse, including placing a purse string suture, amputation of the prolapsed region, and urethropexy. The urethropexy technique (Kirsch JAAHA 2002) is (although not proven) thought to be associated with the least likelihood of recurrence. Although an amputation of the penis can be performed, this would be excessive for a urethral prolapse and therefore is not recommended due to to urethrostomy-associated complications. Attempting medical management is likely to result in recurrence, so it is generally not recommended.

108

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. Supplementation with physiologic doses of prednisone
b. Mineralocorticoid, glucocorticoid, and NaCl supplementation
c. IV fluids and daily doses of IV dexamethasone sodium phosphate
d. Mineralocorticoid supplementation alone

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.

109


A 6-month old male Newfoundland presents for a physical exam. Cardiac auscultation reveals a 3/6 left systolic murmur at the heart base. Further diagnostics reveal the diagnosis of mild to moderate subaortic stenosis. What should you tell the owner?

a. The prognosis is poor. Most cases of mild to moderate aortic stenosis do not live past 4 years of age despite all therapy.
b. The prognosis is fair. Sudden death may occur at any time, and the dog has an increased risk for infective endocarditis.
d. The prognosis is relatively good. Balloon dilation of the stenotic region is the treatment of choice and has a high success rate.
e. The prognosis is good if the dog has not developed congestive heart failure yet. Prophylactic treatment with furosemide for congestive heart failure should be prescribed.

The correct answer is the prognosis is fair. For dogs with very mild subaortic stenosis, the prognosis is good. Dogs with moderate or severe disease, however have a much more guarded prognosis. Sudden death may occur at any time, and the dog has an increased risk for infective endocarditis. Ventricular arrhythmias can occur and may be the factor leading to sudden death in these patients. Animals with aortic stenosis are at increased risk for infective endocarditis and should be placed on prophylactic antibiotics whenever they undergo a surgical procedure, dental procedure, get an open wound, or experience anything that may potentially lead to bacteremia. Balloon dilation does not improve the prognosis for dogs with subaortic stenosis, though does improve the prognosis for dogs with pulmonic stenosis. Starting furosemide before the onset of congestive heart failure is not advised.

110


A 9 year old male Labrador Retriever presents for acute onset of circling to the right, head tilt to the right, nystagmus to the left, and vomiting. The rest of the physical exam is unremarkable. CBC, chemistry panel, urinalysis, and otic exam were unremarkable. After 14 days of supportive care, the dog has completely recovered on its own. What is the most likely disease this dog had?

Canine idiopathic vestibular disease (Old dog vestibular disease)
Bacterial meningitis
Otitis interna
Inflamed polyp in the middle ear

The correct answer is canine idiopathic vestibular disease (Old dog vestibular disease). This disease is usually diagnosed after all other vestibular causes have been ruled out. Otitis interna would be ruled out with an otic exam, CBC, and lack of pain and fever. Bacterial meningitis could be ruled out by a CBC and lack of pain and fever. Polyps in the ear rarely occur in dogs; most aural polyps occur in cats. In addition, an otic exam would rule this out anyway.

111

Pheochromocytomas are not very common in dogs; however, their presence can result in hypertension, tachyarrhythmias, seizures, and collapse. What is the substance secreted by this tumor?

Estrogen
Calcium
Catecholamines
Cortisol
Aldosterone

A pheochromocytoma is a tumor of the adrenal medulla. To review, the adrenal gland is composed of the adrenal cortex (outer layer) which is divided into the zona glomerulosa, zona fasciculata, and zona reticularis.

The zona glomerulosa is the main site of aldosterone production. The zona fasciculata produces glucocorticoids (mainly cortisol). The zona reticularis is the site of androgen production.

The adrenal medulla is the inner part of the adrenal gland and consists of chromaffin cells. These cells are responsible for making catecholamines (epinephrine and norepinephrine).

112


How is pulmonary thromboembolism definitively diagnosed in a live patient?

Cytology
Blood gas analysis
Contrast radiographs
Plain radiographs

The correct answer is contrast radiographs. Angiography is the gold standard for diagnosing PTE. If positive, there are sudden interruptions in blood and contrast flow. Plain radiographs are often normal or have mild changes. Cytology samples would mainly show blood and would not be considered diagnostic or definitive. Blood gas changes typical for PTE are hypoxemia and hypocapnia, but these are not specific for PTE. CT angiography is also a reasonable test to confirm PTE.

113


There are several procedures that are typically performed while correcting medial patellar luxation in dogs. Which one of the following is not performed while repairing a medially luxating patella?

Medial release of the soft tissues
Medial transposition of the tibial tuberosity
Block recession of the trochlear groove
Lateral imbrication of the retinaculum

The correct answer is medial transposition of the tibial tuberosity. If you have a medially luxating patella, you need to transpose the tibial tuberosity laterally in order to line up the patellar tendon with the rest of the stifle in an effort to reduce the likelihood of patellar luxation. The two most important procedures that reduce the incidence of recurrence are lateral transposition of the tibial tuberosity and modifying the trochlear groove of the femur.

114


Which of the following is not used as a medical management option in congestive heart failure in a dog?

Enalapril
Lidocaine
Furosemide
Sodium restricted diet

The correct answer is lidocaine. Lidocaine is used for treating ventricular arrhythmias. Sodium restricted diets, ACE inhibitors such as enalapril, and diuretics such as furosemide decrease blood volume and preload. ACE inhibitors also reduce afterload by preventing production of angiotensin-II, a potent vasoconstrictor. Pimobendan is also beneficial in the management of congenstive heart failure in the dog due to its positive inotropic effects.

115


A dark red vaginal discharge in a bitch 3 weeks after whelping indicates what process?

Retained placentas
Normal response
Pyometra
Subinvolution of placental sites
Metritis

The correct answer is normal response. Dark red vaginal discharge occurs normally for up to 6 weeks after whelping. Subinvolution can cause fresh bleeding for 12-15 weeks post-partum. Metritis is usually accompanied by systemic signs and may have abnormal vaginal discharge but not usually hemorrhage. Retained placentas typically do not occur in bitches. Pyometras occur during the luteal phase when progesterone levels are high, up to 9 weeks after estrus, and would not occur post-whelping.

116

Dolly, a 3-year old female spayed Siamese mix, presents with a history of weight loss over the last month. She is now vomiting occasionally and has a decreased appetite over the last 2 weeks. She has not eaten in the last 2 days. She is current on vaccines. Temperature is 103.7 F (39.8 C). You can palpate an abdominal mass effect in the mid to caudal abdomen. You believe the cat has a foreign body and are concerned about a possible intestinal perforation. Abdominal tap is negative. Pre-anesthetic bloodwork shows neutrophils 25,000 /ul (2,500-12,500/ul), bands 3,000 /ul (0-300/ul), globulins 6.9 g/dL (2.6-5.1 g/dl). Your x-ray machine is not working today and you recommend an abdominal exploratory. Upon exploratory, the intestines are severely hyperemic and the mesenteric lymph nodes are greatly enlarged. You cannot find a foreign body and no perforations are seen. There is a small amount of yellow tinged sticky ascites. What do you do?

a. Biopsy the lymph node and intestine and discuss a poor prognosis with the owner
b. Euthanize the cat on the table since you are unable to reach the owner over the phone about the poor prognosis
c. Start the cat on prednisolone and hypoallergenic diet for severe inflammatory bowel disease
d. Perform a fecal flotation and start sulfadimethoxine for a severe coccidial infection
e. Refer to an oncologist for work up of gastrointestinal lymphoma

This cat most likely has Feline Infectious Peritonitis, or FIP, which is caused by a mutation of a feline corona virus. Fever, weight loss, and gastrointestinal symptoms are the most frequent presentation. However, this virus may attack multiple organs and can be difficult to diagnose; the only definitive way to diagnose this disease is via histopathology. Clinical symptoms, blood results, and corona virus titers can all be used in combination to help aid in the suspected diagnosis of FIP. Unfortunately, there is no cure for this disease and it is currently considered a fatal disease.

Due to this cat's declining and critical health and strong evidence to support the diagnosis of FIP, euthanasia may be the most humane option. If the owner cannot be reached, however, it is the best option to go ahead and take biopsies while you are in surgery and then discuss the prognosis and differentials in detail when you can reach the owner. An animal should not be euthanized without owner consent.

Inflammatory bowel disease should not cause ascites and fever.
Parasites can lead to ascites, but typically would not cause the elevations of white blood cells and globulins with fever.
While lymphoma may be a possibility, it is less likely in this young cat. The biopsies would help to differentiate.

117


You confirmed chylous pleural effusion in your feline patient and referred to a specialist. The owner wants to discuss treatment options with you. The cat has had an extensive workup and no underlying cause has been found. Medical management has been tried for the last 3 months to no avail. The cat has been on a low fat diet and Rutin with intermittent thoracocentesis when needed. Which of the following treatments would be the best option and be most likely to resolve the effusion?

Ligation of thoracic duct and pericardectomy
Place a chest tube to keep drained consistently for 1 week and this should resolve the fluid
Vitamin E and milk thistle supplementation
Chemotherapy
Somatostatin

Surgery is the treatment of choice if medical therapy is failing. The best chance for resolution of a chylous effusion is ligating the thoracic duct and pericardectomy. Even with surgery, the effusion can still continue but this is the best chance for a cure.

Somatostatin is a naturally occurring substance in gastric, pancreatic, and biliary secretions. In recent years, analogues of somatostatin have been used to successfully treat chylothorax in humans. The mechanism by which non-traumatic chylothorax may benefit from this treatment is unclear; however, resolution of pleural fluid (chyle and postoperative serosanguineous effusion) in both dogs and cats has occurred after administration of octreotide (somatostatin). It is extremely expensive and not as likely to cure the effusion as surgery would.

Vitamin E and milk thistle supplements are sometimes used in cases of liver disease but not indicated for chylous effusion.

Despite chest tube placement to keep the fluid drained, the effusion will continue to occur because the drain does not stop the fluid from being produced.

Chemotherapy would not be indicated in a case of idiopathic chylous effusion.

118


A 5-year old male castrated English Springer Spaniel presents for a dental exam. The dog has a history of aggressive chewing on tennis balls and frisbees. The oral exam reveals brown, worn-down incisors, canines, and premolars. The dog is otherwise normal and healthy. What is the cause for the teeth turning brown?

a. Excessive chewing has predisposed the teeth to infection. The brown coloration is a sign of bacterial infection.
b. The dog was probably given tetracycline antibiotics as a puppy, which causes a permanent brown discoloration of teeth.
c. The excessive chewing has worn away the enamel of the teeth. The underlying dentin is naturally brown.
d. The teeth are brown due to the formation of tertiary dentin, which stains easily.

The correct answer is the teeth are brown due to the formation of tertiary dentin, which stains easily. Aggressive chewing of things like rocks, tennis balls, cage bars, etc. causes abrasion of dentin. Tertiary dentin, which is produced as a response to the wearing of the teeth, stains easily. Tertiary dentin will usually prevent the exposure of the pulp cavity unless its production cannot keep up with its rapid wear.

119


It is a busy day in the clinic and you are down to your last appointment. You are excited to leave for the day and can't wait to finish this general examination of a 1-year old female cat that was just adopted from the local rescue. The owners would like a general health screen along with information on spaying the cat. On physical exam, you detect a continuous machinery murmur, which is audible on both sides of the chest. Otherwise, the examination was unremarkable, pulses were strong and symmetrical, normal temperature, heart rate, and respiratory rate. The cat was purring making it difficult to hear the murmur but you are certain it is present. You discuss with the owners the likelihood of a patent ductus arteriosus and recommend an echocardiogram to confirm the diagnosis. You also explain to the owners that this condition, although seen in cats, is much more commonly seen in dogs. Assuming the owners will go on to have surgery performed, what muscular landmark allows the surgeon to determine he/she is at the 5th rib space?

Superficial pectoral muscle
Cutaneous trunci muscle
Scalenus muscle
Latissimus dorsi muscle
Serratus ventralis muscle

The correct answer is scalenus m. This applies to both dogs and cats. The 5th rib marks the end of the muscular portion of the scalenus and the beginning of the external abdominal oblique. It is almost impossible to remember all the origins and insertions of muscles; a good tip is to try and at least remember those that provide important surgical landmarks.

The scalenus lies ventral to the origin of the cervical and thoracic parts of the serratus ventralis. It attaches to the first few ribs and the transverse processes of the cervical vertebrae and inserts on the 5th rib.

The serratus ventralis is fan-shaped and originates on the transverse processes of the last five cervical vertebrae and the first seven or eight ribs. It inserts on the scapula.

The superficial pectoral muscle originates on first two sternebrae and usually part of the third. It goes on to insert on the whole crest of the greater tubercle of the humerus.

The latissimus dorsi covers most of the dorsal and some of the lateral thoracic wall. Its origin is at the spinous processes of the lumbar and last 7 or 8 thoracic vertebrae. It inserts on the teres major tuberosity of the humerus and teres major tendon.

The cutaneous trunci muscle is a thin sheet of muscle that covers most of the dorsal, lateral, and ventral walls of the thorax and abdomen. This muscle is responsible for twitching the skin and is innervated by the lateral thoracic nerve.

120


A 10 year old female spayed German shepherd dog presents for collapse and difficulty breathing. Your physical exam shows pale mucous membranes, a fluid wave in the abdomen and a splenic mass. Aspiration of the abdominal fluid shows hemorrhagic effusion that does not clot. Which of the following is commonly found with your presumed diagnosis?

Factor VIII deficiency
Tumor lysis syndrome
Hypercalcemia
Disseminated intravascular coagulation
Von Willebrand's disease

The presumed diagnosis based on the given signalment, physical findings, and diagnostics is splenic hemangiosarcoma, which is often associated with DIC.