VetPrep NAVLE Flashcards

Question

**A cat with a Cryptococcus infection and liver failure should not be treated with ketoconazole for which of the following reasons?** - It causes hypoadrenocorticism in cats - It is nephrotoxic to cats - diarrhea in cats - It is hepatotoxic and causes vomiting - It is not effective in treating Cryptococcus

Answer 1

Answer: **It is hepatotoxic and causes vomiting** Explanation The correct answer is it is hepatotoxic and causes vomiting and diarrhea in cats. Ketoconazole is an azole antifungal. It is effective against Cryptococcus, but it causes severe Gl upset and anorexia, particularly in cats. It is also hepatotoxic, making it a poor choice for the cat described in the question.

Answer 2

Answer: **Correction of acidosis, electrolyte abnormalities, and hyperosmolality** 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.

Answer 3

Answer: **High Pa02** Explanation The correct answer is high PaO2. PaCO2, blood pressure, PaO2, cerebral metabolism, and certain drugs can affect cerebral blood volume and intracranial pressure. In head trauma patients, you want to prevent an increase in intracranial pressure by keeping cerebral blood flow relatively low without causing hypoxia. To keep cerebral blood flow in the low-normal range, the cerebral metabolic rate and PaCO2 should be kept low. Factors that would cause the cerebral metabolic rate to go up include fever, seizures, pain, etc. Mean arterial pressure should be maintained in the normal range to prevent hypotension, hypoxia, and cerebral ischemia.

Answer 4

Answer: **Regular.** Listed from shortest acting and most potent to longest acting and least potent: *Regular, NPH, Lente, PZI, Ultralente*. The treatment of DKA involves IV fluids and regular insulin, given either by CRI or the intermittent IM dosing technique. Regular insulin is continued until the patient is eating well and is hydrated, and can be switched to a longer-acting insulin, to be given SQ at home.

Answer 5

Answer: **Prepare a brief presentation for the staff, create visual aids, and provide an informal written summary of the study** Explanation Using a combination of communication formats - verbal, visual and written - to explain concepts is ideal. Informal language should be used to communicate with lay staff. Highly technical terminology should be avoided. While having the staff read the study independently might sound ideal, some individuals do not possess the knowledge of statistics and medical terminology required to fully understand a study. Requiring staff to take test or create a presentation on unfamiliar material might create anxiety. While creating a presentation for the staff is a good idea, focusing on the descriptive statistics is not recommended. Highly technical or advanced terminology should be avoided. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 127-148. *The most appropriate method for Dr. Jones to share the study results with the veterinary staff is to prepare a brief presentation, create visual aids, and provide an informal written summary of the study. This approach combines verbal, visual, and written communication, ensuring the information is accessible without overwhelming the staff with technical details. Avoiding highly technical terminology and using informal language will help in effectively conveying the necessary changes to the team.*

Answer 6

Answer: **Confirm client ownership of the patient prior to humane euthanasia** Explanation Confirming client ownership of the patient is the most appropriate next step since the client and patient are not previously known to the clinic/ veterinarian. While obtaining client consent is important prior to humane euthanasia, verbal consent is less appropriate than written consent when the client and patient are not previously known to the clinic/veterinarian. Discussing options for handling the patient's remains and escorting the client to a comfortable, quiet area are important prior to humane euthanasia, however confirming client ownership should be completed first. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 55-56. *The most appropriate next step is to confirm client ownership of the patient before proceeding with humane euthanasia, especially since the client and patient are new to the clinic. While obtaining written consent and discussing options for the patient's remains are important, verifying ownership should be prioritized to ensure proper and ethical procedures are followed.*

Answer 7

Answer: **Assure the owner that feeling doubt regarding a euthanasia decision is normal and encourage the client to complete a quality-of-life score for the patient.** Explanation Doubt is a normal part of the emotional response to considering humane euthanasia. Reviewing quality of life indicators can help clients feel more confident and experience less doubt regarding euthanasia decisions. Feeling doubt surrounding humane euthanasia is normal. When doubt is encountered, encouraging the owner to evaluate their own feelings surrounding euthanasia is preferred. While providing a clinical opinion about the appropriateness of humane euthanasia is helpful, the veterinarian should avoid pressuring the owner into performing humane euthanasia. Encouraging a dialogue with the owner regarding the pet's quality of life is more helpful in managing client doubts than listing clinical evidence in support of euthanasia. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 69-72. *The most appropriate response is to assure the owner that feeling doubt about a euthanasia decision is normal and encourage the client to complete a quality-of-life score for the patient. Doubt is a common emotional response, and reviewing quality of life indicators can help the owner make a more confident decision without feeling pressured. Engaging in a dialogue about the pet's quality of life is more supportive than listing clinical reasons for euthanasia.*

Answer 8

Answer: **The results generate a hypothesis which can be tested in further studies** Explanation The purpose of a case study is to generate a hypothesis. Case studies cannot be used to test a hypothesis. Further research is needed to test the hypothesis that Substance A has a clinical benefit. Case studies carry less strength of evidence than clinical trials. Case reports are not used to test hypotheses. A hypothesis may be generated in a case report, but it cannot be confirmed without further study. A cause-and-effect relationship cannot be established in a case report because there is no control group. Source: (1) Reviewing the Evidence: How to be a discriminating Reader. Litster, A. L. American College of Veterinary Internal Medicine (2) Conference Proceedings, 2017. (2) Guideline on writing a case report. Alsaywid, B. S. and Abdulhaq, N. M. Urology annals, 2019, 11(2), pages 126-131. *Case reports are valuable for generating hypotheses, but they cannot test or confirm a hypothesis on their own. They provide preliminary observations that need to be investigated through controlled studies to establish a cause-and-effect relationship and determine the efficacy of treatments like Substance A.*

Answer 9

Answer: **There are several options for treatment of hyperthyroidism. I will review the options with you today, and I would like to e-mail some more detailed information for you to review before you decide which you would like to use for Flopsy.** Explanation In this option, complex information is presented in small, manageable chunks. The client is receiving initial information directly from the veterinarian and can also review the written information at their own pace. This option involves repetition, which is helpful in reinforcing the information. Finally, this answer incorporates both verbal and written communication to aid understanding. While methimazole or radioiodine therapy are acceptable treatment options for hyperthyroidism, in each of these scenarios the veterinarian is making assumptions about the client's goals. In the option that addresses methimazole therapy, the veterinarian has not adequately reviewed the other therapeutic options and has therefore not established informed consent. In the option that addresses radioactive iodine therapy, the veterinarian assumes that the client does not wish to incur the expense of therapy and leads the client toward therapy with methimazole instead. While providing comprehensive information via e-mail is a wonderful idea, a combination of verbal and written communication is preferred. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 32-33. *The most appropriate option is to inform the owner that there are several treatment options for hyperthyroidism and to review these options together during the visit. Additionally, offering to e-mail detailed information allows the owner to review the options at their own pace before deciding on the best treatment for Flopsy. This approach ensures informed consent and combines verbal and written communication, which reinforces understanding and supports the decision-making process.*

Answer 10

Answer: **Recognize that the client is experiencing a symbolic loss and provide contact information for a therapist experienced in pet bereavement counseling.** Explanation The best answer involves recognizing that the client is experiencing a symbolic loss. Symbolic pet losses occur when companion animals represent another loss in a client's life. Providing contact information for a therapist experienced in pet bereavement counseling is a good choice for ensuring that the client is adequately supported. Primary loss is felt following the death of a client's personal pet. Secondary losses include the disruptions to the life of the client that are created by the primary loss. Ambiguous loss is experienced when the client does not know the fate of their companion animal, such as in cases of lost pets. When a client experiences any type of pet loss, providing contact information for pet bereavement services is recommended. Having the information on-hand and readily available to clients is important. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 68-69 and 95-98.

Answer 11

Answer: **Call the owner directly to confirm her wishes for euthanasia and have another employee confirm over the phone as an additional witness. Have the agent sign the euthanasia request form.** Explanation This is a tricky situation and can be difficult to handle when the client's emotions are involved. Clearly the dog is in poor condition and the request for euthanasia is not unreasonable. However, the owner needs to give direct permission for this to occur. Calling the owner for consent for the euthanasia is the correct way to approach this case. If the owner cannot be reached and there is no documentation for consent, then it is best to wait until there is valid documentation If a euthanasia appointment is scheduled in advance and they are new clients, have them bring the medical records and ensure you will have the appropriate documentation you will need to carry out the euthanasia to try and avoid this type of conflict. When they schedule the appointment, if the owner will not be present, let them know confirmation by the owner over the phone or a written statement will be needed and should be brought and kept in the medical record. Failure to receive such consent from the dog's owner is a serious liability for you as the veterinarian. Despite the appearance, this man could be bringing the dog in for euthanasia against the dog's owner's wishes and it is your responsibility to properly document that euthanasia was requested by the owner. *The best option is to call the owner directly to confirm her wishes for euthanasia and have another employee confirm the conversation over the phone as an additional witness. The agent should then sign the euthanasia request form. This ensures that the owner's consent is properly obtained and documented, which is crucial for legal and ethical reasons. It also helps to prevent any potential misunderstandings or conflicts, ensuring that the decision is made in accordance with the owner's wishes. If the owner cannot be reached, it would be best to wait until proper documentation is obtained.*

Answer 12

Answer: **Dr. Thomas should discuss the cystocentesis procedure, explain that risks like bladder rupture and vagal response are uncommon, and obtain verbal consent for the procedure.** Explanation The correct answer involves explaining the procedure, outlining the potential risks, and obtaining consent for the procedure. Verbal consent is typically adequate for a routine procedure when there is a long-standing veterinary-client-patient relationship. Informed consent is needed even for routine procedures. Providing assurances that the procedures will go smoothly is inappropriate, as the owner should be made aware of potential complications as a part of informed consent. The risks of performing a procedure should be neither over- nor under-stated. Either written or verbal consent would be acceptable to document informed consent in this situation. However, in the answer option that includes written consent, the veterinarian failed to discuss the potential complications of the procedure. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 47-58. *The most accurate approach for obtaining informed consent for urine collection via cystocentesis is for Dr. Thomas to discuss the cystocentesis procedure, explain the potential risks—such as bladder rupture and vagal response, although these are uncommon—and obtain verbal consent. Verbal consent is typically sufficient for routine procedures when there is an established veterinary-client-patient relationship. It's important to ensure the owner is aware of potential complications as part of the informed consent process, without overstating or understating the risks.*

Answer 13

Answer: **Surgery and conservative therapy are the two main options for treatment of an ACL tear, and they vary in cost and effectiveness.** Explanation In this option, the veterinarian acknowledges that there is more than one treatment option and is honest about the cost differences without leading the client to a particular decision. The incorrect options each lead the client toward a particular choice. In each of the incorrect options, the veterinarian makes a judgement about the client's finances and goals. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 112-115. *The most appropriate way for Dr. Blackwell to discuss the management options for an ACL tear in Snickers is to explain that surgery and conservative therapy are the two main options, highlighting that they vary in cost and effectiveness. This approach acknowledges the different treatment possibilities without making assumptions about the client's finances or goals, allowing the owner to make an informed decision based on their preferences and circumstances.*

Answer 14

Answer: **Obtain informed consent from the client regarding the patient's participation in the clinical trial.** Explanation Obtaining informed consent from the client is the most appropriate next step. Informed consent is necessary for participation in clinical trials. Participation in clinical trials must be voluntary and non-coercive. Owner consent should be established prior to discussing the patient's case or sharing medical records with another veterinarian. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 58. *The most appropriate next step is to obtain informed consent from the client regarding Buck's participation in the clinical trial. Informed consent is essential for participation in clinical trials and ensures that the client's decision is voluntary and non-coercive. Consent should be obtained before discussing the case or sharing medical records with another veterinarian.*

Answer 15

Answer: **In client communication, a veterinarian with a collaborator style does not dominate the conversation while the veterinarian with either the guardian or teacher style does dominate the conversation** Explanation The guardian style of veterinarian communicates in the following manner: They dominate the conversation and provide all of the information to the client. They typically present only the treatment option they feel is best and are therefore, the primary decision maker. The teacher style of veterinarian provides information to the client but may also encourage them to seek additional information on their own. They typically dominate the conversation and present all options without emphasis toward the veterinarian's own treatment preference. The collaborator style of veterinarian shares decision making power and is approximately equal to the client in terms of doing most of the talking. They share medical information with the client that is relevant to the preferences provided by the client. All options are given and the client's and veterinarian's preferences are shared until a collaborative decision is made. Any individual veterinarian can take on multiple roles depending on the situation and client but in general, the collaborator is viewed as the optimal choice for both veterinarian and client in the majority of situations. *In client communication, a veterinarian with a collaborator style differs from the guardian and teacher styles by not dominating the conversation. Instead, the collaborator shares decision-making power and engages in a balanced dialogue with the client. The guardian and teacher styles typically involve the veterinarian dominating the conversation, with the guardian making decisions and the teacher presenting all options without a preference. The collaborator is generally considered the optimal style, fostering a shared decision-making process based on mutual input.*

Answer 16

Answer: **When and where was the puppy vaccinated?** Explanation "When and where was the puppy vaccinated?" is the most appropriate phrasing because the question is open-ended. The use of open-ended questions is encouraged to improve client communication. Open-ended questions allow the client to provide a comprehensive answer, which gives the most information to the medical team. Additionally, this option does not lead the client toward a particular answer. Questions beginning with "did," "has"" and "is"" are closed questions, or questions for which there is only one answer (yes or no). Closed questions limit the information the client is being invited to provide. Additionally, the phrasing of the three incorrect options might lead the client to answer "yes"" even if they aren't sure about vaccinations. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 14. *The most appropriate question to obtain additional medical history is, "When and where was the puppy vaccinated?" This open-ended question encourages the client to provide detailed information without leading them toward a specific answer. Open-ended questions are effective in improving client communication, allowing the medical team to gather more comprehensive information about the patient's history. In contrast, closed questions, which often result in simple yes or no answers, limit the information provided.*

Answer 17

Answer: **What's been going on with your pet?** Explanation What's been going on with your pet? This is an example of an open-ended question that allows a client to tell their story in their own words without leading or prompting. Why didn't you bring your pet to the veterinarian when this first began last week? Questions beginning with why should be avoided as they imply guilt or responsibility and may invoke a defensive response from a client. It sounds like your pet has been vomiting intermittently for several months. This is an example of a reflective listening statement. While this can be very effective in communication, it is not an open-ended question. When did your pet's vomiting start? This is a specific, pointed question rather than an open-ended one that will likely invoke a short response. This may allow the discovery of important information but should be reserved until after a client has explained the relevant history in their own words. You seem very concerned about your pet's condition. This is an example of an empathic statement that is also used by veterinarians with good communication skills but it is not an open-ended question. *The best example of an open-ended question that a veterinarian with good communication skills might use at the beginning of an appointment is, "What's been going on with your pet?" This question invites the client to share their story in their own words without leading or prompting, allowing for a more comprehensive understanding of the situation. Open-ended questions like this one are crucial for gathering detailed information and building rapport with the client.*

Answer 18

Answer: **I apologize for your wait. I was delayed by an emergency with another patient.** Explanation When clients are angry due to being kept waiting, personal ownership of an apology ("I apologize...") is preferred over an apology without ownership ("I'm sorry that..."). Additionally, apologies which were accompanied by an explanation for the wait are preferred. In each of the incorrect options, there was no direct ownership of the apology. While triage of emergencies is an important clinic policy, relating this information to an owner is unlikely to dissipate their anger regarding their wait. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 117-118. *The most effective way to dissipate Janice's anger about the wait is to say, "I apologize for your wait. I was delayed by an emergency with another patient." Taking personal ownership of the apology and providing a brief explanation for the delay acknowledges the inconvenience and helps to diffuse the client's frustration more effectively than simply stating a policy or offering an apology without ownership.*

Answer 19

Answer: **Explain that medical stabilization and emergency surgery is indicated, review possible complications with the owner, and obtain verbal and written consent for the necessary procedures.** Explanation Explain that medical stabilization and emergency surgery is indicated, review possible complications with the owner, and obtain verbal and written consent for the necessary procedures. The risks of performing a procedure should be neither over- nor under-stated. Obtaining both verbal and written consent for procedures is preferred. Providing assurances that the procedures will go smoothly is inappropriate, as the owner should be made aware of potential complications as a part of informed consent. While presenting death as a potential complication is reasonable, the risks should not be overstated. Other potential surgical and anesthetic complications should also be discussed. Obtaining both verbal and written consent for surgical procedures is preferred. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 47-58. *The most appropriate steps for the veterinarian are to explain that medical stabilization and emergency surgery are indicated, review possible complications with the owner, and obtain both verbal and written consent for the necessary procedures. It's important to provide a balanced explanation of the risks without overstating or understating them, ensuring the owner is fully informed. This approach helps the owner understand the situation and the potential outcomes, leading to a more confident and informed decision.*

Answer 20

Answer: **How familiar are you with urethral obstruction in cats?** Explanation Use of a question to gauge the client's current knowledge base is recommended. This option does not suggest an assumption of the client's level of knowledge. This option is posed as an open question, which maximizes the amount of information that the client is likely to share. The use of open-ended questions is encouraged to improve client communication. Open-ended questions allow the client to provide a comprehensive answer, which gives the most information to the medical team. Additionally, this option does not lead the client toward a particular answer. Questions beginning with "do" are closed questions, or questions for which there is only one answer (yes or no). Closed questions limit the information the client is being invited to provide. Both statement options assume the level of knowledge the client possesses and should therefore be avoided. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 14 and 31-33. *The most appropriate way for Dr. Jones to begin a discussion about urethral obstruction in cats is to ask, "How familiar are you with urethral obstruction in cats?" This open-ended question helps gauge the client's current knowledge without making assumptions. It encourages Anna to share what she knows, allowing Dr. Jones to tailor the explanation to her level of understanding. Using open-ended questions like this one is recommended for effective client communication.*

Answer 21

Answer: **Great job recognizing hypotension in our patient today!** Explanation This feedback is both specific and timely. Providing detailed feedback is recommended rather than using general statements. Incorrect options are those that use general statements instead of specific feedback. Source: 101 Veterinary Practice Management Questions Answered. Donnelly, A. L. 2010. American Animal Hospital Association. Page 105. *The most appropriate option for providing positive reinforcement and feedback to Mia is: "Great job recognizing hypotension in our patient today!" This feedback is specific and timely, which is more effective than general statements in reinforcing her skills and encouraging continued learning and development.*

Answer 22

Answer: **Discuss the importance of open body language and a warm demeanor when interacting with clients.** Explanation When giving feedback, the focus should be on correcting behavior. Feedback should also be specific and timely. Feedback should not focus on intangible qualities such as the employees perceived attitude or intentions. Provide feedback that is both specific and timely. Source: 101 Veterinary Practice Management Questions Answered. Donnelly, A. L. 2010. American Animal Hospital Association. Page 105. *The most appropriate option for providing feedback to the receptionist is to discuss the importance of open body language and a warm demeanor when interacting with clients. This approach focuses on specific, correctable behaviors and provides timely feedback that can help improve the receptionist's interactions with clients, enhancing the overall client experience.*

Answer 23

Answer: **Dr. Harper explains that the goats have an intestinal parasite called the barber pole worm, reviews the FAMACHA scale with the owner using non-technical language, and cautions the owner that culling may need to be considered for goats who repeatedly have high FAMACHA scores.** Explanation Diagnosis, prognosis and treatment options should be communicated in clear, non-technical language that the owner can easily understand. Providing the owner with easy-to-understand information that is designed for use by non-experts, such as the FAMACHA scale, is recommended. The prognosis of an illness should not be over-or under-stated. Presenting a realistic picture of the prognosis regarding herd health is important. Assuring the owner that the goats will recover is inappropriate. Discussion of standard herd management options including culling should not be omitted from a discussion about herd health and management options, even when the owner has a strong bond with animals in a production setting. The use of highly technical medical terminology should also be avoided when communicating with clients. Use of clear, common language is recommended. It is best to select appropriate educational resources that reflect the knowledge level of the client. While recommending textbooks and journal articles to highly knowledgeable and experienced goat producers might be a reasonable step, this owner's low experience and training level would benefit more from non-technical resources designed for lay people. Instructing an inexperienced owner to administer an anthelmintic with no further direction is not ideal. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Pages 25-38. *The most appropriate option for educating Zelda about genetic selection for Haemonchus resistance is for Dr. Harper to explain that the goats are infected with the barber pole worm, review the FAMACHA scale using non-technical language, and caution Zelda that culling may need to be considered for goats with repeatedly high FAMACHA scores. This approach ensures that Zelda understands the situation clearly, including the importance of herd management practices like culling, while using language that is accessible to someone with her level of experience. Providing realistic information about the prognosis and management options is crucial, especially given Zelda's strong emotional bond with her goats and her goal of making the creamery her primary source of income.*

Answer 24

Answer: **Explain that the injection will stop the heart and cause death.** Explanation This explanation is clear and accurate. This phrasing also contains non-technical language that is easy for a lay person to understand. When communicating with clients, avoid using euphemisms such as "pass away," or "sleep forever." Using overly technical medical terminology should also be avoided when communicating with clients, as some clients may not understand what "cardiac arrest" means. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 100-109. *The most appropriate phrasing when discussing the process of humane euthanasia with Anna is to explain that "the injection will stop the heart and cause death." This explanation is clear, accurate, and uses non-technical language that is easy for a layperson to understand. Avoiding euphemisms and overly technical terms ensures that the information is communicated in a straightforward and compassionate manner.*

Answer 25

Answer: **What are your goals regarding end-of-life care for Tippy?** Explanation This is the most appropriate phrasing because the question is open-ended. The use of open-ended questions is encouraged to improve client communication. Open-ended questions allow the client to provide a comprehensive answer, which gives the most information to the medical team. Additionally, this option does not lead the client toward a particular answer. All of the incorrect options feature closed questions. Questions beginning with "do," and "is" are closed questions, or questions for which there is only one answer (yes or no). Closed questions limit the information the client is being invited to provide. When communicating with clients, avoid using euphemisms such as "let the patient go." Finally, veterinarians should avoid leading the owner toward a particular decision. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 14 and 100-126. *The most appropriate question for Dr. Jackson to initiate a quality-of-life discussion with Tippy's owner is, "What are your goals regarding end-of-life care for Tippy?" This open-ended question encourages the owner to share their thoughts and priorities, providing valuable information for the medical team. It avoids leading the client toward a specific answer and fosters a more meaningful and comprehensive discussion about Tippy's care.*

Answer 26

Answer: **Obtain verbal consent for euthanasia via phone, with a second staff member listening to and confirming the owner's consent, then document the conversation in the medical record before proceeding with euthanasia.** Explanation For cases involving a previously known client and patient, in which the possibility of euthanasia is discussed in advance of an anesthetic procedure, verbal consent via phone is acceptable. Having more than one staff member confirm the consent for euthanasia via phone and document the conversation is recommended. In such a case, written consent is not essential, and insisting on written consent may create more stress for the client. When accepting consent for euthanasia via phone, having a second staff member confirm the client's wishes is recommended. If verbal consent for euthanasia has been given and the procedure has already been completed, then written consent is unnecessary. Having the owner return to the clinic to sign a written consent form may create more stress for the client. However, some type of owner consent is required prior to humane euthanasia. Consent prior to euthanasia is always necessary. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley- Blackwell, 2010. Pages 55-56. *The most appropriate way for Dr. Smith to proceed is to obtain verbal consent for euthanasia via phone, with a second staff member listening to and confirming the owner's consent. This conversation should then be documented in the medical record before proceeding with euthanasia. This approach ensures that consent is properly obtained and recorded, reducing stress for the client while adhering to ethical and legal standards.*

Answer 27

Answer: **Explain that you have some bad news to share, then discuss the clinical findings, prognosis, and treatment options using clear, non-technical language.** Explanation Using a verbal cue to prepare the owner for bad news is recommended. Findings, prognosis and treatment options should be communicated in clear, direct language that the owner can easily understand. The use of euphemisms or overly positive language should be avoided when relating bad news to clients. Presenting a realistic picture of the prognosis is important. The use of highly technical medical terminology should be avoided when communicating with clients. Though a bleeding mass in the abdomen is a common cause of hemoabdomen in dogs, we do not yet have enough information to present this differential as a definitive diagnosis. Source: Handbook of Veterinary Communication Skills. Edited by Carol Gray and Jenny Moffett. Wiley-Blackwell, 2010. Page 104. *The most appropriate approach is to begin by gently preparing the owner by saying, "I have some bad news to share." Then, discuss the clinical findings, prognosis, and treatment options using clear, non-technical language. This approach ensures that Rebecca is prepared for the difficult news and that the information is communicated in a way she can easily understand. Avoiding euphemisms or overly technical terms helps to present a realistic and compassionate explanation of the situation.*

Answer 28

Answer: **Affected animals have a normal activated clotting time and partial thromboplastin time** Explanation The correct answer is affected animals have a normal activated clotting time and partial thromboplastin time. Affected animals usually have less than 10% of Factor VIll and have prolonged ACT and APTT. The disease commonly affects dogs and cats and mostly only males, since it is an X-linked recessive trait. Females with the gene for the disease are usually unaffected carriers unless they were the offspring of an affected male and a carrier female. ***PowerPage: Hemostasis *In Hemophilia A, affected animals do not have normal activated clotting time (ACT) and partial thromboplastin time (APTT). Instead, these times are prolonged due to less than 10% of Factor VIII. This X-linked recessive disease commonly affects male dogs and cats, while females are typically unaffected carriers unless bred from an affected male and carrier female.* **Coagulation Protein Disorders in Animals: Key Information** Definitions and Types: • Congenital Coagulation Disorders: Early-age symptoms, often fatal with severe deficiencies. • Factor I (Fibrinogen) Deficiency: Severe bleeding; treated with fresh-frozen plasma. • Factor II (Prothrombin) Disorders: Rare; treated with plasma or whole blood. • Factor VII Deficiency: Prolonged PT; minimal clinical bleeding. • Factor VIII (Hemophilia A): Common in dogs, X-linked; treated with cryoprecipitate. • Factor IX (Hemophilia B): Similar to Hemophilia A; treated with plasma. Acquired Coagulation Disorders: • Liver Disease: Reduced production of coagulation proteins, potential DIC. • Vitamin K Deficiency: Impaired production of Factors II, VII, IX, X. • Anticoagulant Rodenticide Toxicity: Inhibits vitamin K recycling; treated with vitamin K1. Disseminated Intravascular Coagulation (DIC): • Causes: Secondary to infections, heat stroke, neoplasia. • Stages: Hypercoagulable (initial), hypocoagulable (advanced). • Diagnosis: Thromboelastography, hemostasis tests (APTT, PT, fibrinogen). • Treatment: Address underlying disease, heparin for hypercoagulable stage, plasma for hypocoagulable stage. [Merck Coagulation Protein Disorders](https://www.merckvetmanual.com/circulatory-system/hemostatic-disorders/coagulation-protein-disorders-in-animalsg)

Answer 29

Answer: **Binds to antithrombin, which subsequently accelerates the interaction between antithrombin and activated factor X or thrombin** Explanation Heparin inactivates activated factor X and thrombin, thus halting the coagulation cascade. Remember, factor X is related to the common pathway of the coagulation cascade, whereas thrombin is necessary to convert fibrinogen to fibrin. *Heparin works as an anticoagulant by binding to antithrombin, which then accelerates the inhibition of activated factor X and thrombin. This action halts the coagulation cascade, as factor X is part of the common pathway, and thrombin is crucial for converting fibrinogen to fibrin.*

Answer 30

Answer: **Pyruvate** Explanation During the anaerobic process of glycolysis, a single molecule of glucose forms 2 molecules of pyruvate in the cell cytoplasm. Under aerobic conditions, pyruvate is converted to acetyl coenzyme-A and fed into the TCA cycle. In anaerobic conditions, pyruvate is preferentially transformed to lactate in an effort to maintain ATP production and allow regeneration of NAD (required for continued glycolysis). *Pyruvate is the end-product of glycolysis and is converted to lactate under anaerobic conditions. In the absence of oxygen, this conversion helps maintain ATP production and regenerates NAD, essential for continued glycolysis. Under aerobic conditions, pyruvate is converted to acetyl coenzyme-A for the TCA cycle.*

Answer 31

Answer: **Liver; less than 2.5 mmol/L** Explanation Lactate is primarily metabolized by the liver and, in health, it should be low (< 2.5 mmol/L). The kidneys and skeletal muscle also metabolize lactate to a lesser extent. Lactate is typically associated with anaerobic metabolism and has been used to predict survival in gastric dilatation volvulus in dogs and colic and sepsis in horses.

Answer 32

Answer: **Factor IX** Explanation The correct answer is factor IX. The vitamin K dependant factors are II, VII, IX, and X. This is important when animals are exposed to a vitamin K antagonist, such as many rodenticides. ***PowerPage: Hemostasis

Answer 33

Answer: **Oxacillin** Explanation Oxacillin is the preferred antimicrobial used to test for methicillin resistance. Oxacillin resistance implies resistance to all penicillins, cephalosporins, imipenem, and beta lactam/beta lactamase inhibitors and combinations such as amoxicillin/clavulanic acid. Oxacillin is used instead of methicillin because it is more stable and widely available. *Oxacillin is used to test for methicillin resistance in bacterial culture and sensitivity reports. Oxacillin resistance indicates resistance to all penicillins, cephalosporins, imipenem, and beta-lactam/beta-lactamase inhibitor combinations like amoxicillin/clavulanic acid. It is preferred over methicillin due to its stability and availability.*

Answer 34

Answer: **Regurgitation** Explanation The correct answer is *regurgitation*. Vascular ring anomalies entrap the esophagus and trachea. Circular compression of the esophagus results in physical obstruction and regurgitation. Less commonly, they affect the trachea. ***PowerLecture: Vascular Ring Anomalies

Answer 35

Answer: **Left atrial and left ventricular enlargement with pulmonary hyperperfusion** Explanation The correct answer is *left atrial and left ventricular enlargement with pulmonary hyperperfusion*. In dogs with a VSD, the shunt occurs during systole when both ventricles are contracting so blood is shunted from the left ventricle almost directly into the pulmonary artery. The right ventricle acts as a conduit between the left ventricle and pulmonary artery and is less commonly affected by the shunted blood. The excess blood flow is found in the pulmonary vasculature, left atrium, and left ventricle, thus enlarging these structures.

Answer 36

Answer: **The prognosis is fair. Sudden death may occur at any time, and the dog has an increased risk for infective endocarditis.** Explanation 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.

Answer 37

Answer: **Right atrium** Explanation The correct answer is right atrium. Although the reason for this predilection is unknown, this is the most common site in the heart for hemangiosarcoma to occur. ***PowerPage: Hemangiosarcoma

Answer 38

Answer: **Herpes simiae** Explanation The correct answer is *Herpes simiae*. This is a herpes B virus. Old world monkeys can transmit this disease by bite or scratch. Macaques are the most frequent carriers. In monkeys, the disease can cause mild cold sore like lesions in times of stress. This strain of herpes is potentially fatal to humans. Similarly, humans carry a strain of herpes (herpes simplex virus) which can cause fatal encephalitis in monkeys. Hepatitis B, tuberculosis, and measles are all zoonotic, but do not cause encephalitis.

Answer 39

Answer: **Coccidia are incredibly environmentally resistant and difficult to disinfect; Coccidia are also species-specific so the baby is not at risk but the other cat could become infected** Explanation Coccidiosis or infection with the protozoan. Isospora is very common in young cats and dogs. The disease is very difficult to disinfect and rid from the environment. It is important to pick up the stools as soon as possible to avoid sporulation and contamination of the environment with cysts. Luckily, Isospora is species-specific so zoonosis is not a concern. [Coccidiosis of Cats and Dogs](https://www.merckvetmanual.com/digestive-system/coccidiosis/coccidiosis-of-cats-and-dogs) **Coccidiosis of Cats and Dogs: Key Information for Veterinary Professionals** Definition and Causative Agents: • Coccidiosis: Intestinal infection caused by protozoan parasites of the genus Cystoisospora. • Species: Cystoisospora canis, C. ohioensis, C. felis, C. rivolta. Clinical Findings: • Symptoms: Diarrhea, abdominal pain, anorexia, vomiting, dehydration. • Severe Cases: Hemorrhagic diarrhea, weight loss, and possible death in young or immunocompromised animals. Diagnosis: • Fecal Examination: Identification of oocysts via flotation techniques. • PCR Assays: Molecular confirmation. Treatment: • Anticoccidial Drugs: • Sulfadimethoxine: 55 mg/kg initially, then 27.5 mg/kg daily for 5-20 days. • Toltrazuril: 10-20 mg/kg once daily for 2-3 days. • Ponazuril: 50 mg/kg once daily for 3 days. Prevention and Control: • Sanitation: Regular cleaning of living areas. • Reduce Stress: Minimize factors predisposing to infection.

Answer 40

Answer: **Proper disposal of feces eliminates the threat of transmission to other animals** Explanation The life cycle of *Gnathostoma* involves a small copepod intermediate host (similar to Dracunculus worms). Copepods are small crustaceans that are found in freshwater habitats (i.e. ponds). Eggs passed in the feces are not infectious unless first ingested by copepods so proper disposal of feces prevents transmission to other animals. Adult worms live in the mucosa of the stomach and cause gastritis. They can also create nodules in the stomach which can ulcerate and lead to severe peritonitis. Human cases of gnathostoma usually occur from ingestion of undercooked fish or other animals and can cause gastritis or peritonitis. Larva may undergo cutaneous or neural migration (rare). Control is typically achieved by preventing cats from hunting in areas where the parasite is found. It is thought that albendazole is effective against *gnathostomiasis*.

Answer 41

Answer: **2(13/3 C1/1 P3/2 M1/1)** Explanation The correct answer is 2(13/3 C1/1 P3/2 M1/1).

Answer 42

Answer: **Clean litterbox daily and wash hands thoroughly. Immunocompromised people should avoid the litter box.** Explanation Toxoplasmosis is a zoonotic disease. Cats are the reservoir. Clinical signs are typically seen in younger cats but can occur in older cats or immunocompromised cats as well. Signs can vary from diarrhea to fever, malaise, orthopedic diseases, uveitis, or neurological signs. Oocysts are shed in the feces, where they take around 5 days to sporulate and become infective. Isolating the affected animal will decrease risk of transmission to other animals. Cleaning the litterbox daily will decrease the risk of exposure of infective oocysts to humans. Toxoplasmosis can cause birth defects or still births in humans, so pregnant women should avoid the litter box. Immunocompromised people should also avoid cleaning the litter box. Treatment of choice for cats is typically clindamycin.

Answer 43

Answer: **No treatment is necessary** Explanation This coccidian is not parasitic in dogs and cats and no treatment is necessary for the cat. The parasite has shown up on fecal exam because it is merely passing through the digestive tract secondary to coprophagy. Eimeria is identified as having 4 sporocysts or a distinct micropyle cap. Eimeria are parasitic in birds, reptiles, and herbivores. The owner should be informed of the parasite, and her rabbits should be treated. Isospora is the infectious coccidian in dogs and cats and is treated with Sulfadimethoxine (Albon).

Answer 44

Answer: **Ileocolic artery** Explanation The correct answer is ileocolic artery. The site for colonic resection is limited by tension on the ileocolic artery when trying to suture your new end of colon to the rectum. Sometimes the tension is too great and instead of a colocolic anastomosis, an ileocolic anastomosis must be performed. Essentially you are trying to connect a section of ascending colon to the rectum. Now that can be pretty far! Performing an ileocolic anastomosis is not ideal because you eliminate the ileocecal valve, and that may predispose the animal to bacterial overgrowth. The caudal mesenteric artery gives branches to the rectum and descending colon. The left colic artery also feeds the descending colon. The pudendal artery supplies the external genitalia. The ileocolic artery provides blood supply to the ascending and transverse colon.

Answer 45

Answer: **Measure serum fTLI concentration** Explanation EPI is characterized by the lack of production of pancreatic digestive enzymes and is best diagnosed by measuring trypsin-like immunoreactivity. EPI occurs when 90% of pancreatic exocrine function is destroyed. fTLI concentration is measured from a fasted blood sample and a trypsinogen level less than 8ug/L is diagnostic. Typically cats with EPI also have concurrent chronic pancreatitis as well as low levels of cobalamin. The exocrine pancreas is responsible for secreting intrinsic factor. Intrinsic factor binds cobalamin to allow for gut absorption. Amylase and lipase concentrations do not provide reliable information regarding pancreatic function in cats.

Answer 46

Answer: **Scents are moved to the vomeronasal organ** Explanation The flehmen response, as described in the question, helps animals trap pheromone scents in the vomeronasal organs (VNOs) so they can be analyzed more closely. Pheromones are the chemical signals emanating from other animals. When a horse draws in an organic odor, he curls up his lip to temporarily close the nasal passages and hold the particles inside. The upward head tilt seems to help the airborne molecules linger in the VNOs, which are located under the floor of the horse's nasal cavity. While sex pheromones are the most common flehmen trigger, they are not the only ones, and the response itself does not indicate sexual interest.

Answer 47

Answer: **Listeriosis** Explanation Listeria monocytogenes may cause an acute meningoencephalitis with microabscesses in the area of the brainstem and cranial nerve roots. However, there are other clinical forms of listeriosis that may be seen, such as abortion and septicemia of neonates. Usually, only individual animals are affected and not the herd. The animals commonly become infected after consuming spoiled silage. In general, the clinical signs seen are associated with dysfunction of the caudal brain stem, cerebellar peduncles, or spinal cord. Mycoplasma bovis will not result in central nervous system disease, especially in such a short time span (can cause otitis media-interna). Polioencephalomalacia does not result in cranial nerve signs and is caused by a thiamine deficiency. Ingestion of perennial ryegrass (grows between June and September in northern hemisphere) will cause ataxia and tremors as a result of activating GABA receptors when it is infected with an endophytic fungus. ***PowerLecture: Central Nervous System

Answer 48

Answer: **Theiler’s disease** Explanation The correct answer is Theiler's disease (aka serum sickness or serum hepatitis). Theiler's disease will cause an acute multifocal to diffuse hepatitis along with necrosis. PA toxicity results in the triad of biliary hyperplasia, fibrosis, and megalocytosis. Chronic-active hepatitis can cause a suppurative or lymphoplasmacytic inflammatory response in the liver. ***PowerPage: Hepatobiliary Diseases of Horses ***PowerLecture: Hepatobiliary Disorders

Answer 49

Answer: **345 days** Explanation The correct answer is 345 days, although gestational length can range from 330-360 days. It is good to have knowledge of previous gestational lengths because individual brood mares have the same/similar gestational lengths every year, allowing accurate estimate of foaling date. Additionally, this is important because many horse owners want mares to foal in mid-January for the reason that in racing, all horses have an artificial birthday on January 1st. In order to achieve this, it is recommended to breed in mid-February. Since the horse is seasonally polyestrous and would naturally start cycling in April or May, artificial lighting is often used starting in mid-December to promote estrus in mid-February. Most foals are considered premature if born prior to 320 days and prolonged gestation is typically associated with greater than 365 days. ***PowerLecture: Gestation and Parturition

Answer 50

Answer: **0.16%** Explanation You do not need to know anything about the disease in this question in order to get the correct answer. You are told that the disease is recessive and has a carrier rate of 8% Because the trait is recessive, homozygotes will be the only individuals affected. In order for a foal to be born homozygous for the trait, BOTH parents MUST be carriers. The chances of both parents being carriers is 8% × 8% (or 0.08 × 0.08) = 0.0064 or 0.64%. If both parents are carriers, the offspring has a 1 in 4 chance of inheriting two mutant alleles (50% chance for each allele from each parent). Since the chances of both parents being carriers is 0.64% and the chance of having a homozygous offspring in that case is 1 in 4, the overall expected frequency of diseased foals is 0.0064 × 0.25= 0.0016 or 0.16%.

Answer 51

Answer: **Hypoallergenic diet and prednisolone for inflammatory bowel disease** Explanation Lymphocytic plasmacytic enteritis is consistent with inflammatory bowel disease. The main treatments of this disease include controlling the underlying cause for the disease, controlling inflammation, and controlling bacterial overgrowth when needed. Steroids and hypoallergenic diet are the mainstay treatments for this disease. Prednisolone and budesonide are the two corticosteroids most often used. Metronidazole can also aid in treatment. Cisplatin is a chemotherapeutic agent that is contraindicated for the use in cats for any disease. Fortiflora is a probiotic that could possibly help with clinical signs of IBD, however is not necessarily a treatment for the disease itself. Metoclopramide could potentially help clinical vomiting from underlying IBD, but is a pro-motility agent that could worsen diarrhea and is not a treatment for IBD. While routine parasite control and fecal testing are important, fenbendazole is not a direct treatment for IBD. This indoor cat should probably have a fecal test, but Giardia is unlikely the cause for the histopathologic findings.

Answer 52

Answer: **Feline asthma, prednisolone** Explanation Feline asthma, also known as feline allergic bronchitis, is acute or chronic airway inflammation that occurs due to various stimuli. The triggers of this airway inflammation are largely unknown but underlying environmental allergens are suspected. The mainstays of therapy include corticosteroid administration and in some cases bronchodilators. In this young indoor cat with a negative fecal and heartworm test, infectious causes are less likely. Pneumonia typically causes more of a patchy alveolar pattern, most often causes a fever, and would be less likely a chronic condition. Congestive heart failure in a young cat with no heart murmur is very unlikely.

Answer 53

Answer: **Hypoxia** Explanation Post anesthetic cortical blindness results from poor perfusion during anesthesia. The visual cortex is extremely sensitive to the effects of hypoxia (poor perfusion/oxygenation) which can result in blindness. Not all arrhythmias will necessarily compromise tissue perfusion (for example isolated VPC's or first degree AV block etc.). Hypersensitivity or allergy to anesthetic gases used (such as isoflurane gas) are rarely documented. Elevated end-tidal CO2 indicates poor ventilation (such as from inadequate fresh gas flow, increased dead space, saturated up soda-lyme, a deep anesthetic plane, etc.), but not necessarily poor perfusion.

Answer 54

Answer: **Mirtazapine** Explanation Although, all of the options given can potentially help a cat with renal disease feel better, the only medication considered an appetite stimulant is mirtazapine. Mirtazapine is both a noradrenergic and serotonergic antagonist. The antagonism of presynaptic alpha-2 receptors increases the release of Noradrenaline and Serotonin (5HT). The blockage of the 5HT2A, 5HT2C and 5HT3 receptors redirects Serotonin to the 5HT1A receptor. Mirtazapine also antagonizes H1 receptors and the antagonism of this receptor and the 5HT2C receptor appear to be the mechanism by which appetite is increased. Famotidine (Pepcid) is an H-2 receptor blocker while omeprazole (Prilosec) is a proton pump inhibitor. Both reduce gastric acid secretion. Maropitant (Cerenia) is an anti-emetic. It is a neurokinin-1 inhibitor, which inhibits Substance P in the CNS. Metoclopramide is a prokinetic and anti-emetic drug. The mechanism for its anti-emetic effects is from antagonism of dopamine at its receptors in the chemo-receptor trigger zone of the brain.

Answer 55

Answer: **Increase in total peripheral resistance, increase in cardiac contractility, bronchodilation** Explanation The correct answer is increase in total peripheral resistance, increase in cardiac contractility, bronchodilation. Epinephrine is an alpha- and beta-adrenergic stimulant which causes peripheral vasoconstriction, increase in total peripheral resistance, increase in cardiac contractility and cardiac output, and bronchodilation. It is often used in cardiac arrests and anaphylactic shock. It is also found in some local anesthetic agents because of its vasoconstrictive effects, which prolongs effect of the anesthetic.

Answer 56

Answer: ** Explanation Ketoconazole is the best choice. This medication, along with other -azoles (fluconazole, itraconzole), are commonly prescribed treatments for Malassezia. Terbinafine is another antifungal medication that is becoming more popular for the treatment of Malassezia and dermatophytosis. Although, Griseofulvin is an antifungal it is not effective against Malassezia. Prednisone and carprofen may help with inflammation, but not clear the infection.

Answer 57

Answer: ** Explanation The correct answer is hypoproteinemia. 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 Ill.

Answer 58

Answer: **metronidazol** Explanation The correct answer is metronidazole. You should know that fenbendazole is actually the treatment of choice for Giardia, but metronidazole has historically been the most widely accepted option. If fenbendazole is not offered as an answer choice, choose metronidazole. If fenbendazole were offered as an answer choice, it would be the best option.

Answer 59

Answer: **Recession trochleoplasty** Explanation The correct answer is recession trochleoplasty. This technique is part of a surgical repair method for luxating patellas. Weight reduction is nearly always a therapeutic component to managing orthopedic disease. Leveling of the tibial plateau and cranial transposition of the fibular head are two surgical options for correcting a torn cranial cruciate ligament. ***PowerPage: Cruciate Ligament Disease ***PowerLecture: Cranial Cruciate Ligament Rupture

Answer 60

Answer: **Nephrotoxicity** Explanation Nephrotoxicity is not a reported side effect of azathioprine. All others on this list have been reported as side effects or have been associated with the use of azathioprine. Gl upset is the most common of the 4 listed, although it is still relatively infrequent. The other 3 listed side effects are uncommon, but can be life-threatening, so they must be discussed with the owner before starting treatment. Cats are more sensitive to these side effects than dogs because of a deficiency in thiopurine methyltransferase, the enzyme used to metabolize azathioprine. Azathioprine should be used with caution, if at all, in cats.

Answer 61

Answer: **Low-dose dexamethasone suppression test** Explanation The correct answer is low-dose dexamethasone suppression test. Tests used to try to differentiate PDH from an adrenal tumor include LDDST, HDDST, abdominal ultrasound, and endogenous plasma ACTH assay. With hyperadrenocorticism patients, LDDST and HDDST results show elevated cortisol levels at the 8-hour post-dexamethasone administration sample (normal animals would show suppressed cortisol levels at the 8-hour sample). PDH patients will show brief cortisol suppression at the 4-hour post-dexamethasone sample on some LDDST and HDDST tests. Patients with adrenal tumors causing Cushing's will not exhibit suppression of cortisol levels at the 4-hour post-sample. Although no patients with adrenal tumors should show suppression at the 4-hour post-sample, some PDH patients will not show cortisol suppression at the 4-hour post-sample either. Just as a recap, you look at the 8-hour post-dexamethasone sample to determine if the patient has Cushing's or not (should be elevated with Cushing's), and you look at the 4-hour post-sample to try and differentiate if the patient has PDH (will show cortisol suppression) or if you cannot determine if the patient has PDH or an adrenal tumor (no cortisol suppression).

Answer 62

Answer: **Yersinia pestis** Explanation The correct answer is Yersinia pestis. In order to make this determination remember that Yersinia pestis is usually transmitted to cats and dogs as a result of ingesting infected rodents or via bites from the prey's fleas. Dog and cat fleas are poor vectors of Plague. Dogs usually recover and you may lance the "buboes" and flush it, but dispose of organic material properly.

VetPrep NAVLE Flashcards

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