Week 4 March 3 Day 5

Question 1

Topic: Congenital Defects - Canine

The correct answer is persistent right aortic arch. This vascular ring anomaly is an inherited defect that causes a constricting obstruction of the esophagus at the level of the heart base. There is a breed predilection for German Shepherd Dogs and Irish Setters. Clinical signs of regurgitation usually manifest as the puppy is weaned off of milk and onto solid foods. PDAs, pulmonic stenosis, and diaphragmatic hernias of the small intestines should not cause regurgitation; however, vomiting may be a clinical sign if there is an obstruction associated with the diaphragmatic hernia of the small intestine.

Question 2

A dog presents to your clinic for fever and lymphadenopathy. You perform an aspirate of the lymph node and see large, bipolar staining coccobacilli. The owner mentions that he saw his dog eating a rat a few days ago. What is causing the dog’s illness?

Francisella tularensis
Yersinia pestis
Staphylococcus aureus
Pasteurella multocida

Answer 2

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

–> Note the “paper clip” appearance of the coccobaccili

Question 3

A 6-year old Labrador Retriever presents to your clinic with a sudden onset of anorexia, depression, vomiting and diarrhea. This dog has a history of going on a fishing trip with the owner approximately one week ago. CBC results include a leukocytosis and thrombocytopenia. A low albumin is noted on the chemistry panel. On fecal sedimentation, trematode eggs are visualized. What is the most likely diagnosis?
Salmon-poisoning disease
Cryptosporidium
Salmonella
Parvovirus

Answer 3

The correct answer is salmon-poisoning disease. In order to determine the correct diagnosis you need to put together several key pieces of information. The signalment gives you a heads up in that this dog is a sporting breed. The history practically gives away the answer when you put it together with the physical exam findings. The CBC and Chemistry results are not all that rewarding. The fecal sedimentation results should reinforce your suspicion that this is salmon poisoning. Remember, the dog eats the fish which had a fluke (Nanophyetus salmincola) which had Neorickettsia helminthoeca.

–> Note: Nanophyetus salmincola on cytology

Question 4

A 3-year old male castrated Labrador Retriever presents for severe hemorrhagic enteritis, lethargy, and anorexia. The dog has a history of going fishing with the owner about one week before the onset of the clinical signs. The physical exam reveals generalized lymphadenopathy. Which of the following is the most likely etiologic agent causing these clinical signs?

Nanophyetus salmincola
Salmonia fish
Neorickettsia helminthoeca
Paragonimus ketticotti

Answer 4

The correct answer is Neorickettsia helminthoeca. This dog most likely has salmon poisoning disease. The etiologic agent of the disease is the rickettsia, Neorickettsia helminthoeca, which is vectored by the intestinal fluke, Nanophyetus salmincola. Dogs get the disease by eating salmonid fish infected with the cercaria of the fluke, which harbor the rickettsia. Clinical signs along with finding fluke eggs in the feces of the dog is usually enough to make the diagnosis. Paragonimus kellicotti is a lung fluke of the dog.

Question 5

A dog presents to you with suspected hyperadrenocorticism. You would like to try to diagnose and differentiate between pituitary dependent and adrenal dependent hyperadrenocorticism with one test. Which of the following tests for hyperadrenocorticism is primarily a screening test, but can also be a differentiating test?

Low dose dexamethasone suppression test
High dose dexamethasone suppression test
Endogenous ACTH level
ACTH stimulation test
Urine cortisol:creatinine ratio

Answer 5

The 8-hour post-dexamethasone sample is used to determine if the pet has hyperadrenocorticism. If the 8-hour sample is above 1.4 ug/dL, the test is diagnostic for hyperadrenocorticism (either pituitary dependent or adrenal dependent). If the 4-hour sample is below 1.4 ug/dL or less than half of the baseline value, it is diagnostic for pituitary dependent hyperadrenocorticism.

The urine cortisol:creatinine ratio is a screening test to rule out hyperadrenocorticism, if it is normal. The endogenous ACTH level and high dose dexamethasone suppression tests are differentiating tests only. An ACTH stimulation test is a screening test but cannot differentiate pituitary versus adrenal dependent hyperadrenocorticism.

Question 6

A 5-year old female spayed Labrador Retriever presents for further evaluation after jumping out of the back of a pick-up truck. What are the most likely regions for a traumatic hernia to occur?

Flank and prepubic region
Diaphragmatic and umbilical region
Umbilical region and perineal region
Perineal and diaphragmatic region

Answer 6

Traumatic injuries are more likely to cause a flank or prepubic hernia than any other type of reported hernia. Umbilical hernias are almost exclusively congenital in nature. Perineal hernias are seen in older male dogs and is thought to be secondary to excessive hormones that result in weakening of the pelvic diaphragm. Finally, diaphragmatic hernias can occur secondary to trauma but are not as commonly noted as flank and prepubic.

Whenever a patient presents with unknown trauma or after being hit by a car, it is appropriate to take x-rays as 20% of dogs with diaphragmatic hernias will present several weeks after injury as a result of missing the diagnosis on physical examination alone.

Question 7

Dopamine is often used for which of the following reasons?

To increase heart rate
To decrease blood pressure
To increase arterial blood pressure
To increase contractility of the heart

Answer 7

The correct answer is to increase blood pressure. High doses of dopamine are used as an alpha agonist to increase peripheral resistance and increase blood pressure. It is often used during anesthesia and emergency situations to alleviate hypotension.

Question 8

Your client raises show rabbits and her cat named Neffer has been eating the rabbit feces. She brings Neffer’s fecal matter in for examination and the fecal float reveals Eimeria (see image). Which of the following treatments are indicated for this cat?

Sulfadimethoxine
Sulfasalazine
Doxycycline
No treatment is necessary
Fenbendazole

Answer 8

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).

Question 9

Which of these antibiotics is very poorly absorbed from the feline gastrointestinal tract, provided the tract is intact?
Clindamycin
Sulfadiazine
Neomycin
Chloramphenicol

Answer 9

Explanation
The correct answer is neomycin. As with most aminoglycosides, neomycin is poorly absorbed through the GI tract. For this reason, it is sometimes used orally to alter intestinal flora without systemic absorption. The other antibiotics are absorbed from the GI tract.

Question 10

A 4-year old female spayed tabby cat presents for labored breathing over the last 2 weeks. You suspect pleural effusion based on exam, and thoracocentesis produces a milky fluid. The cat’s temperature is 102.0 F (38.9 C) and bloodwork is unremarkable. You suspect the fluid to be chyle. How would you confirm this suspicion?

Answer 10

Measure triglycerides on the effusion as compared to peripheral blood.

Chyle has a high triglyceride content and if the effusion has a higher triglyceride value than the concurrent peripheral blood sample, this is most diagnostic.

Other than pyothorax, cytology of effusions do not typically show bacteria. This does not aid in the diagnosis but may help to rule out pyothorax.

Protein content of the effusion is not helpful due to the interference of the refractive index by the high lipid content of the fluid.

Question 11

A cat presents with a mid diaphyseal femoral fracture. The cat lives both indoors and outdoors and the owner is unsure of how the fracture occurred. Which repair method will result in the highest likelihood of failure?
Intramedullary pin
Interlocking nail
Type I External Fixation
Limited contact dynamic compression plate with 6 cortices engaged in each fragment

Answer 11

The least effective repair method of the choices listed is to place an intramedullary pin in a femoral fracture. Intramedullary pins are strongest in bending but do not provide enough stability by themselves. They are great as an adjunct to a bone plate. Placing a Type I external fixator on a femur is acceptable, however many feel that the fixator pins result in substantial morbidity when going through the large musculature of the femur. A limited contact dynamic compression plate is an acceptable method of repair as well as an interlocking nail which would provide great strength in bending, limit axial motion, and limit rotational motion.

Question 12

A 3-year old, male castrated domestic short-hair cat is presented to you for hematuria, strangiuria, and pollakiuria of 3 days duration. The cat has no other historical medical problems. What is the most likely diagnosis?

Bacterial urinary tract infection
Bladder stones
Fanconi syndrome
Transitional cell carcinoma
Feline idiopathic cystitis (FIC)

Answer 12

Also known as FLUTD or FUS, FIC is the most common cause of signs referable to the lower urinary tract in young, otherwise healthy cats.

Psychological stressors and environmental factors play an important role in the pathophysiology of this disease.

Less than 2% of otherwise healthy cats under the age of 10 with lower urinary tract signs have primary bacterial UTI. Bladder stones are possible, but not nearly as common as FIC. While TCC is the most common bladder cancer seen in cats, it is still rare, and chiefly occurs in geriatric cats. Fanconi syndrome is a proximal tubular disease (most often seen in Basenjis) that does not cause lower-tract signs.

Question 13

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?

You recommend a coronavirus titer to determine it the cat is actively infected
Feline infectious peritonitis is not contagious and because her other cat died of FIP does not mean this cat will succumb to the disease
Place the cat on L-lysine to prevent or suppress any infection with FIP
Her other cat may develop symptoms within the next two weeks because FIP is highly contagious
Perform a PCR on the cat’s feces to see if the virus is being shed

Answer 13

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 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 Gl upset. PCR on the feces would detect coronavirus, but does not distinguish between the enteric coronavirus and the mutated FIP form of the virus.

Question 14

A 12-year old female spayed Persian cat is presented to you for a 4 cm mass on the dorsal neck. On exam, the mass is a firm, freely movable, subcutaneous mass that is hairless and appears slightly melanotic. You take thoracic radiographs and bloodwork which are unremarkable. You perform a marginal excision and submit the mass for histopathology which comes back as a basal cell carcinoma that is completely but narrowly excised and has a high mitotic rate of 25 per 10 high-powered fields (400x). What should you recommend for adjunct treatment and follow-up?

Wider excision of tissue around the surgical field
Observation of the site for recurrence
External beam radiation therapy
Chemotherapy with doxorubicin

Answer 14

Basal cell tumors are common in older cats and most (greater than 90%) display benign behavior, even when histologically malignant
If the tumor is diagnosed by cytology or histopathology without surgical removal, many veterinarians will recommend monitoring without surgical removal although these masses can ulcerate or get fairly large.

Question 15

If you palpate a mare for pregnancy at day 30, what structure are you feeling for?

Ovarian location
Enlarged uterine artery
Fetus
Chorionic vesicle

Answer 15

The correct answer is chorionic vesicle. At this early in pregnancy, the other structures would not be located. A fetus does not become palpable until about 90-120 days. Ovary location and enlarged uterine arteries are not palpably changed until 7 months of pregnancy.

Question 16

A 10-day old, 130 pound thoroughbred colt is presented to you for a 2-day history of watery diarrhea. The foal gestational period was 327 days with a normal parturition reported. Serum IgG concentration, measured at 1 day of age, was 550 mg/dL. The foal produces watery diarrhea during the examination (see image) and nurses once per hour. The colt appears dull but responsive. The vital parameters taken as the foal rests are as follows:
Temperature 102.9F (39.4 C)
Pulse 120 beats/min
Respiratory Rate 80 breaths/min
Based on the limited information presented here, what is the LEAST likely cause of the diarrhea noted in this case?

Rotavirus
Salmonella sp.
Foal Heat Diarrhea
Septicemia
Clostridium perfringens

Answer 16

Based on the more concerning clinical signs, foal heat diarrhea is the least likely cause. Foal heat diarrhea is associated with the mare’s first estrous cycle after parturition, typically occurring between 8-12 days after parturition. Almost always, foal heat diarrhea is transient and not associated with clinical signs (ie. lethargy, inappetance, fever); it is also self-limiting. The cause of foal heat diarrhea is not exactly known, but hormonal changes, diet changes and/or intestinal floral changes are some possible causes. The other possible answers are all causes of diarrhea in the foal and can be associated with significant clinical signs and changes in blood parameters (CBC, biochemistry profile).
This case also tests your knowledge of healthy foals. Some things to recognize in this question include: the gestation length is slightly short (normal gestational period ~ 340 days), the serum IgG is low (normal IgG > 800 mg/dL), the nursing activity is decreased (normally nurse 4-6 times/hour) and the colt has mild elevations in temperature, pulse and respiratory rate.

Question 17

You suspect equine infectious anemia is a cause of abortion in a mare. What test would confirm this diagnosis?

Coggin’s Test
Indirect Coomb’s Test
Liver biopsy with immunofluorescent antibody
Direct Coomb’s Test
Blood smear

Answer 17

The correct answer is Coggin’s test. This test is an agar immunodiffusion to detect serum antibodies against the retrovirus causing equine infectious anemia. Coomb’s tests are done to diagnose immune mediated hemolytic anemias. The blood smear and liver biopsy would not show anything specific for equine infectious anemia.

Question 18

Which condition is associated with apical fracture of the proximal sesamoid bones, avulsion fractures of the palmar aspect of the third metacarpal bone, or fractures of the distal third of the small metacarpal bones in horses?

Deep digital flexer tendenitis
Superficial digital flexor tendonitis
Suspensory ligament desmitis
Sweeney

Answer 18

The correct answer is suspensory ligament desmitis. The presence of these fractures would indicate ultrasonography as the next diagnostic test to evaluate for suspensory ligament desmitis, since these fractures are present with this condition 25% of the time.

Question 19

A 3 month old foal presents to you with a cough. On your exam, you note that the horse has a respiratory rate of 50, temperature of 103 F (39.4C), and has wheezes on auscultation. You also note abdominal tucking on inspiration. You perform a transtracheal wash and find gram positive pleomorphic rods on cytology. What is your diagnosis?

Rhodococcus (Corynebacterium) equi
Equine infuenza
Streptococcus equi ssp. zooepidemicus
Streptococcus equi ssp. equi

Answer 19

The correct answer is Rhodococcus (Corynebacterium) equi. The signalment and clinical signs are most consistent with Rhodococcus equi infection. The pleomorphic gram positive rods on cytology make this clearly the best choice. The pleomorphic rods of Rhodococcus are often said to look like simplified Chinese characters, so keep this in mind if you are shown cytology on the exam. Another helpful diagnostic tool is the presence of single or multiple abscesses within the lung fields observed via thoracic radiography or ultrasonography.

Question 20

You have diagnosed onchocerciasis in a 12-year old horse that has an inflamed and alopecic area on the skin of the forehead.

What is the most effective single treatment?
Tetracycline IV
Antihistamines
Topical corticosteroids
Ivermectin
Increasing essential fatty acids in the diet

Answer 20

The skin lesions are caused by reaction to the migrating microfilaria of Onchocerca cervicalis. The adult worms live in the ligamentum nuchae. Culicoides midges act as intermediate hosts and transmit the microfilaria to sites such as eyes, eyelids, forehead and ventral midline. Ivermectin or moxidectin generally bring about marked improvement within 2 to 3 weeks. Microfilaria are not killed by the other answer choices provided.

Question 21

A 2-year old mare presents to you several weeks after recovering from a mild upper respiratory infection. She now presents with edema and sloughing of the legs (see image), chest and abdomen as well as mucosal petechial hemorrhages. She is sore and reluctant to move. Biopsy of the skin lesion is consistent with aseptic necrotizing vasculitis. What is the most likely diagnosis?

Idiopathic thrombocytopenia
Type I hypersensitivity
Cantharidin toxicity
Purpura hemorrhagica
Bastard strangles

Answer 21

This is the clinical and histologic appearance of purpura hemorrhagica. It is a type-Ill hypersensitivity which is when antigen-antibody complexes accumulate, leading to disease.
Purpura hemorrhagica most commonly occurs 2-4 weeks after exposure to certain infectious agents or vaccines. This condition is most commonly seen subsequent to infection with Streptococcus equi subsp. equi or vaccination against it but it can also be associated with other pathogens, particularly respiratory pathogens including other streptococcal species and equine influenza.
Regardless of the cause, purpura hemorrhagica results from accumulation of antigen-antibody complexes that deposit on blood vessel walls and activate a strong immune response (vasculitis). The leaky blood vessels lead to hemorrhage and edema.
Bastard strangles refers to the condition when Streptococcus equi subsp. equi creates abscesses in unusual sites (other than the lymph nodes draining the throat) such as abdominal or lung lymph nodes.
Cantharidin toxicity (also known as blister beetle toxicity) leads to mucosal irritation and results in colic and cystitis. It can also lead to hypocalcemia.
Primary immune-mediated thrombocytopenia (sometimes called idiopathic thrombocytopenia) can be seen in horses but is not consistent with the necrotizing vasculitis described in the case.

Type I hypersensitivity reactions are immediate reactions (such as urticaria) invoked by an antigen or allergen.

Question 22

A rancher in California has found several 8-month old steers dead in a corral holding 40 animals. Others in the group appear depressed and have diarrhea. The animals are being fed oat grass hay harvested from the neighboring field. As you examine two of the ill animals you note cardiac arrhythmias, rumen stasis, and generalized muscle weakness. You find some leaves in the rumen of one animal you necropsy. Nearby you notice some bushes surrounding the hay field, dropping leaves into the field (see photo) that appear to be the same ones found in the rumen. What is the plant responsible for these problems?

Astragalus sp
Nerium oleander
Senecio jacobea
Prunus sp
Lupinus sp

Answer 22

Oleander contains potent cardiac glycosides that alter sodium-potassium ATPase leading to altered excitability. Lawn/garden clippings fed to livestock are a frequent source of these plants. Other plants which contain cardiac glycosides include foxglove, azalea, laurel, lily-of-the-
valley, milkweed, and dogbane. Bufo toads also secrete similar toxins.

Question 23

A 4 year old dairy cow presents for circling to the right, poor appetite and depressed attitude. On physical exam, the right side of the cow’s face and the right ear are drooping (facial paralysis). What is the most likely causative agent for these signs?

Pasteurella multocida
Histophilus somni
Mycoplasma bovis
Listeria monocytogenes

Answer 23

Listeria monocytogenes is the most common CNS infection in adult ruminants. Infection is often associated with feeding of silage. It causes microabscesses in the brain resulting most commonly in unilateral cranial nerve signs such as facial nerve paralysis, vestibular signs (circling), head tilt, and dysphagia. CN V-XII may be involved. Head pressing may be seen in some cases. It is also a cause of abortions.
Treatment is with tetracyclines or high levels of penicillin.

Mycoplasma bovis in young calves can affect some animals with otitis interna, so the calf shows (uni or bilateral) facial paralysis, ear droop, and vestibular signs such as head tilt, nystagmus, and ataxia. There may be purulent discharge from the aural canal. M bovis can also cause pneumonia, polyarthritis and tenosynovitis. This condition can be difficult to treat and result in many animals with chronic illness.
Histophilus somni can commonly be a cause of respiratory disease and septicemia, as well as TEME (thromboembolic meningoencephalitis) or otitis media /interna in young feedlot animals where they exhibit head tilt, nystagmus, circling and stumbling.

They may also develop ipsilateral facial paralysis. So in this case the main differential is the age of the animal and the fact that this is often a feedlot animal, plus H somni tends to be a more fulminant systemic disorder.

Question 24

Bovine spongiform encephalopathy (BSE or mad cow disease) is not only a health concern for the management of cattle but also has potential public health implications if bovine nervous tissue from infected cows is consumed by humans. BSE has been implicated in a condition that mimics which of the following human diseases?

Creutzfeld-Jakob disease
Charcot-Marie-Tooth disease
Cockayne syndrome
Churg-Strauss syndrome
Crohn’s disease
Crigler-Najjar syndrome

Answer 24

BSE is a transmissible spongiform encephalopathy suspected to be caused by a prion.
True Creutzfeldt-Jakob disease (CJD) is a rare disorder that can occur due to a genetic mutation or may occur sporadically. Patients may experience psychiatric symptoms such as depression or a schizophrenia-like psychosis. Unusual sensory symptoms may also occur.
Neurological signs progress to difficulty walking and involuntary movements, and, by the time of death, patients become completely immobile and mute.
Variant Creutzfeldt-Jakob disease (vCJD) typically affects younger people and has been strongly linked to exposure, probably through food, to cattle BSE.

Question 25

A 1-month old Charolais calf presents as a result of exercise intolerance and collapse. The only abnormality is elevated AST, CK, and LDH. Selenium and vitamin E levels were submitted for analysis and are normal. CS collected by lumbosacral puncture is normal. What is your most likely diagnosis? Myophosphoryase deficiency White muscle disease Tetanus Brain abscess

Answer 25

The correct answer is myophosphorylase deficiency. This is a genetic disease that has been identified in Charolais cattle. Affected cattle are born with a deficiency in the enzyme phosphorylase. Your other main differential would have been white muscle disease, but vitamin E and selenium levels are normal. Tetanus would present differently (rigid paralysis), and a brain abscess is highly unlikely as there are no neurological deficits mentioned.

Question 26

The 35-day postpartum recumbent dairy cow in this image has normal vital parameters, appetite, and milk production but has mucus and pus draining from her vulva. Speculum exam shows this material exiting the cervix. Rectal exam shows that she has an involuting uterus and normal ovaries. Which of the following treatments should be administered to help treat this condition and have the fewest negative economic effects such as prolonged milk withdrawal? Intrauterine metronidazole Intrauterine penicillin Systemic diethylstilbestrol Systemic cetiofur Intrauterine chloramphenicol

Answer 26

The diagnosis is endometritis. This is based on the involuting post partum uterus and the normal vital signs (TPR). Intrauterine penicillin (after 30 days) or tetracycline or ceftiofur can be beneficial. The negative impact can be antibiotic residues in milk (up to 80 hours for penicillin and 96 hours for tetracycline in milk) and in tissues (up to 12 days for penicillin), so some prefer to use dilute povidone iodine, or uterine lavage with saline. Systemic ceftiofur achieves adequate intrauterine levels and is thus the safest and best of the options listed. Prostaglandins can also be given to "short cycle" the cow which will aid in treating the endometritis. The other drugs listed are not legal for use in the USA, and could cause harmful residues to appear in milk...

Question 27

Topic: Photosensitization 1. What is the difference between primary and secondary photosensitization?

Answer 27

Primary sensitization occurs when an animal ingests one of the following plants: Hypericum perforatum [St. John’s wort]) and fagopyrin from Fagopyrum esculentum [buckwheat. Secondary photosensitization occurs in patients suffering from hepatic disease. The chlorophyll is converted to phylloethrin and, under normal conditions, is excreted via bilirubin metabolism. In patients with hepatic disease, phylloethrin is not excreted properly and when exposed to the sunlight leads to skin damage.

Question 28

An 8-week-old intact female Pomeranian is presented for a new puppy exam. She has had no prior veterinary care and her owners report that she is doing well at home. On physical exam, the puppy is bright, alert, and responsive, with a body condition score of 4/9 and mucous membranes that are pink and moist. You note the presence of a continuous heart murmur that can be auscultated from any point on the thorax, although it is most intense in the 3rd intercostal space at the heart base. Lung sounds are within normal limits and no other abnormalities are detected on exam. You perform thoracic radiographs, which demonstrate characteristic changes to the cardiac silhouette but no evidence of congestive heart failure. Assuming this condition is treated promptly, by a skilled specialist, what is the puppy's prognosis? Guarded prognosis, due to high likelihood of treatment-associated complications く Excellent long-term prognosis following successful treatment Correct Answer Fair prognosis, although long-term complications are common Poer prognosis, with sudden death likely Explanation A patent ductus arteriosus results in a continuous "washing machine" murmur. The puppy has an excellent prognosis if the surgery is performed prior to six months of age before sequelae such as mitral insufficiency and volume-overload-induced myocardial failure develop. Surgical complications are uncommon, especially in healthy puppies without evidence of existing CHF.

Question 29

Where is the most common location that a horse develops an impaction resulting in colic? Heum Diaphragmatic flexure Pelvic flexure Correct Answer Sternat flexure Explanation The most common site for impaction in the horse is the pelvic flexure. At this region of the large colon, the colon narrows resulting in impaction of feed material/ingesta in some horses. Poor feed quality, poor dentition or reduced water intake may predispose a horse to impaction of the pelvic flexure. The colic is usually mild to moderate and is often successfully treated medically.

Question 30

Type I vagal indigestion occurs as a result of Omasal transport failure ♥ Faluetocnuctale Correct Answer Abomasal impaction Failure of pyloric outflow Explanation Failure to eructate results in free gas bloat. Type Il vagal indigestion is caused by omasal transfer failure and results in a large fluid-filled rumen. Type Ill vagal indigestion is when failure of pyloric outflow occurs. In this situation, cows will have internal vomiting and accumulate chloride in the rumen. This causes them to become alkalotic, hypochloremic, hypokalemic and appear much sicker. Type IV vagal indigestion is (rarely observed in cattle) abomasal impaction. Suffolk sheep tend to develop this form of vagal indigestion.

Question 31

A cattle producer has been dealing with an increased frequency of diarrhea in his young calves, resulting in the death of nearly 10% of his calves. You have worked with the producer to increase the number of calves receiving colostrum, as well as improving the facility's cleanliness and nutrition practices. Given that these measures have not resulted in significant improvement, you elect to perform testing for common bacterial and viral pathogens. You submit five separate fecal samples for analysis, each collected from different areas of the farm. When you receive results from the reference lab, you see that each sample shows a predominance of a different bacterium and a different virus. The results from each sample are listed as answer options below. Which sample is the most beneficial in terms of helping you determine your next steps? Campylobacter jejuni, Breda virus X Salmonella spp., coronavirus Your Answer Clostridium perfringens, parvovirus く Escherichia coli, rotavirus Correct Answer Yersinia enterocolitica, astrovirus Explanation All of these pathogens have been implicated in calf diarrheas, but many are also found in healthy calf feces. Calf diarrhea is multifactorial and it is difficult to implicate exposure to a pathogen alone as the sole cause of disease. With that said, the most important bacterial pathogen in calf diarrhea is E. coli and the most common viral cause of calf diarrhea is rotavirus.

Question 32

A 9-year old Standardbred stallion comes to see you for evaluation of muscle atrophy. You examine the horse and note atrophy of the lateral thigh and gluteal muscles. When the horse is backed up, spasmodic hyperflexion of either hindlimb occurs resulting in a high-stepping gait. Which of the following is most likely responsible for the observed signs? Castor bean intoxication Black walnut intoxication Red mapte intoxication Senecio or groundsel intoxication く Sweet pea intoxication Correct Answer Explanation This case describes a horse with stringhalt or sudden flexion (contraction of the lateral extensor tendons) of one or both hind legs. It is most evident when the horse is backing up slowly or turning. It can involve one or both hind legs. The etiology in some cases is unknown but the condition can be associated with chronic intoxication of sweet peas (Lathyrus spp.). Australian stringhalt has been associated with flatweed ingestion (Hypochoeris radicata). The precise pathogenesis is not understood, but a mycotoxin affecting the long myelinated nerves in the hind limbs has been suggested based on the types of nerve damage seen in affected horses. Black walnut intoxication is associated with laminitis and colic after exposure to wood shavings of black walnuts. Red maple intoxication is associated with acute hemolytic anemia. Senecio or groundsel intoxication is associated with liver disease after chronic exposure. Castor bean intoxication is associated with severe gastrointestinal irritation and hemorrhagic diarrhea.

Question 33

You are using a Bain circuit to anesthetize a ferret. Which of the following measures is the most important thing to do to prevent re-breathing of carbon dioxide by the ferret? く Maintain high flow rates of oxygen in the circuit Correct Answer Make sure that the endotracheal tube extension is longer than the ferret Make sure the soda-lime canister is fresh Your Answer Make sure the pop-off and one-way valves are opening correctly Explanation A Bain circuit is a non-rebreathing system (in contrast to circle systems used more commonly in larger animals). Therefore, there is no carbon dioxide absorber such as soda lime. Instead, you must use sufficient oxygen flow rates to constantly flush the system (typically at least 100 ml/kg/min). The system is not dependent on valves as a circle system is. A long endotracheal tube will increase re-breathing and should not be used

Question 34

What breed of dog is predisposed to exocrine pancreatic insufficiency? Labrador Retriever Maltese German Shepherd Correct Answer Rottweiler Boxer Explanation In a study published in JVIM in 2007, Boxers, Rottweilers and Labrador Retrievers were under-represented in a population of dogs with EPI. The most common cause of EPI is pancreatic acinar atrophy (PAA). It has been suggested that PAA is inherited as an autosomal recessive trait in German Shepherd dogs, however a genetic marker has not been found yet.

Question 35

A new horse owner calls you and wants to know how to prevent calcium carbonate urolith formation in a horse. Which of the following promotes calcium carbonate urolith formation? Maintaining an acidic urine pH Your Answer < Maintaining an alkaline urine pH Correct Answer Low urine specific gravity Low amounts of mucoproteins Explanation The correct answer is maintaining an alkaline urine. Calcium carbonate stones in horses have a higher likelihood of forming in alkaline urine. Mucoproteins in urine may serve as a nidus for stone formation but is not specific for calcium carbonate stones.

Question 36

A 3-year-old neutered male Domestic Shorthair presents for multiple deep lacerations. The cat, which normally lives indoors, escaped last night and came home with wounds this morning. He is quiet, alert, and responsive with a temperature of 102.9°F. There are lacerations and some mild bruising across his trunk, but the remainder of his exam is unremarkable. You perform a complete blood cell count, serum biochemistry, and thoracic/abdominal radiographs, which do not reveal any abnormalities. You elect to anesthetize the cat for wound repair. Which of the following medications can be included in your anesthetic plan to provide pain relief for this cat? Midazolam Your Answer Diazepam く Ketamine Correct Answer Acepromazine Alfaxalone Explanation The best choice from the options given is ketamine, an NMDA receptor antagonist. Inhibiting NMDA receptors can decrease pain wind-up, decreasing this cat's postoperative pain. Acepromazine is a phenothiazine; it provides sedation, but no analgesia. Alfaxalone is a water-soluble neuroanesthetic that has minimal to no analgesic properties. Diazepam and midazolam are benzodiazepines, which are useful as anxiolytics, but not as analgesics.

Question 37

A 6 year old previously healthy 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? Pulmonary thromboembolism Correct Answer Pneumothorax Aspiration pneumonia Congestive heart failure Explanation 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.

Question 38

You are a small-animal veterinarian practicing in Georgia. A 7-week-old male German Shorthair Pointer puppy, obtained one week earlier, is presented for a new puppy exam. According to his owners, he has had no prior veterinary care. On exam, the puppy is bright, alert, and responsive. He has a temperature of 101.2°F, pink and moist mucous membranes, and no apparent abnormalities on thoracic auscultation, abdominal palpation, ophthalmic exam, or otoscopic exam. The owner is familiar with raising puppies and has already started him on high-quality puppy food. What tests or treatments do you recommend for the puppy at this initial visit? く Fecal parasite exam, distemper/adenovirus/parvovirus/parainfluenza vaccine, begin parasite prevention Correct Answer leartworm test, rabies vaceine, begin parasite prevention Heartworm test, fecal parasite exam, Bordetella vaccine Bordetetta vaceine, rabies vaceine, distemper/adenovirus/parvevirus/parainfluenza vaccine Explanation The correct answer is fecal parasite exam, DAPP vaccine, and begin parasite prevention. A fecal parasite exam should always be performed at an initial puppy visit to assess for the presence of intestinal parasites. The DAPP vaccine is a core vaccine that can be started as early as six weeks of age, so the puppy should also receive this vaccination at this visit. Finally, heartworm prevention should be started at a puppy's first visit. The minimum age for heartworm prevention varies by product, but a number of products are approved for puppies of this age. There is no benefit to performing a heartworm test in this puppy, because the prepatent period of heartworm disease is 6-7 months; this puppy is not old enough to test positive for heartworms. The rabies vaccine should not be given to puppies under 12 weeks of age. While some bordetella vaccines may be appropriate for a 7-week old puppy, this is a non-core vaccine and should not replace the more-important DAPP vaccine.

Question 39

Felix is an 11-year-old male neutered Domestic Shorthair cat with Stage 2 chronic kidney disease. Felix's owner calls you on a Monday morning. She is very concerned because Felix began acting ill over the weekend and she had to take him to the emergency clinic. Although you have not yet received the emergency clinic report, the owner tells you that the ER veterinarian mentioned that Felix had developed a complication that could cause blindness and she prescribed a daily medication for him. Which complication of chronic renal disease did Felix likely develop? Hypertension Correct Answer Proteinuria Dehydration Anemia Acidosis Explanation Cats with chronic renal failure can develop many secondary conditions. If the ER doctor was concerned about potential blindness resulting from hypertension, Felix was likely prescribed medication to address elevated blood pressure. Hypertension is a common sequela of chronic kidney disease and, in severe cases of hypertension, cats can experience retinal detachment. These cats are often treated with amlodipine, a calcium channel blocker. Alternatively, hypertension may be treated with telmisartan, an angiotensin Il receptor blocker, which addresses both hypertension and proteinuria. In cases that develop proteinuria, benazepril may be prescribed. Anemia can be treated with erythropoietin, dehydration can be treated with fluids, and acidosis is treated by balancing electrolytes.

Question 40

You need to perform emergency splenectomy to remove a mass in the spleen. You want to choose anesthetic agents that do not cause the spleen to enlarge/engorge. With that in mind, which of the following options is the best combination? Acepromazine followed by diazepam and ketamine Morphine followed by diazepam and ketamine Your Answer Correct Answer Xylazine and thiopental Acepromazine and propofol A mixture of thiopental and propofol Explanation Acepromazine can cause splenic enlargement and sequestration of red blood cells in the spleen. This is often striking and evident on radiographic or sonographic exams of animals sedated with acepromazine. Thiopental is a thiobarbiturate which induces splenic engorgement; this makes surgical manipulation and removal of the spleen more difficult. Xylazine, diazepam, ketamine, propofol, and opioids such as morphine do not increase the size of the spleen.

Question 41

Which of the following is not a form of anthrax in humans? Intestinat Cutaneous Patmonary Vocular Correct Answer Explanation The correct answer is ocular. Sorry, it's a human health question, but it is a potential biochemical warfare agent and the public expects veterinarians like you to know this.

Question 42

A 2-year old indoor-outdoor female spayed domestic short hair cat presents to you for inappetance and vomiting. The cat vomits and the contents include several 3 cm long nematodes with spine-covered heads. You are able to identify the worms as Gnathostoma. Which of the following is true about these worms? The parasite does not cause disease in humans Your Answer The life cycle involves a rodent intermediate host The parasite is typically found in dry, dusty environments Proper disposal of fees eliminates the threat of transmission to other animals Correct Answer The life cycle involves a flea intermediate host 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.

Question 43

Staphylococcus aureus is an important cause of foodborne illness in humans. Which of the following statements is TRUE about Staphylococcal food poisoning? Most affected individuals have severe signs and may need to be hospitalized Common signs of foodberne illness with S. aureus include skin rash or headache and fatigue It usuatty takes 4-7 days after ingestion before any clinicat signs are displayed VIllness is caused by strains of the bacteria that make a heat-stable enterotoxin Correct Answer The usual source of infection is from an infected animal Explanation in humans. S. aureus are Gram-positive cocci. Some strains are capable of producing a highly heat-stable protein toxin that causes foodborne illness The usual source of infection is from human contamination by food handlers which then inoculate meat or other dishes. Typical incubation time is 1 to 8 hours. Common signs of infection include abdominal cramps/pain, vomiting, diarrhea, nausea, and chills. Most cases are relatively mild with uneventful recovery in 1-2 days.

Question 44

Your first appointment of the day is a long-time client who presents a cat they just found around their barn a week ago, who is now named Chester. You estimate his age to be about 6 months old. Chester seemed fine for the first three days, then developed signs of illness. He is now vomiting yellow fluid and having intermittent diarrhea. The client mentions the cat has refused food and water since last night. Abnormalities noted on your physical exam include depression, T 105.2°F, HR 250 bpm, ~8% dehydration, and abdominal pain on palpation with emesis elicited. Which of the following abnormalities on a CBC would lead you to consider a canine parvo SNAP test as a next step? X Leukocytosis with a left shift Your Answer Leukocytosis with eosinophilia Leukopenia with tymphopenta Leukopenia with neutropenia Correct Answer Explanation On a CBC, the lab finding of leukopenia with neutropenia would point to a suspicion of feline distemper. Feline distemper is better known as feline panleukopenia, which is a decrease in all white blood cells. We typically see a leukopenia with feline distemper, but even more so a prominent neutropenia as compared to lymphopenia. Feline panleukopenia virus is a parvovirus that is highly contagious and very hard to eliminate in the environment similar to the canine parvovirus. While a SNAP Parvo Antigen Test (Idexx) is only approved and licensed for detecting canine parvovirus, it is generally known this test can also detect FPL antigen in feline fecal samples. FeLV and FIV are other differentials for this presentation, but the acute nature and the incubation period of panleukopenia are more similar to this presentation. Leukocytosis is not seen with feline panleukopenia virus, nor is thrombocytopenia.

Question 45

After treating a chicken for cholera with penicillin, she develops a thickened, whitish, lesion in the mouth. What is your diagnosis? Fowl pox candidiasis Ergotism Correct Answer Salmonellosis Explanation The correct answer is candidiasis, aka thrush or sour crop. It is common for chickens to develop Candida albicans infections after use of antibiotics. Lesions consist of thickened mucosa and whitish raised circular ulcers that can be seen in the mouth, crop, or esophagus. This can be treated with copper sulfate in the water or nystatin in feed.

Question 46

An animal can be said to have acceptable, or even good, welfare when it is to stressors present within its environment. Not coping coping Accepting Correct Answer Not adapting Explanation Proper animal welfare is defined as animals coping with stressors in the environment.

Question 47

A 4-year-old female spayed Border Collie presents on emergency. She spent the afternoon outside with her owner, who was working in her garden. The owner is concerned that her dog may have eaten an insecticide the owner was applying to her plants. The owner has brought the product label for you to examine and you note that the insecticide is an organophosphate. On exam, you observe the following abnormalities: hypersalivation, increased lacrimation, increased upper respiratory sounds, respiratory depression, muscle tremors, and ataxia. You also note that the dog has urinated on herself and there is loose stool coming from the rectum. A number of medications will be needed to successfully treat this dog's toxicity. Which medication do you give first? < Atropine Correct Answer Activated charcoal 2-PAM (pralidoxime) Your Answer Diazepam Explanation Organophosphate toxicity is often fatal if not treated. Atropine sulfate is administered first, to treat the muscarinic symptoms of this toxicity (salivation, lacrimation, urination, defecation). Respiratory secretions are a primary cause of respiratory failure and death in organophosphate toxicity; atropine counteracts this effect. After administering atropine, 2-PAM (pralidoxime chloride) is given as a slow intravenous infusion to reactivate acetylcholinesterase, allowing it to break down acetylcholine that is continually stimulating the cholinergic system. Diazepam has been used to treat the nicotinic and central nervous symptoms, which are muscle fasciculations, tremors and seizures. Activated charcoal is used to adsorb unabsorbed toxin in the Gl tract and facilitate its excretion.

Question 48

A woman presents a middle-aged male intact domestic short hair to your clinic. She found him as a stray where she lives out in the country. She noticed he was lethargic and hanging around her yard, so she was feeding him in order to capture him and bring him to the vet. She states there are many stray cats and prairie dogs around her property. On physical exam, the cat is lethargic, has a temperature of 104.9F (40.5 C), severe mandibular lymphadenopathy with a draining tract under the chin, and is covered in fleas. His breathing is tachypneic. What do you do first? ♥wearprotection-and-etarantine the-animat,thereatthe-stete-veterinariar Correct Answer Run a CBC/Chemistry/Urinalysis, flush the abscess with dilute chlorhexidine solution, and start broad spectrum antibiotics Your Answer Clean the abscess and send the cat home on a 3-week course of Doxycycline tablets followed with 6 cc of water Gram stain cytology of the draining tract lesion Euthanize the cat immediatety Explanation This animal is exhibiting signs of plague caused by the bacteria Yersinia pestis. Plague is usually transmitted by the bites of infected fleas. Carnivores can also contract plague when they eat an infected rodent. Clinical symptoms can occur in 1-2 days in cats, but in humans, the incubation period can be up to 8 days. A tentative diagnosis can be made with a Gram's stain cytology of infected material, such as the draining lesion of this cat. Yersinia pestis is a gram negative bacterium and has a bipolar safety-pin appearance. Definitive diagnosis is based on culture. However, before collecting any samples, the state vet or CDC should be contacted. The samples have to be collected and submitted under strict guidelines to prevent the spread of disease. Plague is highly zoonotic and bubonic, septicemic, pneumonic, and meningeal forms can occur. Early treatment is critical for survival. Antibiotic treatment early in the course of disease can greatly improve prognosis. Any persons exposed at all to this cat should seek treatment, including hospital staff, the owner, her family, etc. Because of the cat's clinical status, the most likely thing that will occur is euthanasia, but the state veterinarian will give instructions on how best to handle this animal.