NAVLE Feline

regarding vaccine associated fibrosarcomas in cats...which is false 1. If a nodule appears at a vaccine injection site, it should be removed and submitted for histopathology if it is present longer than 3 months or if it is greater than 2cm in diameter 2. Sites of chronic inflammation, such as those that are induced by adjuvanted vaccines, have been implicated in causing vaccine associated sarcomas 3.The incidence of vaccine associated sarcomas is 1:100,000 Correct Answer 4. Rabies purevax is a non-adjuvanted vaccination alternative to help reduce the risk of vaccine associated sarcomas Your Answer

(3)- The incidence of vaccine associated sarcomas is generally reported to be 1:10,000. Adjuvant is a substrate added to vaccines to stimulate the immune system. This is added frequently to killed antigen vaccines. It is not uncommon for an inflammatory nodule to develop at the injection site. However, as long as it is small and recedes within 3 months, it is not considered to be a problem. It is thought that promotion of local inflammation has been a major factor in the development of some vaccine associated tumors. Rabies purevax is a live canarypox vaccine engineered to contain rabies DNA.

Wstrus in cats, defined as the behavioral receptivity to mating, typically lasts about________ Interestrus, the period between one estrus and the next, has a variable duration of _________

- 7 days (usually between 4-10 days) - 7-21 days.

what is KOH helpful for? Congo red stain? Frypan blue exclusion test? silver stain?

- A KOH test is used to aid in the diagnosis of fungal infection, usually cutaneous infections from dermatophytes. - Congo red stain is typically used to stain for amyloid fibrils and may sometimes be used to identify a specific type of Shigella. - Trypan blue is a cellular viability stain. - Silver staining is used to identify proteins, commonly type III collagen. It may also be used to identify certain fungal organisms.

Which is a possible cause of low PaO2 (hypoxemia) in an anesthetized cat?

- hypoventilation - diffusion impairment - VQ mismatch - Low inspired O2 - shunt

A 10-year old spayed female barn cat presents with dyspnea and cyanosis. Based on your physical exam, you suspect pyothorax. Thoracocentesis yields a foul-smelling purulent material. You make a smear of the exudate and perform a Gram stain. The cytology is shown below (100X objective) and you see the Gram-positive branched filamentous rods identified by the arrows. Based on this finding, you suspect that the cat has an infection with either Actinomyces spp. or Nocardia spp. Which of the following tests would differentiate the two?

Acid-fast staining is used to differentiate specific types of bacteria known as acid-fast organisms. Acid-fast stain is most commonly used to look for Mycobacteria, which are acid-fast. Nocardia and some bacterial spores and coccidian parasites are also acid-fast. In this case, an acid-fast stain would differentiate Nocardia (which is acid-fast) from Actinomyces (which is not acid-fast).

Yogi, a MN 9-year old Siamese, is being treated for chronic renal failure. He presents for his routine examination and bloodwork. His renal panel shows: BUN 48 mg/dl (19-34 mg/dl) creatinine 4.0 mg/dl (0.9-2.2) phosphorus 10.2 mg/dl (3.0-6.1 mg/dl) calcium 12 mg/dl (8.7-11.7 mg/dl) albumin 3.5 g/dl (2.8-3.9 g/dl) potassium 4.8 mEq/L (3.7-6.1 mEq/L) USG 1.008, negative sediment, negative urine culture blood pressure 148/110 mmHg.

Aluminum hydroxide- Phosphorus is absorbed in the intestine and stored in bone. Kidneys excrete the excess phosphorus not needed. When renal function is compromised, the kidneys can no longer perform this function, thus leading to hyperphosphatemia. Cats with increasing phosphorus levels should be placed on a phosphorus binder. If the calcium is also elevated, as is the case with this cat, a non-calcium based binder should be chosen to prevent exacerbation of the hypercalcemia. The most commonly used non-calcium-based binder is aluminum hydroxide. If this cat had normal calcium, Epakitin ( a calcium based phosphorus binder) would also be an acceptable choice.

Which type of lung pattern is most typical of aspiration pneumonia?

Alveolar pattern mostly involving the right cranial and middle lung lobes -Pneumonia is most commonly characterized by an increase of pulmonary densities with a patchy or lobar pattern. Aspiration usually involves the right middle and cranial lung lobes.

What is the most common cause of Cat Scratch Disease in humans?

Bartonella henselae. Usually, you will see a papule at the site of inoculation followed by fever and local lymphadenopathy one week later. The lymphadenopathy will last months but is self-limiting. Neat! Cats are generally asymptomatic. B. quintana is the cause of Trench Fever in humans, which is transmitted by the human louse. Borrelia burgdorferi is the causative agent of Lyme disease.

A 9-year old DSH cat initially presented with a history of decreased appetite and intermittent vomiting. On physical exam the cat is approximately 5% dehydrated. There is no palpable slip noted in the thyroid region. Blood work performed showed a BUN of 44 mg/dL (19-34 mg/dl) and creatinine of 2.4 mg/dL (0.9-2.2 mg/dl). PCV is 55 % (30-45 %). Glucose was 180 mg/dL (60-120 mg/dl). Abdominal radiographs showed a questionable pattern in the area of the duodenum but it was not obstructive. A barium series was then performed and did not show any obvious filling defects or delayed emptying. How should you treat this patient? a. Perform an ultrasound of the urinary tract followed by a nephropyelogram b. Recommend an exploratory laparotomy and obtain biopsies c. Begin patient on amoxicillin/clavulonate d. Admit patient for fluid therapy and supportive care

D- With the information given, we can be sure that this patient has a mild azotemia which is more than likely pre-renal in origin. With acute renal failure, BUN and creatinine values would be much more increased. There is no indication of an infection and treating blindly with an antibiotic is inappropriate. An exploratory laparotomy would be premature at this time but may be indicated if the patient does not respond to supportive care. It is possible this patient has a mild case of pancreatitis or indigestion. It is best to admit the patient for supportive care and consider performing an abdominal ultrasound.

A feline patient has only been eating canned dog food for the past 8 years. What are you concerned about?

Dilated cardiomyopathy- Dog foods do not contain the amount of taurine that cats need to maintain vital organ function. A taurine deficiency can lead to dilated cardiomyopathy in cats. H

A 6-year old domestic short hair presents to you with a history of weight loss and steatorrhea. On examination, you can palpate thickened small intestinal loops of bowel. You are suspecting EPI (exocrine pancreatic insufficiency). How would you diagnose this condition?

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.

How does enalapril work?

Enalapril is an angiotensin-converting enzyme (ACE) inhibitor used as a vasodilator, antihypertensive agent, and heart failure treatment. It works by preventing the conversion of angiotensin I to angiotensin II, thus reducing aldosterone concentrations and causing diuresis. Its dilatory effects on the efferent arterioles of glomeruli help to palliate protein losing nephropathies. It is often used in conjunction with diuretics.

Your colleague is preparing to perform a punch biopsy of a dermal mass in a cat under local anesthesia. He adds epinephrine to his lidocaine before administering the local anesthetic. What is the rationale for adding epinephrine?

Epinephrine is used with lidocaine to cause local vasoconstriction, preventing rapid systemic absorption. This is typically done to prolong the duration of local anesthetic effects of lidocaine by maintaining it at the site. It can decrease systemic uptake and toxicity, but it is not a lidocaine antagonist. Epinephrine does not neutralize the pH of lidocaine; sodium bicarbonate is sometimes added for this purpose.

An 8-month old kitten with chronic diarrhea presents for acute onset of vomiting and inappetance. You are currently treating the cat for coccidia since Isospora was identified on the fecal test yesterday. Yesterday the cat was clinically alert and otherwise healthy on examination. You palpate a mid-abdominal mass effect today which was not palpated yesterday and the cat seems painful upon palpation. Temperature is normal and labwork is unremarkable. Ultrasound is not immediately available. Radiographs show an obstructive pattern with dilated loops of small intestine but no overt mass effect is visible. You are suspicious of which diagnosis and what is proper therapy?

Intussusception is an invagination of an intestinal segment into the lumen of the adjacent segment. This occurrence most often happens in young animals with a history of recent enteritis. This leads to a mechanical obstruction which can be partial or complete. This condition is more common in dogs but also occurs in cats. It can be life-threatening and should be corrected surgically. A barium study may be of benefit in trying to diagnose the problem prior to surgery. Foreign body obstruction is also a possibility, especially in a young cat, but due to the history, less likely than intussusception.

A male neutered domestic short hair cat presents to you with urinary obstruction. Your treatment room diagnostics show a BUN > 140 mg/dL (19-34 mg/dl) and a K+ of 9.0 mEq/L (3.7-6.1 mEq/L). You immediately give the cat dextrose and fluids and successfully unblock your patient. An hour later, you monitor your patient and find him trembling uncontrollably. What should you check first?

Ionized Ca levels- In some cases, during the immediate post-obstructive period, cats will develop hypocalcemic tetany. The mechanism is considered to be secondary to laws of mass action that drive down calcium as a result of existing hyperphosphatemia. Judicious use of calcium gluconate can quickly restore their electrolyte balance and prevent further complications such as hypocalcemic seizures.

You need to heavily sedate a 3-year old fractious cat for an ear exam. You would like to use an alpha-2 adrenergic agonist. Which drug can you use? Yohimbine Thiopental Medetomidine Atipamezole Acepromazine

Medetomidine- strong sedative that causes peripheral vasoconstriction and bradycardia as side effects. (side note)- Yohimbine and atipamezole are reversal agents for alpha-2 adrenergic agonists (they are alpha-2 adrenergic blockers), and thiopental is a barbiturate.

Which drug can be used to reverse the oxymorphone?

Naloxone (Oxomoprhone is a mu agonist)

A 9-year old spayed female Siamese cat is presented to you for a 6-month history of polydipsia (the owner has documented water consumption of 110 ml/kg/day) and a 1 month history of weight loss and progressively decreasing appetite. Which of the following is a likely differential to explain these clinical signs?

Renal failure is the differential most likely to be associated with pu/pd accompanied by decreasing appetite and weight loss.

White cats or cats with areas of white fur on the face or ears are predisposed to developing what type of tumor?

Squamous Cell Carcinoma from UV light. These lesions are usually ulcerative and appear around the nose, ears, or eyelids.

A 6-year old intact male domestic short haired cat presents with acute onset exophthalmos of the right eye in the past 2 days. He is painful on palpation around his eye and head. The eye can be retropulsed with minimal resistance. He has not been eating in the past day and has a rectal temperature of 103.4F (39.7 C). What is the most likely diagnosis?

The answer is a retrobulbar abscess. Acute, painful exophthalmos is usually due to retrobulbar abscessation. These lesions are usually painful and may be swollen. These animals are frequently systemically ill with fever and leukocytosis. Causes of retrobulbar abscesses include penetrating wounds, foreign bodies, spread from dental or sinus infection, and hematogenous spread. Glaucoma does not cause exophthalmos, although, chronically it can cause buphthalmos which may appear similar. Anterior uveitis also does not cause exophthalmos.

The 2-year old intact female domestic short hair cat shown in the picture below (super duper enlarged mammary glands that look symmetrical) presents for bilateral mammary masses. The cat has a normal activity and appetite at home. On physical exam, the cat is bright and alert. All mammary glands are enlarged but non-painful on palpation. What is the treatment for this cat? - bilateral radical mastectomy followed by chemotherapy - Radiation therapy - Bilateral radical mastectomy without chemotherapy - Ovariohysterectomy - Abx

The cat in the image has mammary gland hyperplasia or fibroadenomatous/fibroepithelial hyperplasia. It most commonly occurs in young, intact female cats due to increased progesterone exposure. It is characterized by affecting one or more mammary glands, which become enlarged and are non-painful. Most affected cats are systemically well and do not show signs of illness or pain. Treatment for the condition is removal of the source of progesterone via ovariectomy or ovariohysterectomy. If no source of progesterone can be identified, or if the glands do not respond to spaying, a progesterone receptor blocker such as aglepristone can be administered as well. Differential diagnoses for this condition include mammary neoplasia and mastitis. Mammary cancer more commonly affects older cats and would be less likely to affect all glands simultaneously and symmetrically like the cat shown in the picture. Mastitis would be painful, inflamed, and the cat would likely be acting systemically ill.

On a cat's annual exam, the owner complains about a chronic cough. You perform a routine fecal flotation and see double operculated eggs with asymmetric terminal plugs. What are these?

The correct answer is Capillaria aerophila eggs. Capillaria ova look similar to Trichuris eggs but are smaller and have asymmetric terminal plugs. Most cases of Capillaria are asymptomatic but chronic cough may be seen.

Which of the following does not occur in cats with diabetes mellitus? Dull hair coats Polyuria Pelvic limb weakness Cataracts

The correct answer is cataracts. Cataracts occur in dogs with diabetes mellitus, but not in cats. Plantigrade stance, pelvic limb weakness, and difficulty jumping are often clinical signs seen in cats with DM. Polyuria is not as common of a complaint in cats as in dogs because owners usually don't notice them going to the litter box more often. Polydipsia is usually more noticeable. Cats also often get dull haircoats with DM.

A 5-week old domestic short hair kitten is presented for ataxia and tremors. The owner notes that the kitten was found several weeks ago and has always had tremors and difficulty keeping its balance. On physical exam, the kitten is ataxic, hypermetric, has a wide based stance, and head tremors. The kitten is otherwise normal on physical exam. What is the neuroanatomic location of the kitten's lesion?

The correct answer is cerebellum. Cerebellar dysfunction results in inability to regulate and measure motor function. Clinical signs of cerebellar lesions include ataxia, dysmetria, vestibular signs, delayed postural reactions, and sometimes upper motor neuron signs in the limbs. In utero or perinatal infection of kittens with feline panleukopenia virus often results in cerebellar hypoplasia, leading to the clinical signs mentioned in the question.

A cat presents for vomiting of 7 days duration. On physical exam, you are able to see a string attached to the base of the tongue. Abdominal radiographs show pleating of the intestinal tract but no evidence of perforation. What is the treatment of choice?

The correct answer is surgery. A string that has been present for more than a couple of days or one with evidence of pleating of the intestines should not be pulled or cut because the risk of intestinal perforation is high. Abdominal surgery to remove the string foreign body is the best treatment.

A 1-year old male neutered Siamese presents to you with conjunctivitis. He is an indoor only cat and the owners recently adopted an 8 week old kitten that he is in contact with. His clinical signs were initially mild and unilateral but progressed to these findings three days later. What are the two most likely pathogens affecting this cat and what is the treatment of choice?

The most common cause of bacterial conjunctivitis in feline patients is Chlamydophila felis. This disease cannot be distinguished from feline Herpesvirus-1 based on clinical appearance alone. Frequently, feline patients with these symptoms are infected with both of these diseases simultaneously. Diagnosis of Chlamydophila felis is made by visualizing typical elementary bodies in the cytoplasm of conjunctival epithelial cells or obtaining a positive fluorescent antibody (FA) test on a conjunctival scraping. The treatment of Chlamydophila felis is topical tetracycline QID for one week post resolution of clinical signs.

A 12-year old Himalayan cat presents to an emergency clinic with a 2-day history of progressive dyspnea. The cat is an indoor-outdoor cat and was previously healthy. It is currently not on any medications and is up to date on all vaccinations. On physical examination the cat appears stressed and is intermittently open-mouth breathing. On auscultation of the chest there are decreased heart sounds and lung sounds. There are no obvious murmurs noted. The patient appears to be taking rapid, shallow, breaths. Radiographs confirm the presence of pleural effusion and the owners consent to a thoracocentesis which yields a clear-to-milky white fluid. What comparisons will you make to confirm the presence of chylothorax?

The pleural fluid obtained has a milky white appearance as a result of its high triglyceride content. Any patient that has an effusion triglyceride content higher than that of the serum is considered to have a chylothorax. Chyle is lymphatic fluid which contains a high quantity of fat. Abnormal flow or pressures in the thoracic duct are thought to cause exudation of chyle from lymphatic vessels into the thorax. The presence of chylomicrons in the sample, a cholesterol content greater than or equal to that of the serum, and a positive ether clearance test are also supportive chylothorax. Chylous fluid is typically white to pink in color, opaque and can have a variable specific gravity (1.019-1.050 in the cat). The protein level is variable (2.6-10.3 g/dL) and the white blood cell count can be over 7,000 cells/ul.

A 4-year old male Manx cat presents to you because the owners found an empty, opened pill vial in the bathroom and the cat vomited. On physical exam, you note ptyalism and facial edema. The cat's mucous membranes are pale and slightly icteric. You perform a blood smear and detect Heinz bodies in erythrocytes. The cat's packed cell volume (PCV) is 26% (30-45%). The owners provide you a list of the medications in the medicine cabinet which are acetaminophen (Tylenol), finasteride (Propecia), enalapril (Vasotec), and omeprazole (Prilosec). What treatments should you institute for this cat? Emesis and methylene blue Activated charcoal and whole blood transfusion Prednisone and amoxicillin Acetylcysteine and S-adenosylmethionine

The specific antidote is acetylcysteine which binds to some of the reactive metabolites of acetaminophen and increases the availability and synthesis of glutathione. Other treatments may include S-Adenosylmethionine (SAMe) which has hepatoprotective and antioxidant properties. Cimetidine can be given to inhibit the p450 oxidase in the liver and limit formation of toxic metabolites. Ascorbic acid can also be used as an adjunct treatment to bind toxic metabolites. In cats with signs of hypoxemia from severe hemolytic anemia (PCV <20%), a transfusion and further supportive care may be warranted. Acetaminophen toxicity-Cats can die from oxidative damage and methemoglobinemia within 1-2 days of ingestion. It may also be associated with hepatotoxicity in cats, although this is seen more frequently in dogs. cats are particularly sensitive to acetaminophen because they have decreased glucuronyl transferase activity which conjugates acetaminophen to glucuronic acid for excretion.

You are treating Molly, an 8-year old feline, for hyperthyroidism. She is currently on methimazole 2.5 mg orally every 12 hours. Her labwork, including renal values, have been stable since diagnosis 2 months ago and her thyroid level is under control. The only concern is that Molly is experiencing extreme facial pruritis leading to excoriations. You believe this is due to a side effect of the medication. What other treatment option would be the best therapy for Molly?

The treatment of choice for hyperthyroidism in a case such as this would be radioactive iodine, or I-131 therapy. Molly would be a good candidate for this procedure since her renal values have remained stable while on methimazole. Thyroidectomy can be performed, but many times some thyroid tissue is left behind or there is ectopic thyroid tissue, which means the hyperthyroidism continues or can recur at a later time. Also, this procedure carries more risk than does I-131 therapy.

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

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

In cats, unlike dogs, many bone tumors do not have a high metastatic rate and do not necessarily require adjunct chemotherapy although histopathology would be needed to confirm the tumor type and grade.

True

What is the strongest indication for a blood transfusion in a cat? 1.Acute blood loss with PCV of 22 2. Chronic blood loss with PCV 27 3. Chronic blood loss with PCV 15 4. Acute blood loss with PCV of 15

acute blood loss with a PCV of 15. Usually, a blood transfusion is indicated in a dog or cat with a PCV of less than 20. However, an animal with chronic blood loss will have compensated and adapted to the state of anemia and is not as critical. An animal that undergoes acute blood loss is much more critical as they have not had an opportunity to compensate.

A 3-year old male castrated domestic short hair cat presents for crusting and pruritus around the face, neck, and ears. Which of the following should be least likely on your list of differential diagnoses?

eosinophilic granuloma. Eosinophilic granulomas or linear granulomas are usually linear in shape and pink-yellow in color. Typically, they don't crust and are not usually pruritic. Notoedres acariasis, insect bite hypersensitivity, and dermatophytosis more characteristically cause pruritis, crusting, and often affect the head, neck, and ears.

What is the most common cause of rectal prolapse in a kitten?

gastrointestinal parasites. You should perform a fecal float and smear.

Direct bilirubin is formed by the liver, and is elevated in

hepatic or biliary disease. Highest levels of direct bilirubin are seen in obstructive liver diseases. Its concentration in the blood is normally very low (0-0.2 mg/dL) and slight increases can be significant.

what is cholangiohepatitis and what is the prognosis?

inflammation of the biliary system and liver parenchyma. It can be autoimmune in nature, or may be triggered by underlying infection or neoplasia. Concurrent diseases often include pancreatitis and inflammatory bowel disease. Prognosis is good

Typical findings for lymphocytic portal hepatitis is __________. what is the prognosis?

is infiltration of lymphocytes and plasma cells but not neutrophils into portal areas. This is in contrast to chronic cholangiohepatitis which typically has neutrophils in portal areas. Good, mean survival >2yrs

unilateral facial nerve paresis caused by

most commonly idiopathic; however in cats it can sometimes be caused by things such as nasopharyngeal polyps, neoplasia and trauma. Prognosis for recovery is guarded and the clinical signs are typically permanent. The unaffected facial nerve can become affected as well. Treatment for idiopathic disease is supportive including eye lubrication and management of corneal ulcers. Drooling usually resolves over several weeks. Steroids have been used in humans with Bell's palsy but it has not been shown to be effective in animals. Otitis media-interna and chronic ear disease can make animals at higher risk for nerve paralysis and a CT of the bulla is recommended rather than radiographs. Bulla osteotomy may be recommended for animals with middle ear disease or those prone to chronic otitis media-interna. In dogs, facial paralysis has been seen with hypothyroidism.

A 3-year old female Persian cat presents for routine physical exam. The cat seems to be doing well at home and has no clinical signs. Abdominal palpation reveals bilaterally enlarged kidneys. Ultrasound exam shows multiple, large, fluid-filled structures in the parenchyma of the kidneys. What is the most likely diagnosis?

polycystic kidneys. Persian cats are predisposed to developing polycystic kidneys.

In post hepatic/pre hepatic obstruction, you should expect to see elevated serum ___________

post-hepatic liver enzymes (ALT, ALP, GGT, AST) due to hepatocellular damage and cholestasis.

main treatment of non-suppurative cholangiohepatitis is

prednisolone since it is most often immune in origin. Ursodiol is often used for its immunomodulatory, hepatoprotectant, and antifibrotic effects. It helps with the flow of bile through the liver. Other helpful therapies include S-adenosylmethionine (SAMe) and Vitamin E. Metronidazole or Clavamox are often used in conjunction with prednisolone if infection is suspected but is not the primary treatment for this disease. Antibiotics are more important in suppurative cases. Chlorambucil is used as an immunosuppressant in refractory cases of cholangiohepatitis when the prednisolone is not enough to control the disease.

Cats are induced ovulators. If a queen ovulates but does not become pregnant, a ____________ occurs and______________develop and secrete _____________. This inhibits _______ release from the hypothalamus and secretion of _____ and ____ from the anterior pituitary, preventing return to estrus (typically for _______ days).

psuedopregnancy corpora lutea progesterone GnRH LH, FSH 45-50

Mrs. Smith has been a long-term client at your practice. She recently brought in a 14 week-old spayed female kitten that she adopted from the humane society. The kitten has been scratching at her ears and shaking her head non-stop since her adoption. Mrs. Smith had some leftover clotrimazole ointment that was prescribed for her Labrador retriever Larry last summer after he had been swimming in the pond. The owner has seen no improvement since starting the clotrimazole ointment and she is upset about adopting a defective kitten with gross brown ears. What is the most likely reason that the kitten has not improved?

the most likely explanation is that the owner is using the wrong medication because she assumed that the thick brown discharge from the dog's yeast otitis was the same as the thick brown debris of the mite otitis. Ear mites are incredibly common, especially in kittens. This is a critical time to educate the owner on the importance of diagnosing before treating.

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

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