NAVLE questions2

Serum T4. The signalment and clinical signs are highly compatible with hyperthyroidism. Canned food diet, ectoparasiticide exposure, and mixed breed origin are probable risk factors for Hyperthyroidism. The three treatment options are antithyroid medication, radioactive iodine therapy, and surgical thyroidectomy. Refs: Cote, Clin Vet Advisor 2nd ed. pp. 562-5 and the Merck Veterinary Manual online edition. Image courtesy, Nottingham Vet School

A 12-year-old neutered male mixed-breed cat presents with weight loss, polyphagia, polydipsia, polyuria, and unkempt haircoat. The cat is thin and has tachycardia. Which one of the following tests is most likely to confirm the presumptive diagnosis? A - Serum T4 B - Abdominal radiographs C - Urinalysis D - Abdominal ultrasonography E - Fecal examination

This is the clinical picture of multiple cartilaginous exostosis (MCE-scroll down for details) also called osteochondroma, a benign proliferative disease of bone and cartilage typically seen in the metaphyseal region. Can be on any bone, including ribs, long bones, vertebrae (especially thoracic spinous processes). See in YOUNG dogs, cats, horses, humans. Stops when growth plates close. Often asymptomatic, but can see pain, lameness if compress overlying nerves, tendons. Can see neurological signs if compress spine. Follow this link to see the original Merck image with explanatory text. Do not confuse osteochondroma with OsteochonDROSIS (OC) or Osteochondrosis dissecans (OCD). Primarily a JOINT problem, (especially SHOULDER, stifle) in 4-10 month old rapidly-growing large breeds. Hypertrophic pulmonary osteopathy is a paraneoplastic disease middle-aged-older dogs/cats, secondary to mass in thorax, abdomen- see swollen distal limbs. Chondrosarcoma, Fibrosarcoma are older animal diseases typically > 6 years. Refs: Pasquini's, Tschauner's Guide to Small Animal Clinics, vol 1, 2nd ed. pp. 608-11, and the Merck Veterinary Manual online edition.

A 14-month old female beagle-mix dog is presented with several firm non-painful swellings attached to her ribs. A thoracic radiograph shows the image below. What is the clinical diagnosis? A - Multiple cartilaginous exostoses B - Osteochondrosis C - Hypertrophic pulmonary osteopathy D - Chondrosarcoma E - Fibrosarcoma

The diagnosis is foreign body ingestion. Multiple dorsoventral projections of the body are available for review. Linear amorphous heterogenous opacity consistent with fiber is visible throughout the proximal GI tract. A complete small animal skeleton, most likely the rat the snake also ingested, is visible immediately caudal to the fiber material. Radiopaque markers were placed to aid in surgical planning. Click here to see surgery. Click here to see foreign body (blanket). Refs: The Merck Veterinary Manual online edition. Radiographic interpretation and images courtesy, Dr A. Zwingenberger and Veterinary Radiology.

A 20-year-old Burmese python is presented for unusual lethargy after its meal of a rat. Which one of the following choices is the most likely diagnosis? A - Foreign body B - Egg peritonitis C - Pneumonia D - Normal radiographs E - Dysecdysis

Systemic sulfonamides like trimethoprim sulfa have been associated with keratoconjunctivitis sicca (KCS), sometimes irreversibly. Another drug-associated cause of TRANSIENT KCS is the combination of recent general anesthesia and atropine. Other causes of KCS include: Distemper, Immunologic (think ATOPY), Breed (Pugs, Yorkies), and trauma (Proptosed eyeball). Ref: The Merck Veterinary Manual online edition.

A 7 year old female spayed Border Collie is presented with two very goopy, gunk-covered eyes. A Schirmer tear test finds less than 10 mm/minute of wetting, a decreased result from the normal of at least 15mm / minute of wetting. The owner reports that the dog has been on "some kind of medicine" for the last 10 days, but it is actually his girlfriend's dog, and he doesn't know what the medicine is. Keratoconjunctivitis sicca (KCS) secondary to the drug is suspected. Which drug may be causing the KCS? A - Amitraz B - Trimethoprim sulfa C - Griseofulvin D - Itraconazole E - Prednisolone

The preferred answer is canine pyometra. Pyometra is a life-threatening emergency which typically requires immediate surgery (ovariohysterectomy) if the cervix is closed and there is no obvious discharge. Open cervix pyometras are likely to present with a purulent discharge, simplifying Dx, but surgical ovariohysterectomy is still STRONGLY recommended. Pyometra should always be near the top of your DDX when presented with an older intact female dog or cat with a fever and distended abdomen. Follow these links to see a pyometra radiograph in a Norwegian Elkhound and to see a pyometra ultrasound in a cat. Refs: Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 1164-5 and the Merck Veterinary Manual online edition.

A 7 year-old intact female poodle is presented. The owner has noted a lot of drinking and some urinary accidents in the house in the last week and that the dog hasn't seemed herself either. Yesterday she vomited twice. On physical exam the dog appears depressed and listless, has dark injected mucous membranes and a distended tender abdomen. T=104 F (40 C)..[N=99.5-102.5 F] HR=100 bpm.....[N=110-120] RR=30 brpm......[N=15-34] What diagnosis is of most immediate concern? A - Pyometra B - Intestinal foreign body C - Hepato-splenic tumor D - Diabetes mellitus E - Pregnancy

The rat has the best prognosis. MAMMARY GLAND TUMORS are typically BENIGN in rats (but MALIGNANT in mice). As many as 50% of boid snakes (boas, pythons) harbor the retrovirus which can cause Inclusion Body Disease (IBD). IBD can cause regurgitation, weight loss and in later stages neurologic signs, like failure to right itself. Febrile catarrhal (mucopurulent oculonasal discharge) in a ferret is suggestive of Canine Distemper (poor Px). Refs: Quesenberry and Carpenter, Clin Med and Surg of Ferrets, Rabbits and Rodents, 3rd ed. pp. 79-80, Plumb's Vet Drug Handbook, 7th ed. pp. 50-2 and the Merck Veterinary Manual online edition.

A clinic's waiting room has A Rottweiler dog with foreleg osteosarcoma A white mouse with a mammary gland tumor on her belly A Norway rat with a mammary gland tumor near her neck A snot-nosed ferret with a chin rash and crusts around the eyes A thin boa constrictor that can't right itself from dorsal recumbency Which one of these animals has the BEST prognosis? A - Norway rat B - White mouse C - Ferret D - Rottweiler E - Boa constrictor

This is Sarcoptic mange. Sarcoptes NOT common in cattle (think pigs, dogs). Look for crusty pruritus starting on the head and neck. Follow this link to see a Merck image of canine sarcoptic mange. On skin scrape, look for short legs and long UNsegmented pedicles on sarcoptes. In CONTRAST to the long legs and short UNsegmented pedicles of chorioptes (Merck images, both). Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp. 180-2 and the Merck Veterinary Manual online edition.

A cow is presented with pruritus and crusts around the face, as shown in image 1. Image 2 shows the result of a skin scrape (mite). What is the diagnosis? A - Psoroptic mange B - Trombiculidiasis C - Cutaneous onchocerciasis D - Chorioptic mange E - Sarcoptic mange

This is Trichomoniasis , caused by Trichomonas gallinae, and diagnosed by microscopic smear exam of the caseous oral exudates. Look for trichomonads. More a problem in PIGEONS, but can cause disease in chickens. Remember Trichomonas foetus in cattle causes infertility (early embryonic death actually, 1st 2 months pregnancy). Infected bulls are mechanical carriers to cows. Candidiasis is a fungal disease that can look SIMILAR to trichomonas in chickens. Follow this link to see a Merck image of Candidiasis. Caused by Pasteurella multocida, Fowl Cholera causes sudden onset septicemia with VARIABLE signs. (Sudden death, anorexia, depression, mucoid beak discharge, ruffled feathers, diarrhea, increased RR. Aspergillosis presents as respiratory disease. See fungi on microscopic smear, may see granulomatous lumps in lungs. See sudden death with Necrotic enteritis, caused by Clostridium perfringens. Follow this link to see the so-called "Turkish towel" intestinal pseudomembrane of Necrotic enteritis. Ref: Pasquini's Guide to Bovine Clinics, 4th ed. p. 120 and the Merck Veterinary Manual online edition.

A flock from a broiler chicken operation is presented to investigate a disease outbreak characterized by caseous accumulations in the throat and weight loss. A typical bird looks like the image below. Two diseases are suspected: it is either candidiasis ("thrush") or another, similar disease. What is the other disease and how might the diagnosis be confirmed? A - Trichomoniasis, microscopic smear exam B - Fowl cholera, tracheal aspirate culture C - Infectious coryza, AGID D - Aspergillosis, fungal culture E - Necrotic enteritis, fecal flotation

These are ventricular premature complexes (VPCs). You had better be thinking the dog is in early stages of Dilated Cardiomyopathy (DCM). According to Merck, 9th ed. "...ventricular premature contractions on a routine ECG in a presumed healthy DOBERMAN Pinscher or BOXER is HIGHLY SUGGESTIVE of CARDIOMYOPATHY". Echocardiography is the test of choice for definitive diagnosis of DCM. Remember this mnemonic for DCM breed predispositions: "DCM in a BOX" (ie: "D_obes, C_ockers, M_assive dogs (giant breeds), in a BOX_er" ALWAYS FATAL. Death usually in 6 to 24 months after Dx. WORSE Prognosis in DOBES, generally survive less than 6 months from Dx. Ref: Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 210-1 and the Merck Veterinary Manual online edition.

During a routine dental cleaning under isoflurane anesthesia on an 8-year old male neutered Doberman, the ECG monitor shows the following pattern. The dog is stable and doing fine. What is this pattern? A - Atrial fibrillation B - Ventricular premature complexes C - Atrioventricular (AV) block D - Accelerated idioventricular rhythm E - Sinus arrhythmia

Encephalomyocarditis virus (EMCV) is caused by a cardiovirus in the family picornaviridae. Confusingly, the virus is named for its effects on mice. Think of rodents and exotic zoo mammals with EMCV. Pig-to-pig contact, contamination of swine feed and water by rodents or ingestion of dead rodents may cause disease. See pulmonary edema and copious transudate in the respiratory tract, causing cardiac failure. Zoo outbreaks of EMCV have included lions, African elephants, rhinos, hippos, sloths, llamas, antelope and nonhuman primates. An outbreak of lion deaths at a Florida zoo in the USA occurred after feeding them the carcass of an African elephant that had died of EMCV. Edema disease is a neurologic disease caused by a hemolytic Escherichia coli producing Shiga toxin e2 and F18 pili resulting in high mortality in recently-weaned pigs. Glasser's Disease, caused by Hemophilus parasuis is usually an acute disease of 6 to 8 week-old pigs which causes fibrinous arthritis, polyserositis, and meningitis. Porcine Reproductive and Respiratory Syndrome (PRRS), is an arterivirus causing reproductive failure and post-weaning respiratory disease. Pseudorabies is a herpesvirus: infection causes CNS disease in neonates, respiratory disease in weaned pigs, and fever in all ages. Refs: Encephalomyocarditis Virus: Epizootic in a Zoological Collection, Wells et al., J Zoo & Wildlife Med, 20(3), Sep. 1989, pp. 291-6 and the Merck Veterinary Manual online edition.

Most of a litter of European wild boar at a zoological park have died. The surviving piglets are in lateral recumbency with a frothy nasal discharge. Necropsy of the piglets reveals pulmonary edema and copious fluid in the trachea and bronchi along with grayish- white necrotic foci on the myocardium. Which one of the following diseases is the most likely diagnosis? A - Edema disease B - Encephalomyocarditis C - Glasser's Disease D - Porcine Respiratory and Reproductive Syndrome E - Pseudorabies

Cull this cow. Bilateral dilated jugulars say "Severe heart problem". A washing machine murmur and the painful stance, as well as respiratory grunting all point to hardware disease (Traumatic reticuloperitonitis). Treatment is unrewarding- CULL. Prevent problem by making every cow swallow a small bar magnet to attract and hold nails, wire, sharp metal inside the reticulum. COOL FACT: A compass can tell you if a cow has a magnet. Hold it near the brisket. If there is a magnet, compass needle will point to the cow, even if you move the compass. Cardiac lymphosarcoma may present with heart failure signs, but less likely to have such an acute onset of agalactia, painful stance or classic "washing machine" murmur. Monensin/Lasalocid are ionophore coccidiostats associated with cardiac failure- MOST TOXIC to HORSES Cottonseed meal contains Gossypol - see cardiac toxicity/dyspnea/ sudden death in calves; sterility/decreased conception in adults. are associated with cardiac toxicity. Refs: Osweiler's NVMS Toxicology pp. 333, 338-40, Pasquini's Guide to Bovine Clinics, 4 th ed. pp. 76-79, 203,227 and the Merck Veterinary Manual online edition.

NAVLE Question of the Day: A 5-year old Holstein cow is presented with a 2-day history of being off feed and a precipitous drop in milk production. T=103 F (39.4 C)..[N=101.5-103.5 F] HR=132 bpm........[N=55-80] RR=36 brpm.........[N=10-30] The cow stands with abducted elbows, an arched back and is reluctant to move. Physical exam shows intermandibular edema and bilateral jugular distention. A grunt is heard when pressure is applied to her xiphoid and there is a washing machine murmur (almost like splashing sounds) on both sides. There is little rumen activity. What is the recommendation for the farmer? A - Treat with high-dose penicillin/streptomycin B - Check the feed for excess monensin/lasalocid C - Test the herd for bovine leukosis D - Check the feed for cottonseed meal (gossypol) E - Cull this cow

Pentobarbital is one of the most commonly used drugs in IV euthanasia solutions. For the most complete reference on veterinary euthanasia, see the 2013 AVMA Guidelines on Euthanasia. The AVMA report states IV injection of a barbituric acid derivative is the PREFERRED METHOD for euthanasia of dogs, cats, other small animals, and horses. Potassium chloride can be used in conjunction with general anesthesia. Phenytoin and lidocaine are often added to pentobarbital-containing euthanasia solutions to increase cardiac depressant effects. Thiopental is an ultra-short acting thiobarbiturate used for anesthesia induction and for short procedures. Refs: Plumb's Veterinary Drug Handbook, 7th ed. pp. 543-4 and Merck Veterinary Manual online edition.

The major active ingredient in most IV euthanasia solutions is: A - Phenobarbital B - Phenytoin C - Pentobarbital D - Thiopental E - Potassium chloride

The preferred answer is "nothing". Campylobacter jejuni from contaminated chicken is one of the leading causes of enterocolitis IN HUMANS, but the chickens themselves are asymptomatic. Click for more on avian campylobacter. Ref: The Merck Veterinary Manual online edition.

What is the primary clinical presentation in chickens infected with Campylobacter jejuni? A - Enterocolitis B - Nothing C - Diphtheritic tracheitis D - Depression, anorexia, lethargy E - Hemorrhagic diathesis

This is severe PLEURAL EFFUSION. Note the raised trachea, with lung lobes floating in the dorsal chest; lung borders outlined clearly by opacity, but the cardiac silhouette indistinct. See Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 1080-81, for details on pleural effusion. DDX includes NOTHING GOOD---neoplasia, CHF, hypoalbuminemia (secondary to protein-losing nephropathy/liver disease), heartworm, diaphragmatic hernia, trauma/hemothorax, lung lobe torsion to name a few. Pulmonary edema looks different-Think splotchy, cotton-ball lungs, where the tissue of the lung itself is heavy with fluid. Ref: The Merck Veterinary Manual online edition. Image courtesy of Dr. Teri Defrancesco, Copyright 2010, All rights reserved.

What's wrong with this picture? A - Pleural effusion B - Pulmonary edema C - Dilated cardiomyopathy D - Vena caval syndrome E - Diaphragmatic hernia

Compared to other types of hays, alfalfa tends to be higher in calcium, protein, and energy. Click here to see more on pasturing horses and also equine parasite control. Click here to see Common Nutritional Feed Profiles, courtesy of Equi-Analytical Laboratories. Ref: The Merck Veterinary Manual online edition.

Which of the following hays is highest in calcium? A - Alfalfa hay B - Barley hay C - Bermuda grass hay D - Orchard grass hay E - Oat hay

Ampicillin, penicillin and kanamycin can be injected subconjunctivally; best results are obtained with injection into the bulbar conjunctiva. In the past, veterinarians used gentamicin subconjunctivally, but this is now a gray area of off-label use, because gentamicin is not FDA-approved for systemic use in cattle. Oxytetracycline is generally considered the drug of choice for systemic therapy because it is concentrated in corneal tissue. Oxytetracycline cannot be injected in the subconjunctiva because it will cause conjunctival necrosis. Two injections (20 mg/kg, IM) of a long-acting oxytetracycline formulation (200 mg/mL) at 72-hr intervals is the systemic treatment of choice. Refs:Pasquini's Guide to Bov Clin, 4 th ed. p. 178 and the Merck Veterinary Manual online edition. Image courtesy of Dr. John Angelos, copyright 2010, All rights reserved.

A 2 year-old Hereford cow is presented with a 1-week history of blepharospasm, lacrimation and corneal opacity. There is a large central corneal abscess secondary to suspected infectious keratoconjunctivitis (pinkeye). What is an appropriate treatment plan? A - Subconjunctival oxytetracycline, Topical polymyxin B ointment B - Systemic oxytetracyline, Subconjunctival penicillin C - Systemic long-acting penicillin-gentamicin D - Systemic Florfenicol, Topical erythromycin ointment E - Systemic Sulfamethazine, Topical atropine ointment

Watery diarrhea in a SINGLE animal (1-4 weeks) in a group, plus emaciation suggests Cryptosporidiosis. Expect a more acute, lethal presentation of hemorrhagic diarrhea in 1-4 DAY old calves with Colibacillosis, and multiple cases with the viral diarrheas like Rotavirus - (5d-2 wks old, self limiting); Coronavirus, (4-30d). OLDER-animal diarrheas on this list include Coccidiosis ( Older than 21 days and in ALL ages, bloody diarrhea, tenesmus) Ostertagiasis (anorexia, poor growth, diarrhea in less than 2 year olds on pasture- a chronic disease). Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp. 18-23, 258-63 and the Merck Veterinary Manual online edition.

A 2-week old calf is presented that is dehydrated and almost emaciated from weight loss. She has a 1 week history of watery, foamy diarrhea and exhibits tenesmus during examination. The calf is the only sick one in a mixed group of calves that range from 3 weeks to 2 months of age What is the diagnosis? A - Colibacillosis B - Cryptosporidiosis C - Coccidiosis D - Ostertagiasis E - Coronavirus

This is Dorsal displacement of the soft palate (DDSP). The caudal free margin of the soft palate moves dorsal to epiglottis, obstructing the airway and causing exercise intolerance. Rx conservatively, eliminating possible contributing diseases first (ie: rest, anti-inflammatories). Surgical treatments (Sternothyrohyoideus myectomy or soft palate resection) have mixed success rates around 50%. Epiglottic entrapment is a big DDX for DDSP. Outline of the epiglottis can still be seen with epiglottic entrapment, UNlike DDSP. Cleft palate is a newborn disease. See difficulty suckling, dysphagia, MILK DRIPPING from NOSTRILS. Click here to see a Cleft palate. Euthanize if severe. Surgical closure if small. Laryngeal hemiplegia ("Roarers") present with inspiratory noise during exercise and exercise intolerance. Click here to see laryngeal hemiplegia. More than 90% occur on LEFT side. Rx is surgery. Pharyngeal lymphoid hyperplasia (PLH) is common. Thought to be a normal immunologic event in younger horses. Refs: Pasquini's Guide to Equine Clinics, 3rd ed. pp. 22, 104-7 and the Merck Veterinary Manual online edition.

A 3 year old Standardbred mare is presented with a 2-month history of exercise intolerance. Endoscopy shows the following image. What is the diagnosis? A - Laryngeal hemiplegia B - Cleft palate C - Pharyngeal lymphoid hyperplasia (PLH) D - Dorsal displacement of soft palate E - Epiglottic entrapment

This puppy has a laryngeal foreign body near the far left edge of the images. A small, round, mineral opacity is observed within the larynx ventral to C2 on the first lateral projection. This is a good example of why a radiographic review must encompass the ENTIRE image, including the periphery. The patient became dyspneic at this point and was administered oxygen. There is a second round mineral opacity within the descending colon. A small seed was removed from the upper airway using endoscopy. Click here to see normal canine thoracic radiographs. Refs: Cote, Clin Vet Advisor 2nd ed. pp. 1295-97 and the Merck Veterinary Manual online edition. Radiographic interpretation and images courtesy, Dr. A. Zwingenberger and Veterinary Radiology.

A 3-month-old French bulldog is presented with respiratory distress and vomiting. Based on the radiographs shown below, which of the following choices is the most likely diagnosis? A - Laryngeal foreign body B - Normal radiographs C - Cranio-ventral aspiration pneumonia D - Vascular ring anomaly E - Hiatal hernia with gastric displacement

Horses with cauda equina neuritis (also called polyneuritis equi) have a progressive symetric LMN paresis of the tail, bladder, rectum, anal sphincter. Look for urinary incontinence, fecal retention and a weak or paralyzed tail. May see hind limb paresis if lumbosacral spinal cord is affected. Cranial nerves can also be affected, but typically cranial involvement is asymetric. May see temporal or masseter atrophy (Cranial Nerve 5), facial paralysis and exposure keratitis (Cranial nerve 7), head tilt or other CNS signs. Cause is unknown, may be an autoimmune process. Grave prognosis. Eventually euthanized. Herpesvirus myeloencephalopathy (EHV-1) may also present with urinary incontinence, but this is an uncommon manifestation of equine rhinopneumonitis. You would expect to hear a history of the more common EHV signs in other horses from the same farm, like respiratory disease ("snots") in foals and abortions in mares. Refs:Pasquini's Guide to Eqn Clin, 3rd ed. pp. 248, 254 and the Merck Veterinary Manual online edition.

A 4-year old quarterhorse mare is presented with a runny left eye and a urine-scalded perineum. No other horses on the farm are sick. Physical exam reveals a corneal ulcer and keratitis OS (left eye), and atrophy of the temporal and masseter muscles. There is decreased perineal sensation, a weak tail and weak anal sphincter with retained manure. The horse is bright, alert and responsive. T=102.2 F (39.1 C)..[N=99.0-101.3 F] HR=40 bpm............[N=28-40] RR=12 brpm...........[N=10-14] Which one of the following choices is the most likely diagnosis? A - Cauda equina neuritis B - Equine degenerative myelopathy (EDM) C - Botulism D - Nigropallidal encephalomalacia E - Equine protozoal myelopathy (EPM)

90% of localized Demodex cases resolve without treatment. 10% go on to generalized demodicosis. Adult-onset demodicosis is often severe and refractory to treatment. Need to advise owner that many adult-onset cases are medically controlled, but not cured. Avoid Ivermectin in Collies, Shetland and Eng. Sheepdogs, herding breeds or mixed breeds with these breeds in them. Refs: Plumb's Vet Drug Handbook, 7th ed. pp. 753-60, 931-2, Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 342-3 and the Merck Veterinary Manual online edition.

A 5-month old English sheepdog with unilateral peri-ocular alopecia is presented for a routine vaccination visit. A skin scrape shows the following. What is the treatment plan? A - Do nothing B - Weekly Amitraz dip C - Ivermectin 0.3-0.6 mg/kg PO SID 30-60 days D - Imipramine 2 mg/kg PO SID 30-60 days E - Topical imidacloprid and moxidectin, monthly

Signs of hepatic encephalopathy (ataxia, disorientation, vomiting, diarrhea) beginning after weaning combined with polyuria/polydipsia ("drink and pee alot") in a cryptorchid male Yorkshire terrier says Congenital Portosystemic Shunt. Seen most in pure-breeds. Think SMALL Maltese, Yorkshire terrier, Min. Schnauzer. (But can see in Old English sheepdog, Irish Wolfhound) Usually in YOUNG animals, especially after weaning. 50% of males are CRYPTORCHID. Lead poisoning can cause vomiting, diarrhea and CNS signs (blind, hyperactive, seizures). Can see PU/PD in older animals but Hx here puts a shunt first on DDX. Refs: Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 1116-7 and the Merck Veterinary Manual online edition.

A 7-week old male Yorkshire terrier is presented with a 2 week history of on and off vomiting and diarrhea that began around the time he was weaned. The owners relate that he seems to "drink and pee a lot". They report pacing, disorientation, weakness, and "stumbling around". Physical exam is unremarkable, but only one testicle has descended. As the puppy explores the room he appears ataxic, stumbles a few times, and bumps his head into the wall. What is the clinical diagnosis? A - Congenital hiatal hernia B - Portosystemic shunt C - Canine distemper D - Diabetes insipidus E - Lead poisoning

This is Infectious Coryza. Think acute respiratory disease with nasal discharge, sneezing, and SWELLING UNDER THE EYES. Caused by Avibacterium (Haemophilus) paragallinarum, infected flocks are a constant threat to uninfected flocks; farms with multiple-age flocks can perpetuate disease. In the USA, "All-in/all-out" management has essentially eliminated infectious coryza from many commercial poultry farms. Follow this link to see original Merck image of Infectious Coryza. Infectious Laryngotracheitis (ILT) look for gasping, coughing, blood stained beaks, blood occluding trachea on necropsy. A highly contagious herpesvirus infection, severe forms of ILT, can have 50% mortality. In most states ILT is REPORTABLE. Follow this link to see an image of ILT. Infectious Bronchitis is characterized by respiratory signs, decreased egg production and poor egg quality. Classically may see "wrinkled eggs" with inf Bronchitis. Pasteurella multocida causes Fowl Cholera. Think sudden onset septicemia. Signs vary greatly. In acute fowl cholera, dead birds are first indication of disease. May see fever, depression, anorexia, oral mucoid discharge, ruffled feathers, diarrhea, increased respiratory rate. Follow this link to see an image of Fowl Cholera. Another name for Candidiasis is thrush. Think Candida albicans, thickened mucosa, whitish, raised pseudomembranes in crop, mouth and esophagus. Follow this link to see an image of Candidiasis. Ref: The Merck Veterinary Manual online edition.

A flock from a egg layer poultry operation is presented to investigate an outbreak of respiratory disease among a mixed-age population of adult chickens. The owner reports a sudden onset of sneezing, nasal discharge and facial swelling among about 30% of the birds. A typical sick chicken looks like the image below. What is the clinical diagnosis? A - Infectious Bronchitis B - Fowl Cholera C - Infectious Coryza D - Infectious Laryngotracheitis E - Candidiasis

This is Histomoniasis. The combination of characteristic "Bulls-eye" lesions on liver and cecal changes are pathognomonic. Caused by protozoan Histomonas meleagridis, transmitted in eggs of cecal nematode Heterakis gallinarum. Expect a depression/diarrhea presentation. See sudden death picture with Necrotic enteritis caused by Clostridium perfringens. Follow this link to see the so-called "Turkish towel" intestinal pseudomembrane of Necrotic enteritis. Signs of Avian spirochetosis are highly variable, may be absent: see listlessness, shivering, increased thirst, green/yellow diarrhea with increased urates early on. Caused by a tick-borne Borrelia. Look for characteristic enlarged, mottled spleen with petechial hemorrhages, similar to Marble spleen disease of pheasants. See depression, bloody droppings, substantial mortality with Hemorrhagic enteritis of turkeys. Follow this link to see hemorrhagic intestines. Follow this link to see characteristic enlarged spleen. Expect diarrheal presentation with Coronaviral enteritis of turkeys but NOT the characteristic cecal/liver lesions described on necropsy above. Ref: The Merck Veterinary Manual online edition.

A flock from a turkey farm is presented with a mysterious illness. Several dead birds are noted, mostly younger. Sick turkeys are listless, with drooping wings, unkempt feathers, yellow droppings. Among the sick older birds emaciation is observed. Necropsy shows a yellowish green, caseous exudate in the ceca, cecal ulcerations and thickening of the cecal wall. A typical liver looks like the image below. What is the diagnosis? A - Histomoniasis B - Necrotic enteritis C - Avian spirochetosis D - Coronaviral enteritis of turkeys E - Hemorrhagic enteritis of turkeys

Bronchoscopy is the next best step. On radiographs of the thorax, there is an alveolar pulmonary pattern in the left cranial, and right middle lung lobes, with patchy increased opacity in the remaining lobes. The trachea is narrowed at the thoracic inlet, with an apparent linear intraluminal opacity. There is dilation of the pharynx with air, and there is gas within the esophagus and gastrointestinal tract. The tracheal narrowing and intraluminal opacity may indicate edema, mucus, or foreign material in this region. There is secondary upper airway obstruction as indicated by the dilated pharynx and aerophagia. The alveolar pattern is due to bronchopneumonia. Click here to see the 7 inch tracheal foreign body. Click here to see normal canine thoracic radiographs. Refs: Thrall, Textbook of Veterinary Diagnostic Radiology 6th ed. p. 511 and the Merck Veterinary Manual online edition. Radiographic interpretation and images courtesy, Dr A. Zwingenberger and Veterinary Radiology. Normal radiograph links courtesy, Imaging Anatomy Univ. of Illinois Vet Med.

A four-month-old Jack Russell terrier puppy was playing outdoors. Later that evening the owner noticed that the puppy was wheezing and coughing. Based on the radiographs, what would be the best step to take next? A - Bronchoscopy B - Barium swallow C - Edrophonium challenge test D - Trans-tracheal wash E - Dental prophylaxis

Think scurvy (vitamin C deficiency) when you see hemorrhages SQ in a guinea pig. Look for swollen joints (source of lameness) and a hx of lameness, anorexia, diarrhea, weakness. May be thin with a rough hair coat. See increased vulnerability to opportunistic infections, and sudden death. Follow this link to see the original Merck image of scurvy in a guinea pig Rx with daily vitamin C 5-10 mg/kg, PO or IM, for 1-2 wk. AVOID multivitamins! May cause toxicity for overdose of other vitamins. Need minimum 10 mg vitamin C/day (30 mg/day for pregnant sows) in diet. Metastatic Calcification occurs mostly in MALES Nutrional Muscular dystrophy and vitamin E deficiency are the same thing- can present like vitamin C deficiency but without diarrhea. Ketosis is mostly a disease of fat or pregnant animals Ref: The Merck Veterinary Manual online edition.

A necropsy of 16 month old male guinea pig with a 2-week history of anorexia, diarrhea, lethargy and weakness reveals the following. What is the diagnosis? A - Ketosis B - Metastatic Calcification C - Vitamin E Deficiency D - Vitamin C Deficiency E - Nutritional Muscular Dystrophy

Elevated alkaline phosphatase is associated with a poor prognosis prior to surgery for osteosarcoma. If alkaline phosphatase stays elevated postoperatively, the prognosis is even more guarded. The median survival of dogs with appendicular osteosarcoma is only 4-5 months after amputation alone, and 10-12 months with amputation plus chemotherapy. 90-95% of animals with osteosarcoma ultimately develop visible metastatic disease. The foundation of monitoring for osteosarcoma after amputation and adjunct chemotherapy is 3-view thoracic radiographs every 2-3 months. Click here to see a radiograph, metastatic lung tumors in a dog, and another radiograph of feline metastatic lung tumors. Think of microcytotic anemia with iron deficiency in young rapidly-growing animals like piglets and puppies and with portosystemic shunts. Think of polycythemia (high RBCS) most commonly secondary to dehydration. Refs: Cote, Clinical Vet Advisor-Dogs and Cats, 2nd ed. pp. 801-3, Blackwell's 5-Min. Vet Consult Canine-Feline, 4th ed. pp. 1006-7, and the Merck Veterinary Manual online edition.

After diagnosis of appendicular osteosarcoma in a dog, the leg is amputated and chemotherapy is initiated. At follow-up monitoring exam 3 months later, thoracic radiographs are clear. What finding would suggest a guarded prognosis? A - High alkaline phosphatase B - Depressed calcium-phosphorus ratio C - Microcytosis D - Polycythemia E - Elevated albumin, depressed globulin

The nystagmus usually improves markedly within 72 hrs and the cat will likely completely return to normal in the next 2-3 weeks without any medication. This cat most likely has idiopathic vestibular disease. For severe disorientation, consider sedatives (diazepam and acepromazine). Glucorticoids do not usually alter course of disease. Anti-emetics usually not effective. In cats where you cannot rule out otitis externa or media, antibiotic therapy is warranted. Refs: Blackwell's 5-Min Vet Consult Canine Feline, 4th ed. pp. 1026-7 and the Merck Veterinary Manual online edition.

An 8 year-old spayed female DSH cat is presented for right head tilt of 24 hours duration. The cat is up to date on vaccinations. Physical exam shows horizontal nystagmus with the fast phase to the left. The rest of the physical exam is unremarkable. What can the owner be told regarding the cat's treatment and prognosis? A - Fair prognosis with corticosteroids and antibiotics B - Good prognosis with corticosteroids and anti-emetics C - Excellent prognosis with corticosteroid therapy D - Excellent prognosis with corticosteroids and antibiotics E - Excellent prognosis without medication

The radiographs are indicative of a mechanical obstruction due to gastrointestinal foreign body. There are multiple loops of enlarged small intestine which are filled with gas and fluid. There is a segment of bowel that is persistently filled with granular material, which is visible in the ventral abdomen on the lateral projections, and in the right side of the abdomen on the v/d. The spleen is moderately enlarged and normal in shape. The remainder of the abdominal organs appear normal, and peritoneal detail is good. Click here to see normal abdominal radiographs. Refs: Thrall, Textbook of Veterinary Diagnostic Radiology 6th ed. pp. 789-811 and the Merck Veterinary Manual online edition. Radiographic interpretation and images courtesy, Dr A. Zwingenberger and Veterinary Radiology. Normal radiograph links courtesy, Imaging Anatomy Univ. of Illinois Vet Med.

An 8-year-old Yorkshire terrier is presented with a 48-hour history of vomiting.Which one of the following choices is the most likely diagnosis? A - Foreign body obstruction B - Gastroenteritis C - Intussusception D - Splenic neoplasia E - Retroperitoneal mass

Think Pulmonic stenosis if you see RIGHT ventricular hypertrophy, because pulmonic valves blocks outflow from R ventricle (mostly dogs). Follow this link to see a Merck image of Rt. ventricular hypertrophy. Heard as a systolic murmur heard most loudly LEFT chest between the 2nd and 4th intercostal (IC) space; genetic link in beagles. Predilection seen in many breeds, including Eng. Bullldog, Min. Schnauzer, Scotties, Chihuahuas, Cockers, Boxers. Mitral stenosis can be confused with aortic stenosis (also called sub-aortic stenosis [SAS]), a systolic murmur which may be heard most loudly on the left chest between the 2nd and 5th intercostal (IC) space or at the thoracic inlet (lateral to trachea). Mitral dysplasia and other mitral valve problems are heard further back on left at 5th-6th IC. More common in CATS. Tricuspid dysplasia is heard further back on RIGHT at 5th-6th IC. Uncommon. Expect a continuous murmur with PDA. Vast majority detected at first vaccination visit. Refs: Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 1156-57, 905, Cote, Clin Vet Advisor-Dog and Cat 2nd ed. pp. 941-3 and the Merck Veterinary Manual online edition.

During a necropsy on a 4-year old Beagle who died suddenly, a severe right ventricular hypertrophy is noted. Which condition is highest on the differential diagnosis list? A - Mitral dysplasia B - Tricuspid dysplasia C - Aortic stenosis D - Patent ductus arteriosus (PDA) E - Pulmonic stenosis

Aortic stenosis (also called sub-aortic stenosis [SAS]), is a systolic, ejection-type (crescendo-decrescendo) heart murmur which may be heard most loudly on the left chest between the 2nd and 5th intercostal (IC) space or at the thoracic inlet (lateral to trachea). Inherited in Newfoundlands. Predilection in many BIG BREEDS- German Shepherd, Golden Retriever, Boxer, Rottweiler. Mitral dysplasia and other mitral valve problems are heard further back on left at 5th-6th IC. More common in CATS. With pulmonic stenosis see RIGHT ventricular hypertrophy, because pulmonic valves blocks outflow from R ventricle (mostly dogs). Follow this link to see a Merck image of Rt. ventricular hypertrophy. Tricuspid dysplasia is heard further back on RIGHT at 5th-6th IC. Uncommon. Expect a continuous murmur with Patent ductus arteriosus (PDA). Vast majority detected at first vaccination visit. Refs:Cote, Clin Vet Advisor-Dog and Cat 2nd ed. pp. 941-3, Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 96-7, 905 and the Merck Veterinary Manual online edition.

During a routine immunization visit for a 2 year-old neutered male Newfoundland dog, a systolic ejection-type (crescendo-decrescendo) murmur is detected, audible loudest on the left side of the chest between the 2nd and 5th intercostal (IC) space and at the thoracic inlet lateral to the trachea. Which condition is highest on a differential diagnosis list? A - Pulmonic stenosis B - Mitral dysplasia C - Tricuspid dysplasia D - Aortic stenosis E - Patent ductus arteriosus (PDA)

After 28 days. According to the Compendium for Rabies Control, a peak rabies virus antibody titer is reached 28 days after initial vaccination and immediately after booster vaccination. Here are some thoughts on rabies: When in doubt, it is never wrong to check with your local health department. Basically all potential rabies exposures boil down to 2 questions: 1. Who is involved? Animal-Animal exposure (less alarm bells) Animal bites/exposes human (more alarm bells) 2. Was animal vaccinated/up to date on vaccination? Up to date on vaccs (less alarm bells, shorter observation) Vaccinated, but not up to date (Handle on case-by-case basis) Un-vaccinated pet (more alarm bells, euthanize or long observation period) Wild animal, esp. bats, raccoon, skunk (euthanize, send head to state lab) When dealing with rabies questions, ask yourself if this seems like a HIGH-risk exposure (ie: wild raccoon bites a child) or a LOWER risk exposure (ie: Up-to-date vaccinated dog messes with woodchuck but no bite wounds on dog). For high risk lean towards euthanasia/testing or long quarantine. For low risk lean towards short observation period (10 days) and a rabies booster. Refs: The SINGLE BEST REF on rabies is the Compendium for Rabies Prevention and Control, 2011; Nov 4, 2011 / 60(RR06);1-14. For info on post-exposure prophylaxis for people see: Human Rabies Prevention-US, 2008 ACIP Reccs: May 23, 2008 / 57(RR03);1-26,28 and, as always, the Merck Veterinary Manual online edition.

How long after the first rabies vaccination is a dog, cat or ferret considered to be immunized and protected against rabies? A - Same day B - After 24 hours C - After 7 days D - After 14 days E - After 28 days

Antihelminthics are the treatment of choice. This is ascarid (roundworm) infestation and these are classic "milk spots"- liver scars left by migrating ascarid larva traveling to the lungs. In heavy infestation, larvae can cause pulmonary edema, consolidation, severe respiratory distress. May see icterus. Follow this link to see another image of milk spots. A fecal exam would show eggs that look like this. Rx with antihelminthics, like benzimidazoles, ivermectin, pyrantel, levamisole. May need antibiotics to treat secondary bacterial pneumonia, but primary Rx is antihelminthics. Lincomycin is a lincosamide antibiotic used in pigs against mycoplasma pneumonia. Clorsulon is used to treat liver flukes in cattle and sheep. Click here to see an adult ruminant liver fluke, Fasciola hepatica. Click here to see a fluke egg. Refs: Plumb's Vet Drug Handbook, 7th ed. pp. 753-60, 809-12, 778-9, 1183-4, 1520 and the Merck Veterinary Manual online edition.

If the following image is seen on necropsy, what would be recommended as a treatment plan for the remaining group of pigs? A - There is no effective treatment B - Clorsulon PO, all animals C - Lincomycin IM, underweight animals D - Decrease non-protein nitrogen in diet E - Antihelminthics

E. coli causes the characteristic lesions of Edema disease in recently weaned piglets. Marked swelling of the periocular region, forehead and submandibular area follow infection. Piglets may die peracutely. Usually only a few piglets in a group are affected, but affected piglets perish rapidly (within 12 hours). Hemolytic E. coli that produce F18 pili and Shiga toxin 2e are implicated in edema disease. To make a definitive diagnosis, E. coli must be first isolated and then characterized as an edema disease strain (that is, producing F18 pili and Shiga toxin 2e).The course is so rapid that treatment is ineffective. Antibiotics may be administered to unaffected pigs in the group. Brachyspira hyodysenteriae causes Swine dysentery also called bloody scours. Lawsonia intracellularis causes Porcine proliferative enteritis (diarrhea, often with fibronecrotic casts). Clostridium septicum is the agent of Malignant edema in many species. Infection occurs through contaminated wounds and turns affected muscle dark brown or black. Streptococcus suis causes septicemia and meningitis in weaners and growing pigs. Refs: Jackson and Cockcroft, Handbook of Pig Medicine, 1st ed. pp. 94-5 and the Merck Veterinary Manual online edition.

Several piglets in a group weaned 10 days ago in the nursery facility of a large commercial swine operation were found dead. On evaluation, some weaners have swelling around the eyes and forehead. Some are in lateral recumbency and dyspneic. Necropsy of the dead piglets reveals subcutaneous and submucosal edema. The most likely causative organism is... A - Brachyspira hyodysenteriae B - Escherichia coli C - Lawsonia intracellularis D - Clostridium septicum E - Streptococcus suis

Explanation - Feathers serve a critical waterproofing and insulatory function which is disrupted by oil and can rapidly result in hypothermia. Other concerns for oiled birds include GI irritation from ingestion of oil during preening, hemolytic anemia, and pneumonia due to inhalation of oil. Treatments include heat, supportive care, and activated charcoal. Once stabilized, frequent high pressure, warm, mild detergent baths and clean warm water rinses until water beads freely off of the feathers is important. Birds should be placed in warm air flow until dry and they should be maintained on self-skimming ponds for several days after washing to ensure full waterproofing.

The goose shown in the image below was found weak on the shore of a local pond where oil had been dumped. The goose was covered in oil, dehydrated and weak but responsive. Which of the following is an important acute clinical effect of oil on affected birds? Hepatotoxicity Contact dermatitis Lead toxicity Disruption of function of the plumage Nephrotoxicity

The menace response is used to test visual input (cranial nerve II - optic) and blink response (cranial nerve VII - facial). Take care not to induce air movement which would elicit a tactile response (cranial nerve V - trigeminal) instead of visual. Refs: Curtis Dewey, A Practical Guide to Canine and Feline Neurology, 2nd ed. pp. 57,63 and the Merck Veterinary Manual online edition. Image courtesy of Dr. Shirley Scott.

The menace response is used to test which cranial nerves? A - II and VII B - I and VIII C - V and VII D - IX and X E - V and VIII

These are warts, or papillomas, which is related to infection with equine papilloma virus. Equine papillomatosis occurs most frequently in young horses and are most commonly found on the inner surfaces of the pinna, muzzle, distal limbs, and genitalia. They are contagious, and since they usually resolve spontaneously, treatment is rarely pursued. Refs: Wilson, Clinical Veterinary Advisor: The Horse pp. 426-7 and the Merck Veterinary Manual online edition. Image courtesy of Dr. Ines Pinto.

This 3-year-old horse presents for evaluation of this dry, horny, wart-like mass on the distal forelimb. This horse also has smaller wart-like lesions on its muzzle. The other young horses in the herd have similar lesions. Which one of the following is the most likely diagnosis? A - Papillomatosis B - Melanomatosis C - Dermatophilosis D - Pediculosis E - Trombiculosis

This is the cerebrocortical necrosis of Polioencephalomalacia (PEM), basically a nutritional disease. PEM is traditionally associated with LOW THIAMINE but increasingly associated with HIGH SULFUR diets. PATHOGNOMONIC dorsomedial strabismus ("Stargazing"), history and cerebrocortical necrosis that lights up under UV light all suggest PEM. Refs: Pasquini's Guide to Bov Clinics, 4th ed. pp. 140-1 and the Merck Veterinary Manual online edition.

This cow was found recumbent and blind, with dorsomedial strabismus, in tonic-clonic seizures that led to coma and death. On necropsy, lesions shown below light up under ultraviolet light. Click here to see image. What caused this problem? A - High sulfur diet B - Rabies C - Bovine spongiform encephalopathy D - Urea toxicity E - Thromboembolic meningoencephalitis (TEME)

In cattle, Moraxella bovis is the most commonly recognized cause of infectious keratoconjunctivitis, ("Pinkeye"); Other causes include Mycoplasma spp.and Neisseria spp. The severity of infection with Moraxella bovis may increase with infection with IBR or other microbes. Chlamydophila pecorum is the most common cause of pinkeye in sheep. Refs: Pasquini's Guide to Bov Clin, 4 th ed. p. 178 and the Merck Veterinary Manual online edition. Image courtesy of Dr. John Angelos, copyright 2010, All rights reserved.

This is a corneal abscess secondary to infectious keratoconjunctivitis (pinkeye). What is the most commonly recognized organism that causes pinkeye in cows? A - Moraxella bovis B - Chlamydophila pecorum C - Mycoplasma spp. D - Colesiota conjunctivae E - Neisseria spp.

This is Blackleg, caused by Clostridium chauvoei (feseri). Look for peracute, febrile disease. May have acute lameness and a few animals found dead. Some may have edematous, crepitant ("popping, crackling" sound/feel) swellings. Death within 12-48 hrs. Beef breeds mostly, best animals in herd, 6 mos-2 yrs, summer and fall, rarely in winter. The blackleg organism is a normal inhabitant of gut, infection develops WITHOUT wounds, though bruising may precipitate disease. (In contrast to tetanus (Clostridium tetani), which enters via a wound, and causes disease more typically an individual sick cow, not an outbreak). DDX includes: Anthrax (Bacillus anthracis, reportable) Lightning strike (sudden death, single animal) Bacillary hemoglobinuria (Clostridium hemolyticum) Malignant edema (Clostridium septicum). Follow this link to see a pig with malignant edema. Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp. 90, 244-5, and the Merck Veterinary Manual online edition.

Two of the best-growing 14-month old steers at a free range beef operation die suddenly. The farmer reports that one was acutely lame, trembling and prostrate for a half-day before death. The other animal died suddenly. A few other cattle are febrile and lame. On necropsy the following lesions are evident. What is the diagnosis? A - Tetanus B - Bacillary hemoglobinuria C - Malignant edema D - Blackleg E - Infectious necrotic hepatitis

One cause of abdominal fat necrosis (lipomatosis) in adult cattle (and some deer) is prolonged grazing of tall fescue infected with Acremonium coenophialum. Seen throughout the USA where tall fescue is the primary pasture grass. Over 90% of such pastures are infected with the endophyte. Even without fescue exposure, hard masses of necrotic fat are relatively common in adult cattle. On rectal exam, the masses feel like "floating corks" similar to cotyledons, and may be mistaken for a developing pregnant uterus. Remember the other fescue-related problem, fescue mycotoxins, which can cause lameness and hyperthermia in cattle and horses due to an ergot-like mold on tall fescue grass. Fatty liver disease in cattle is a complex metabolic imbalance that can occur when an overconditioned cow reduces feed intake. Most common in periparturient cattle (think of fat cows at calving). Refs: Pasquini's Guide to Bov Clin, 4 th ed. p. 32 and the Merck Veterinary Manual online edition.

What is one cause of abdominal fat necrosis (lipomatosis) in cattle? A - Grazing tall fescue B - Chronic excess protein in ration C - Fatty liver disease D - Aflatoxicosis E - Pregnancy toxemia

Assess body condition of llamas and alpacas by palpating the amount of tissue over the lumbar vertebrae. South American camelids are adapted to high mountain environments and diets. Most adult males (and females through midgestation), maintain appropriate body condition on 10-14% crude protein grass hay with total digestible nutrients (TDN) of 50-60%. Late gestation and heavily lactating females need a higher percentage of crude protein and TDN of 65-70%. Excess legumes in the diet are not typically necessary and may cause obesity. Refs: Fowler's Medicine and Surgery of South American Camelids, 3rd ed. pp. 50-51 and the Merck Veterinary Manual online edition.

What is the best way to evaluate the body condition of an adult llama? A - Palpate over the lumbar vertebrae B - Feel the intercostal spaces C - Digital exam of the supraorbital fossa D - Rectal exam to evaluate pelvic fat E - Weight X height at withers X 0.28

This is Sacrococcygeal dysgenesis, an inherited trait in Manx cats. Look for dysgenesis, agenesis of sacrum or other spinal column abnormalities. May present asymptomatic or with palpable lumbosacral abnormalities and LMN hind limb signs. (Hopping or crouched gait). May see nonprogressive urinary or fecal incontinence, chronic constipation. Sequelae include recurrent urinary tract infections, megacolon. NO treatment. Follow this link to see the original Merck image. Refs: Pasquini's, Tschauner's Guide to Small Animal Clinics, vol 1, 2nd ed. p. 537, and the Merck Veterinary Manual online edition.

What is wrong with this picture? A - Pelvic fracture B - Tail root avulsion C - Left acetabular fracture D - Megacolon E - Sacrococcygeal dysgenesis

Retained placenta occurs in 5-15% of dairy cattle. Very common, about 1 in 10 calvings. NORMALLY, the placenta is expelled in 3-8 hours. If it's still there 12-24 hours after calving, it's retained. Typically, retained placentas are dispelled spontaneously after 4-10 days as the caruncles necrose. An owner may insist you pull it out. Manual removal is usually not helpful-should only be done if placenta comes out with GENTLE traction. Manual removal is contraindicated if cow has signs of septicemia- removal may cause a septic metritis, peritonitis. Refs: Pasquini's Guide to Bovine Clinics, 4 th ed. p. 110 and the Merck Veterinary Manual online edition.

What percentage of dairy cows have a retained placenta after calving? A - 1-4% B - 5-15% C - 25% D - 20-30% E - 30-40%

Think of NERVE ENLARGEMENT with Marek's disease; Also distortion of the pupil, enlargement of feather follicles ("skin leukosis"=condemnation of carcass). May see one leg forward, one leg back, a transient paralysis. Think Infectious Laryngotracheitis (ILT) if there is blood occluding trachea on necropsy. Remember wrinkled eggs go with Infectious Bronchitis. Think Infectious Coryza with sinusitis, swelling under eyes. Ref: The Merck Veterinary Manual online edition.

Which lesions are most commonly associated with Marek's disease? A - Edematous facial swelling with sinusitis B - Hemorrhagic skin lesions C - Nerve enlargement D - Wrinkled eggs E - Blood in the trachea

The spinal nerves, T13, L1, and L2 must be blocked to completely desensitize the flank of a cow. The paravertebral (PV)nerve block targets these nerves. It can be performed via two techniques - the proximal or distal PV block. The proximal block places local anesthetic in the space just caudal to the transverse processes of the vertebrae - T13, L1, and L2. The distal block is placed at the ends of the transverse processes of the vertebrae - L1, L2, and L4 as the nerves gradually coarse caudally after they exit the spinal foramen. Proper placement of the anesthetic results in warming of the skin from vasodilation, anesthesia of the skin and body wall, and a curvature of the spine in some cows. The latter is caused by relaxation of the epaxial musculature on the affected side; the spine curves in a convex manner. See this very good pdf on Local Anesthesia and Analgesia by Dr. Lyon Lee, OK State CVM; pp. 12-14. Refs-Gaynor & Muir Handbook of Vet Pain Mgt 2nd ed. p. 463, Muir, Hubbell, Bednarski, & Skarda's Handbook of VetAnes, 4th ed. pp. 72-80 and the Merck Veterinary Manual online edition.

Which of the following nerves are targeted with a paravertebral block used to perform a standing laparotomy in a cow? A - T13, L1, and L2 B - L1-3, and S1-5 C - L2, L3, S1, and S2 D - L1, L2, L3 E - L1, L2, and L4

Histopathology of the obex is the post-mortem test of choice for scrapie. Immunohistochemistry of the nictitating membrane, though NOT 100% sensitive, can detect scrapie in live animals. A rectal mucosa biopsy test was approved by USDA APHIS in 2008 which is less time-consuming to perform and can be repeated. Immuno-blot testing of biopsied tonsils may detect prion proteins in subclinically-infected sheep less than 1 year old. Antibodies against scrapie/prions are NOT produced. When you think of Scrapie, remember also Bovine spongiform encephalopathy (BSE;cows) and Chronic Wasting disease (CWD; deer, elk). All of these are REPORTABLE. Ref: The Merck Veterinary Manual online edition.

Which one of the following choices is the best post-mortem diagnostic test for scrapie in sheep? A - Histopathology of the obex B - IFA test on whole blood C - ELISA antibody test on serum D - Immunohistochemistry of the third eyelid E - Skin biopsy of scraped area

Mitotane (o,p DDD) is one drug option used to treat pituitary-dependent hyperadrenocorticism (Cushing's disease). It selectively destroys the glucocorticoid-secreting cells of the adrenal cortex. REMEMBER dogs receiving mitotane should be given supplementary glucocorticoids during times of stress (ie: surgery, trauma, acute illness). Alternative treatments include l-Deprenyl (decreases pituitary ACTH secretion) or Ketoconazole (inhibits enzymes of cortisol synthesis). These are used in dogs who do not tolerate Mitotane. NOTE Trilostane is also used in treatment of hyperadrenocorticism. Survival times appear to be similar between Trilostane and Mitotane. Trilostane is typically given lifelong once or twice a day, while maintenance with Mitotane is given 2-3 times per week. Long-term, Trilostane is more expensive than Mitotane. In most respects, Trilostane appears to be safer but patients must be monitored for adrenal necrosis, which can lead to an Addisonian crisis and death if unrecognized. Experienced practitioners may disagree on whether to use Trilostane vs. Mitotane. Refs: Survival Times for Hyperadrenocorticism after Mitotane and after Trilostane Treatments, Chastain and Panciera, Sm Anim Clin Endocrinol. January 2006;16(1):19, Plumb's Veterinary Drug Handbook, 7th ed. pp. 945-9, Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 646-8 and the Merck Veterinary Manual online edition.

Which one of the following drugs is used primarily to treat pituitary-dependent hyperadrenocorticism (Cushing's disease) in dogs? A - Fludrocortisone acetate B - Imidocarb C - Phenoxybenzamine D - Liothyronine E - Mitotane (o,p DDD)

When you hear "Sudden Death" in calves, think White Muscle Disease caused by Selenium/vitamin E deficiency; Think Enterotoxemia caused by Clostridium perfringens type B or C. And think Severe Colibacillosis. Can also see sudden death with encephalitic form of IBR and severe Salmonellosis. Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp. 18, 19, 78, 299 and the Merck Veterinary Manual online edition.

Which three diseases are on the differential diagnosis list when encountering sudden death in a young, fast-growing calf? A - Lasalocid toxicity, Salmonellosis, Lymphosarcoma-juvenile form B - Salmonellosis, Colibacillosis, Enzootic Calf Pneumonia C - White muscle disease, Enterotoxemia, Colibacillosis D - Bovine Viral Diarrhea, Lasalocid toxicity, White muscle disease E - Winter dysentery, Enterotoxemia, IBR-encephalitic form

12-18 months after the initial outbreak, sows are usually no longer transmitting the Porcine reproductive and respiratory syndrome (PRRS) virus, so segregated early weaning and removal of nursery pigs (with concurrent disinfection of nursery before repopulation) may help control the virus. Because it appears that sows generally only abort once, culling after the first farrowing not advisable. Antibiotic administration can help control secondary bacterial infections, but not the arterivirus responsible for PRRS. Adding negative gilts to a herd already infected with the virus is unlikely to result in control. Refs: Jackson and Cockcroft, Handbook of Pig Medicine, 1st ed. pp. 70-71, 187-188 and the Merck Veterinary Manual online edition

Which one of the following represent the most effective control measures in herds infected with porcine reproductive and respiratory syndrome (PRRS) virus? A - Cull all sows after first farrowing B - Maintain therapeutic levels of streptomycin in feed C - Nursery depopulation, segregated early weaning 12-18 mos after outbreak D - Buy PRRS-negative gilts, test on arrival, segregate 45 days, retest before join herd E - Vaccinate boars in contact with sows, maximize pen ventilation

Nothing. Extreme accentuation of sinus arrhythmia (bradycardia), markedly slower during expiration is a normal finding in brachycephalic breeds. No treatment needed if dog is not symptomatic. SYMPTOMATIC animals would present with fainting, weakness. If respond to an atropine test, consider Med Rx with Glycopyrrolate, Propantheline (Pro Banthine ®), Isoproterenol. If poor response, may need a pacemaker. Refs: Blackwell's 5-Min Vet Consult Canine Feline, 4th ed. pp.1262-3, Pasquini's, Tschauner's Guide to Small Animal Clinics, vol 1, 2nd ed. pp. 255-6 and the Merck Veterinary Manual online edition.

While conducting a routine physical on a 4 year old male intact bulldog, an irregular heart rhythm with a slow rate that is markedly slower on expiration is audible during auscultation. T=102.1 F (38.9 C)..[N=99.5-102.5 F] HR=60 bpm............[N=110-120] RR=24 brpm...........[N=15-34] What should be done next? A - Nothing B - ECG C - Echocardiogram D - Chest radiograph, CBC, blood chemistry panel E - Refer to for cardiology consult

When you see regenerative anemia (polychromasia, reticulocytosis, anisocytosis) in a FeLV-positive cat, suspect coinfection with Mycoplasma haemofelis (or Mycoplasma haemominutum). Typically, the anemia of feline leukemia virus (FeLV) alone is NON-regenerative. Mycoplasma haemofelis (formerly called Hemobartonella felis) causes feline infectious anemia, and is treated with tetracyclines. Click here to see regenerative anemia on a blood smear. In the SE USA, Cytauxzoon felis must be differentiated from Mycoplasma felis in cats with regenerative anemias. Think of Toxoplasma gondii (with neurologic and ocular manifestations) more in association with feline immunodeficiency virus (FIV). Refs: Blackwell's 5-Min. Vet Consult Canine-Feline, 4th ed. pp. 490-1, Cote, Clin Vet Advisor-Dog and Cat, 2nd ed. pp. 385-7, Wikimedia Commons and the Merck Veterinary Manual online edition.

A 3 year old male cat is positive for feline leukemia virus (FeLV) by both ELISA and IFA tests. A complete blood count (CBC) shows PCV=19%.................[N=24-45%] with polychromasia, reticulocytosis, anisocytosis WBC=3,600...............[N=3800-19,500] with neutropenia, lymphopenia Thrombocytes=300,000/microliter..[N=300,000-700,000] In addition to feline leukemia, what other infection is suspected in this cat? A - Mycoplasma haemofelis B - Hemobartonella bigemina C - Toxoplasma gondii D - Chlamydophila felis E - Cytauxzoon variabilis

Typically, Brucellosis causes abortion in the LAST HALF of pregnancy, from the 5th month onwards. You might remember "Bruce is usually late". Expect STILLBORN calves. Cows only abort ONCE. Brucellosis is REPORTABLE. The vaccines used are the Brucella abortus strain 19 vaccine or the RB51 vaccine, given to heifer calves 4-12 months old, along with a USDA tattoo in the right ear. Remember: "The right ear is the RIGHT EAR". BVD and Trichomoniasis (occasionally) can cause early abortion in cows, but MOST things cause abortion late, like 3rd trimester. Listeriosis and Trueperella pyogenes can cause abortion at any time during pregnancy. Note the name changes - Trueperella pyogenes used to be called Arcanobacterium pyogenes and before that it was classified as Corynebacterium pyogenes. Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp. 122-3, Smith's Large An Med 3rd ed. pp. 1315-24 and the Merck Veterinary Manual online edition.

Abortions due to brucellosis tend to occur at what stage of pregnancy? A - First trimester B - Second trimester C - Typically an early embryonic loss, prior to pregnancy detection D - At any time during pregnancy E - Last half of pregnancy

This is the clinical picture of Pericardial effusion. Note the spherical "Balloon heart". Follow this link to see a DV view of pericardial effusion. RX of choice is pericardiocentesis. Ascites, distended jugulars suggests RIGHT congestive heart failure (CHF), more than left CHF (pulmonary edema, crackles, wheezes, cough). Cor pulmonale is just another name for right CHF due to pulmonary hypertension. Dilated cardiomyopathy (DCM) should be on your DDX. More likely to hear systolic murmur, arrhytmias, less likely to be muffled heart sounds. ECHOCARDIOGRAPHY resolves DDX between pericardial effusion, DCM and Peritoneopericardial hernia. Refs: Blackwell's 5-Minute Vet Consult Canine Feline, 4th ed. pp. 288-9, 1052-3, Tschauner/Pasquini's Guide to Sm An Clinics, 2nd ed. pp. 230-32 and the Merck Veterinary Manual online edition.

An 8-year old German shepherd is presented with a 1-month history of cough, labored breathing and lethargy. He has fainted a few times after exertion. Upon physical exam pallor and a slow capillary refill time is noted. The dog has jugular distension, diminished, quiet heart sounds, ascites and weak, variable femoral pulses. T=102.0 F (38.9 C)..[N=99.5-102.5 F] HR=140 bpm...........[N=80-120] RR=24 brpm...........[N=15-34] A thoracic radiograph reveals the following. What is the clinical diagnosis? A - Peritoneopericardial hernia B - Dilated cardiomyopathy C - Congestive heart failure (left) D - Pericardial effusion E - Cor pulmonale

This is Cantharidin toxicity caused by blister beetles (Epicauta spp) which swarm in alfalfa hay during harvest. Cantharidin is a potent irritant: see colic, renal disease, hematuria, peracute death. Follow this link to see a Merck image of Hemorrhagic gastritis. Follow this link to see a Merck image of Hemorrhagic cystitis. Enzootic hematuria is a cow disease thought to be caused by Bracken fern toxicity. In horses, see thiaminase-related STAGGERS with bracken fern and with Horsetail (Equisetum spp.) on U.S. West Coast. Sorghum cystitis/ataxia is characterized by cystitis, urinary incontinence ("dribbling" ), posterior incoordination. Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp. 228, Pasquini's Guide to Equine Clinics, 3rd ed. pp. 45, 156, 322 and the Merck Veterinary Manual online edition.

In September, two Quarter Horse mares horses are presented that are pastured in a group of 5 in Oklahoma. The horses eat pasture grass supplemented by alfalfa hay and a small amount of grain. One mare was found peracutely dead this morning. The other is depressed, anorexic and colicy. Physical exam reveals dark, congested mucous membranes with small ulcer-like erosions. The mare makes frequent attempts to urinate, yielding red urine (hematuria) with a urine specific gravity (USG) of 1.006. She makes repeated attempts to drink small amounts of water and keeps her muzzle submerged in the water trough. T=102.7 F (39.3 C)..[N=99-101.3 F] HR=40 bpm............[N=28-40] RR=20 brpm...........[N=10-14] Necropsy of the other mare shows that the stomach and bladder linings are irritated and hemorrhagic. What is the diagnosis? A - Clostridium perfringens type A B - Arsenic toxicity C - Sorghum cystitis D - Cantharidin toxicity E - Enzootic hematuria

In goats and sheep, Staphylococcus aureus can produce a necrotizing alpha toxin which can cause a gangrenous mastitis, sometimes called "blue bag". Staph. aureus is also the most common cause of regular clinical mastitis in small ruminants.(11%-63% of cases). For more on goat/sheep mastitis, see the Maryland Coop Extension website. If this were a cow down with a septic mastitis, you would think of coliform mastitis (E. coli). Refs: Pugh and Baird, Sheep and Goat Medicine, 2nd ed. pp. 459-61 and the Merck Veterinary Manual online edition.

The udder of a goat is cold and bluish, with pitting edema and serous bloody discharge. The animal is down and shocky and appears to have gangrenous mastitis. Which organism is usually associated with cases of severe clinical mastitis in goats and sheep? A - Streptococcus agalactiae B - Escherichia coli C - Pseudomonas aeruginosa D - Staphylococcus aureus E - Arcanobacterium (Actinomyces) pyogenes

This is the typical presentation of spastic paresis, also known as Elso heel. Because spastic paresis is heritable, it is generally best to cull breeding animals. Look for an animal with a stiff hind leg in full extension, whether walking or standing. Affected animals (especially breeding bulls) should be eliminated. Palliative surgical treatments (gastrocnemius tenotomy, tibial neurectomy) are sometimes done to give relief and salvage the animal long enough to gain weight for slaughter. Ref: Pasquini's Guide to Bov Clin, 4 th ed. p.137 and the Merck Veterinary Manual online edition.

This heifer has walked with an increasingly stiff and extended hock and stifle since 2 months of age. The gastrocnemius muscle is contracted, and the animal walks with short pendulum-like steps. What advice should be given to the owner? A - Cull B - Vitamin E supplements C - Radial neurectomy D - Quadriceps tenotomy E - Deep bedding, pectineus tenotomy

IV Fluids, NSAIDS, Frequent milk feeding and ABX if septic. FEVER + DIARRHEA says systemic, and sudden death in another calf the night before suggests SEPTIC. 8 weeks old suggests SALMONELLA. ISOLATE sick calves. Valuable animals may be treated with IV Banamine ®, IV fluids, oral fluids and frequent feedings of milk. Use of antibiotics is controversial. ABX may prolong recovery and shedding and yield a carrier calf. There is risk of developing antimicrobial resistance. If the animal is septic though, need ABX. According to Pasquini's, prognosis is POOR with neonatal salmonella and deaths can approach 100% in affected calves. In adults, ABX may yield clinical cure, but Salmonellae can establish in biliary system and intermittently shed into GI system, leading to environmental contamination. Refs: Pasquini's Guide to Bovine Clinics, 4th ed. pp 18-23,258-63, Smith's Large An Med 3rd ed. p 1429 and the Merck Veterinary Manual online edition.

Two calves aged 8 weeks are presented that are both down and extremely weak. They are depressed and lying in pools of foul-smelling brown diarrhea with a small amount of blood. One other calf died suddenly the night before with no signs at all. They are found to be dehydrated, with rectal temperatures of 105.2 and 105.6 F (40.7 - 40.9 C)..[N=101.5-103.5F], respectively. Based on the condition at the top of the differential diagnosis list, what is the treatment plan? A - Immunize well and sick calves and adult cattle with MLV vaccine, ABX for sick calves B - NSAIDS, ABX in feed & water C - IV Fluids, NSAIDS, Frequent milk feeding, ABX if septic D - Cull sick calves, Disinfect feeding areas, Prophylactic ABX and NSAIDs for well E - Isolate sick calves, Immunize, tx with ABX, cull those that do not respond to treatment

Below stifle, lateral left hind. Feline leukemia virus (FeLV) and rabies vaccinations have been associated with sarcomas. You should always keep a record of where vaccinations were given. Remember your L's and R's for feline vaccination: For FeLV, vaccinate LOW and LATERAL on the LEFT hind. For Rabies vaccinate low and lateral on the RIGHT hind. Here is a direct quote from the AAFP Feline Vaccine Advisory Panel Report (full report- see Appendix 2, p. 1440) "FeLV or FIV antigen (plus any other antigen except rabies) should be administered subcutaneously (SC) on the lateral side of the left hind limb below the stifle joint (vaccine-associated sarcomas arising in the proximal femoral area are difficult to completely excise; placement of vaccines in this area is strongly discouraged)." Click here for a summary of feline vaccine guidelines Refs: American Association of Feline Practitioners (AAFP) Feline Vaccine Advisory Panel Report JAVMA, Vol 229, No. 9, Appendix 2, p. 36, Nov 1, 2006, Cote, Clin Vet Advisor-Dog and Cat, 2nd ed. pp. 385-7 and the Merck Veterinary Manual online edition.

Where should a feline leukemia (FeLV) vaccine be injected? A - Cervical interscapular region B - Below stifle, lateral left hind C - Above stifle, lateral right hind D - Above stifle, lateral left hind E - Below stifle, lateral right hind