NAVLE EXAMPLES

A - Twice as long as film was in developer Explanation Typically you should let the film soak in the fixer bath for twice as long as it was in the developer. This ensures the film can harden properly so it can serve as a well preserved, permanent record.

What is the rule of thumb for how long an x-ray film should stay in the fixer bath? A - Twice as long as film was in developer B - Half as long as film was in developer C - Five minutes D - One minute

a) surgery Explanation The radiographs show the colon in the thoracic cavity. This finding is consistent with a diaphragmatic hernia. The best course of treatment is surgery to return the abdominal organs back into their appropriate place and close the defect in the diaphragm. Note that the cat has an increased respiratory rate, due to the colon being in the chest.

A 10-year old cat presents with a history of chronic constipation and hasn't had a bowel movement in several days. The owner says the cat is uncomfortable and breathing heavy when she strains to defecate. T= 102.8 F (39.3 C), P= 220, R= 75. You take radiographs (see image). Which course of treament is most appropriate for this cat? a) Surgery b) Thoracocentesis c) Manual deobstipation d) Lactulose and Cisapride

A) 85% Explanation 70-90% of all feline mammary tumors are malignant. Spaying a cat before 6 months of age reduces the risk for mammary tumors by 7 fold. The statistics for dogs is a 50:50 chance of malignancy for a single mammary mass.

A 10-year old female spayed Siamese cat presents for a new lump the owner found a month ago. She was spayed last year before she was adopted from the shelter. The owner states that the lump has grown over the last month, and it doesn't seem to bother the cat. On exam, the 2 cm lump is located on the left 2nd mammary gland, and no other lumps are noted. The lump is freely moveable, and chest radiographs are clear. What is the chance that this tumor is malignant? a) 85% b) 20% c) 50% d) 5%

a) butorphanol and theophylline Explanation The radiographs show dynamic collapse of the intrathoracic trachea, carina, and mainstem bronchi. There is a marked redundant tracheal membrane in the cervical region. The left atrium may be slightly enlarged but there is no evidence of left heart failure. Based on these findings, you should suspect that tracheal collapse is the cause of the dog's clinical signs. Treatment options include bronchodilators (i.e. theophylline, terbutaline), cough suppressants (hydrocodone, butorphanol), weight loss, and corticosteroids to control inflammation. In severely affected dogs, sedation may be necessary to break the cough cycle. Dogs should be kept away from smoke and environmental pollution. About 70% of dogs respond to medical management. Those that don't are sometimes treated with stents or tracheal rings, but neither repairs the underlying cartilaginous defect. Furosemide is not an appropriate treatment as there is no evidence of heart failure. Nebulization and coupage are used to treat pneumonia, which is also not present in this case.

A 10-year-old male Pomeranian presents to you with a 3-month history of wheezing and marked respiratory distress. The owner reports that he has been coughing sporadically as if trying to clear his throat of a hairball. The owner is a regular smoker. On your examination, the dog displays moderate expiratory difficulty. You submit blood work and take radiographs including inspiratory and expiratory lateral projections of the dog, which are shown below. Which of the following are commonly used to treat the likely condition? a) Butorphanol and theophylline b) Surgical repair of the defect c) Amoxicillin, nebulization, and coupage d) Meloxicam and fluconazole e) Furosemide and prednisone

a) Magnetic resonance imaging (MRI) of the head Explanation This cat has the signs and symptoms of acromegaly. Acromegaly is caused by excessive growth hormone release from the pars distalis from a tumor in the pituitary gland. Excessive growth hormone causes a defect in the insulin receptors on target cells causing insulin resistant diabetes mellitus. The enlarged head, paws, abdomen, and weight gain despite uncontrolled diabetes is due to the anabolic effects of the growth hormone. Treatment for this condition includes radiation therapy to the pituitary tumor, high doses of insulin to try and control the diabetes, and somatostatin analogs (octreotide) to try and inhibit the release of growth hormone from the tumor. Surgical excision has been used as a form of treatment in people with pituitary tumors, but this has only been rarely reported in cats.

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

a) Lipoma Explanation The cells depicted are well-differentiated adipocytes. These cells are large, appear in aggregates or sometimes singly, and contain fat that stains negatively with Wright's, such that the cytoplasm appears clear. The cells possess a small, round or ovoid, pyknotic nucleus that may be compressed and located in the periphery of the cell. This benign tumor is a lipoma, which is common in dogs. If the mass hinders the animal, it may be removed surgically. Infiltrative lipomas, and their malignant counterpart, liposarcomas, are less common. When sampling for cytology, frequently the first indication that a lipoma has been aspirated is the clear, oily appearance of the material ejected from the aspiration needle onto the slide. Care must be taken while staining to ensure that the material does not wash off the slide, as fat does not adhere readily to the glass surface. Note: Gentle heat fixing of greasy material to a slide may be of benefit in keeping adipose cells adherent to slides during staining. This can be accomplished by holding a slide over a Bunsen burner or lighter or gentle heating on a heating tray/bar for a few seconds so that the side opposite to that containing the cellular material is slowly warmed. The slide must be left to cool completely before staining. Slides coated with poly-l-lysine, which are used for Papanicolaou staining and/or increased adherence of tissue sections to slides, are also helpful in promoting cellular adherence and eliminating loss of cells during staining. Sometimes, local fat will be aspirated and cannot be reliably differentiated from the adipose cells of a lipoma. If there is any doubt as to the presence of a discrete mass, surgical removal with histological evaluation is recommended.

A 13-year old spayed female Miniature Poodle presents with two mobile, soft, well-circumscribed, subcutaneous sternal masses, 3 cm and 6 cm in diameter, respectively. The owner had noticed one mass three months previously. Fine needle aspiration of both masses is performed and smears are prepared. A representative field of both specimens is illustrated below (Wright's 20X). What is your diagnosis? a) Lipoma b) Fungal granuloma c) Mesenchymal neoplasia (sarcoma) d) Mast cell tumor

d) renal neoplasia Explanation The signalment and progressive unilateral paresis are most suspicious for renal neoplasia of budgerigars. Affected birds develop paresis due to pressure exerted on the sciatic nerve by a renal tumor. There is typically normal flexion and extension of the hip joint with decreased flexion, extension, and sensation below the knee as described here. Disc disease is uncommon in birds. Lead toxicity can lead to peripheral neuropathy and paresis but typically there are more multifocal or other accompanying signs such as polyuria/polydipsia, gastrointestinal signs, wing droop, head tilt, or convulsions. Marek's disease typically affects younger animals. Botulism typically presents with flaccid paralysis of the legs, wings, and neck.

A 16-year old budgerigar presents with progressive unilateral paresis of the right leg (see image). There is normal flexion and extension of the hip joint with decreased flexion, extension, and sensation below the knee. The remainder of your skeletal and neurologic examination is unremarkable. Which of the following is most likely in this bird? a) Botulism b) Intervertebral disc disease c) Lead toxicosis d) Renal neoplasia e) Marek's disease

d) hyperkalemic periodic paralysis Explanation The correct answer is hyperkalemic periodic paralysis (HYPP). HYPP is seen in Quarter Horses due to a point mutation in a key part of a skeletal muscle sodium channel subunit. This results in elevation of the resting membrane potential to increase the likelihood of depolarizing. Excess concentrations of potassium can result in failure of the sodium channels to inactivate. Therefore, treatment is directed at decreasing dietary potassium.

A 2-year old Quarter Horse presents for intermittent muscle fasciculation followed by weakness. What condition should you suspect? a) Tetanus b) Grass tetany c) Stringhalt d) Myotonia e) Hyperkalemic periodic paralysis

a) benign neglect Explanation Histiocytomas are typically benign and will often present as a small, raised mass that may or may not be ulcerated. Fortunately, these masses usually regress on their own, and surgical or medical intervention is typically not necessary.

A 2-year old female spayed Dachshund presents for further evaluation as a result of a mass on the pinna noted by the owner. On physical exam, the only abnormality noted was this mass. Cytology is consistent with a histiocytoma. Which of the following is the most reasonable treatment option? a) Benign Neglect b) Chemotherapy using lomustine c) Cryotherapy d) Radical surgical excision e) Radiation therapy

b) demodex Explanation The cigar shaped mites in the image are recognizable as Demodex mites. If you were particularly observant, you would have noticed that there are two different species of Demodex mites here. The longer mite is the typical follicular mite, Demodex canis. The shorter mite is a more superficial Demodex mite that is similar to the feline demodex mite, Demodex gatoi and may be somewhat contagious.

A 2-year old female spayed Leonberger presents to you with hair loss around the face and eyes. A deep skin scraping is shown in the picture below. What is your diagnosis? a) Staphylococcus b) Demodex c) Fungal pyoderma d) Sarcoptes e) Otodectes

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

A 2-year old male castrated Border Collie presents for a 1-week history of small bowel diarrhea. A fecal flotation shows numerous Giardia cysts. What is the treatment of choice for this dog? a) Metronidazole b) Decoquinate c) Albendazole d) Ipronidazole

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

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

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

A 2-year old mare presents to you several weeks after recovering from a mild upper respiratory infection. She now presents with edema and sloughing of the legs (see image), chest and abdomen as well as mucosal petechial hemorrhages. She is sore and reluctant to move. Biopsy of the skin lesion is consistent with aseptic necrotizing vasculitis. What is the most likely diagnosis? a) Idiopathic thrombocytopenia b) Bastard strangles c) Cantharidin toxicity d) Purpura hemorrhagica e) Type I hypersensitivity

b) penicillin Explanation The diagnosis is Listeriosis. Listeria monocytogenes can effectively be treated in the early stages of the disease with penicillin, ampicillin, or tetracycline. Intramuscular procaine penicillin for example has a withdrawal of 10 days for slaughter (meat) and 48 hours for milk if the animal is lactating. Other choices of approved antimicrobials would also likely be effective since L. monocytogenes is susceptible to most antimicrobials. For a list of approved animal drugs see www.farad.org/vetgram. FARAD is the United States Food Animal Residue Avoidance Databank which gives withdrawal information as well as a list of prohibited drugs. The other drugs listed as choices here are prohibited and cannot be legally used in food animals in the USA.

A 2-year old nonlactating dairy cow in California has a sudden onset of head tilt and drooling. The owner also reports that she appears less active and less interested in feed than normal, and today is circling in one direction in the pen. You examine her and find T=105F (40.6 C), HR=96, and RR=32. There is ptosis, drooped ear, and weakness of the lips on the affected side. You take a lumbosacral spinal tap (see photo), and submit the CSF to your lab. The results show elevated protein and WBCs, with the cell type being mainly monocytes. The lab reports seeing some gram positive bacteria in the monocytes of the CSF. Based on these findings what is the best treatment for this condition? a) Chloramphenicol b) Penicillin c) Metronidazole d) Enrofloxacin e) Metoclopramide

c) atrial fibrillation Explanation The correct answer is atrial fibrillation. The baseline shows coarse fibrillatory waves and the rhythm is irregular. For a base-apex lead in the horse, the deep S waves of the QRS complexes are normal. The other answers are incorrect because of the presence of flutter/fibrillatory waves and irregularity of the rhythm.

A 3-year old Thoroughbred presents for evaluation after pulling up late in a recent race. You perform an ECG, which is shown below. What is the rhythm? a) Ventricular premature complexes b) Atrial tachycardia c) Atrial fibrillation d) Normal sinus rhythm e) Ventricular tachycardia

d) Right lateral recumbency abdominal radiograph Explanation A typical GDV occurs with repositioning of the pylorus to the left dorsal abdomen. A right lateral radiographic image is the best position for revealing a gas filled left dorsally-displaced pylorus with a gas-filled ventral fundus separated by a soft tissue band (compartmented stomach). Although the features of a malpositioned stomach may be observed on the other radiographic views, they are often more difficult to interpret than that represented by the right lateral recumbency view. The severe amount of gas within the GI tract that is associated with GDV would make ultrasound exam interpretation extremely difficult at best.

A 3-year old castrated male Doberman Pinscher presents for acute onset non-productive vomiting of 3 hours duration. On exam, the patient is extremely lethargic, tachycardic, has weak pulses and a distended abdomen. Following standard initial emergency treatment for suspected gastric dilation and volvulus, you would confirm the diagnosis with what imaging procedure? a) Dorsal recumbency abdominal radiograph b) Ventral recumbency abdominal radiograph c) Abdominal ultrasound exam d) Right lateral recumbency abdominal radiograph e) Left lateral recumbency abdominal radiograph f) Barium contrast abdominal radiograph

c) neonatal isoerythrolysis Explanation Neonatal Isoerythrolysis (NI) would be a possible cause of the icterus noted in the sclera. NI is common in multiparous mares and usually affects foals between 24-72 hours of age. NI results in hemolysis, hyperbilirubinemia, and icterus. A low packed cell volume would further support NI. NI develops because the newborn foal expresses alloantigens on its red blood cells inherited from the sire that the mare does not have. If the mare becomes sensitized to the sire's specific antigen, maternal antibodies are produced and absorbed by the foal soon after birth. This subsequently results in lysis of the red blood cells.

A 36 hour foal born from a multiparous mare presents for weakness, decreased appetite, and tachycardia. On physical exam, you examine the sclera as seen in the photo. Based on the signalment and findings, what is a likely cause? a) Congenital iron toxicity b) Failure of passive transfer c) Neonatal Isoerythrolysis d) Immune mediated thrombocytopenia

b) string foreign body Explanation The correct answer is string foreign body. The radiographic description is classic for string foreign bodies. Panleukopenia is not likely because of the radiographic findings, and you would also expect more systemic signs such as respiratory disease and fever. With pancreatitis cats do not vomit as commonly as dogs. They usually show vague nonspecific signs. Hepatic lipidosis would not result in an acute onset of vomiting.

A 4-year old domestic short haired male cat presents for an acute onset of vomiting and anorexia of one day duration. On physical exam you note the cat is depressed and approximately 5% dehydrated. Radiographs show an abnormally increased amount of plication of the small intestines. What is your most likely diagnosis? a) Pancreatitis b) String foreign body c) Lymphoma d) Panleukopenia e) Hepatic lipidosis

a) adrenal tumor Explanation The correct answer is adrenal tumor. These tumors are very common in middle-aged ferrets and usually secrete estradiol. Common clinical signs are hair loss, enlarged vulva, pruritus, and behavior changes. Diagnosis is made by clinical signs, ultrasound, and measurement of serum estradiol levels. Treatment is adrenalectomy.

A 4-year old female ferret presents with a history of an enlarged vulva and truncal alopecia. What is the most likely diagnosis? a) Adrenal tumor b) Hypothyroidism c) Sertoli cell tumor d) Insulinoma

c) zinc supplementation Explanation Zinc responsive dermatopathy occurs most frequently in the Siberian Husky. Other species such as cattle, goats, and humans have a similar condition. The exact cause is unknown, but it has been linked to defective intestinal absorption of zinc. Lesions may vary in severity. The response is typically seen within days. The key to answering this question appropriately was to recognize the signalment of the patient, the location of the lesions which is characteristic of zinc responsive dermatopathy, and the fact that there was no infectious etiology such as demodex identified.

A 4-year old female spayed Siberian Husky presents for further evaluation as a result of developing crusting and hyperkeratosis around the eyes, nose, and mouth. A skin scraping did not identify an etiology. How would you treat this dog? a) Ivermectin treatment b) Daily wiping with chlorhexidine pads c) Zinc supplementation d) Corticosteroids

b) Fanconi Syndrome Explanation The correct answer is Fanconi syndrome. Fanconi syndrome is an inherited disease in Basenjis. The disease involves renal tubular defects causing an abnormal loss of electrolytes and solutes leading to hypophosphatemia, hypokalemia, and metabolic acidosis. DM is less likely because serum glucose is normal. The lab abnormalities present in this dog are not consistent with pyelonephritis. Pyometra is not a viable choice as the signalment describes a male.

A 4-year old male castrated Basenji presents for polyuria, polydipsia, and weight loss. Blood work shows P=2.5 (2.9-5.3 mg/dl), K= 3.1 (3.9-5.1 mEq/L), total CO2= 12 (17-25 mmol/L). The remainder of the blood work is within normal limits. Urinalysis shows 3+ glucose. Which of the following is your most likely differential diagnosis? a) Diabetes mellitus b) Fanconi syndrome c) Pyometra d) Pyelonephritis

a) Fenbendazole Explanation The organism is Giardia which can be recognized as a trophozoite with two nuclei outlined by adhesive discs. Giardia should be distinguishable from trichomonads which have a single nucleus and an undulating membrane. The best treatments for Giardia are either fenbendazole or metronidazole.

A 5-month old female cat presents to you for weight loss, chronic diarrhea and steatorrhea. The organism seen in a stained fecal smear is shown in the image below (this is a magnified 40X image, the organism is approximately 15 x 8 um). Which treatment is most appropriate? a) Fenbendazole b) Tylosin c) Sulfadimethoxine d) Penicillin

d) GI parasites Explanation The correct answer is gastrointestinal parasites. You should perform a fecal float and smear. This cat probably has severe diarrhea and has been straining. Dysautonomia is possible but very rare. Panleukopenia does not usually result in a rectal prolapse, but is a cause of diarrhea.

A 5-month old kitten presents to you with a rectal prolapse, as shown in the photo. What is the most common cause of rectal prolapse in a kitten? a) Dysautonomia b) Panleukopenia c) Trauma d) Gastrointestinal parasites

b) cuterebra Explanation Cuterebra is a fly that lays its eggs on soil or plants. The eggs stick to the animal's fur when they come into contact. The eggs hatch, and the larvae either penetrate the skin, are ingested when the animal grooms, or they enter the animal's body through a natural opening, such as the nose. In most cases, the larvae migrate to areas just under the skin on the head, neck, or trunk of the animal. In dogs, cats, and ferrets, who are not the usual hosts of this parasite, the larvae may also migrate to the brain, eye, eyelids, or throat. As the larva grows under the skin, it produces a nodule or swelling. A small opening develops in the skin, through which it breathes. A small amount of drainage may occur around this breathing hole. The treatment is to incise the skin if needed to remove the larva. You have to make sure to remove the larva in whole and not crush it. If it is damaged or crushed, it can cause an anaphylactic reaction. Ctenocephalides is a flea, Ancylostoma is the hookworm, and Culicoides are tiny gnats that most often bother horses and livestock.

A 5-year old indoor/outdoor male neutered short hair presents for a wound on the chest. The owner noticed a hole in the skin and thought he had a ruptured abscess. On close examination of the wound, you notice a larva inside the hole. Which organism is most likely under the skin? a) Culicoides b) Cuterebra c) Ctenocephalides d) Ancylostoma

f) fecal float Explanation Hookworms (Ancylostoma and Uncinaria) are intestinal parasites that suck blood and can cause anemia, enteritis, coughing during larval migration, and dermatitis. Any young dog that is failing to thrive and/or has pale mucous membranes should be tested for intestinal parasites. Hookworm dermatitis, also called Ancylostomiasis is typically seen in conditions with poor sanitation and/or in kennels. Hookworms can be transmitted in utero, during nursing, or via 3rd stage larva penetrating the skin. The most commonly affected skin areas are the pads and interdigital spaces of the feet, but can include any surface that contacts the ground. The larva migrate through the dog's tissues before arriving in the intestines. They cause significant anemia, failure to thrive, or sudden death in young dogs. In mild cases, deworming protocols are often enough; with severe cases blood transfusions and parenteral treatments are often necessary. Skin scraping and impression smears of the affected skin areas are typically unrewarding for isolating parasites. A PCV/TP would show signs of anemia, but not the underlying etiology. Complete blood cell count and chemistry will often show anemia that is regenerative and an eosinophilia. Radiographs would be unrewarding in this case. A biopsy may show migrating larva if biopsied soon after trauma, however this is not a diagnostic test routinely used.

A 6-month old Chocolate Labrador presents for limping and failure to gain weight. He is housed in an outdoor kennel with other hunting dogs. He is fed a large breed dry puppy food. He received his puppy shots at 8, 12, and 16 weeks old. He is quiet, alert, and responsive. His body condition score is 3/9, with rib exposure and poor fat deposition. His mucous membranes are pale pink, with a capillary refill time of 2 seconds. His heart and lungs auscult normally. No abnormalities are felt on abdominal palpation. He is an intact male, and both testicles are descended. The only abnormalities are the pads of his two front feet and left hind foot (see image) that he chews at frequently. What is diagnostic test of choice? a) CBC and chemistry panel b) PCV and TP c) Radiographs d) Biopsy e) Skin scraping f) Fecal float

b) Surgical removal of the feather cyst and follicle Explanation Feather cysts are the avian equivalent of an ingrown hair. A growing feather is unable to protrude through the skin and curls within the follicle. Since feathers are much larger than hairs, cysts can be quite large and painful. They commonly are found in the primary feathers of the wing. The cysts contain keratinized feather material that can be expressed or excised but commonly recur. Treatment of choice is surgical removal of the involved feather follicle.

A 6-year old Sun Conure presents for evaluation of a skin lesion. The owner reports that the bird is very sensitive on the wing near the lesion. On your exam, you note an oval swelling involving the feather follicle as seen in the image below. What is the best treatment for feather cysts? a) No treatment is necessary as feather cysts typically resolve spontaneously b) Surgical removal of the feather cyst and follicle c) Treat with systemic antibiotics for 4-6 weeks d) Lance and drain the feather cyst, flush with saline e) Squeeze and express the material out of the feather cyst

d) Immunosuppressive therapy and a change to a hypoallergenic diet Explanation This cat's image and clinical history of a disappearing and recurring lip ulcer is consistent with an indolent ulcer, part of the eosinophilic granuloma complex. These are mostly found on the upper lip of cats. These lesions can also extend into the oral cavity and can be found at the tongue base or hard palate. Typical treatment involves high doses of corticosteroids and identifying possible underlying allergic disease. Sometimes, antibiotics are indicated if severe infection is present. A hypoallergenic diet can be helpful if food allergy is the cause. Many times, the etiology is unknown but allergy is suspected. Squamous cell carcinoma is also a differential; however, in a cat that has a lesion that comes and goes, this is much less likely. Viral infections in cats usually present with upper respiratory and/or ocular signs.

A 6-year old female spayed indoor only domestic medium hair presents with a large raw lesion on its upper left lip. The owner reports the lesion has come and gone over the past few years. Which of these treatments would likely be most helpful? a) Marginal surgical excision and radiation therapy b) Topical trifluridine and systemic clindamycin c) Wide surgical excision and chemotherapy d) Immunosuppressive therapy and a change to a hypoallergenic diet

c) retrobulbar abscess Explanation 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.

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? a) Anterior uveitis b) Orbital neoplasia c) Retrobulbar abscess d) Glaucoma

a) hypoglycemia Explanation Xylitol is a sugar alcohol present in sugar-free gum that, when ingested, causes a rapid release of insulin in dogs. After ingestion, clinically significant hypoglycemia can develop within 30 minutes and can last for more than 12 hours. Acute hepatic necrosis and failure after higher doses of xylitol ingestion can occur as well.

A 6-year old male neutered terrier mix weighing 10kg presents to you after having ingested 3 pieces of sugar-free gum containing xylitol. What bloodwork abnormality are you expecting to find? a) Hypoglycemia b) Hypernatremia c) Hypocalcemia d) Hyponatremia e) Hyperglycemia

e) Corynebacterium pseudotuberculosis Explanation The correct answer is Corynebacterium pseudotuberculosis. This is a description of caseous lymphadenitis. Infection of supramammary lymph nodes in sheep and goats is of economic importance due the fact that caseous lymphadenitis can cause weight loss in the individual, can become a herd problem, and could also be a potential public health concern.

A 7-year old doe presents with abscessation of the supramammary lymph nodes. What is the most likely diagnosis? a) Arcanobacterium pyogenes b) E. coli c) Caprine arthritis and encephalitis virus d) Mycoplasma mycoides e) Corynebacterium pseudotuberculosis

b) Immune mediated hemolytic anemia Explanation The image shows a positive slide agglutination test. The dark patches in the sample are caused by antibodies attached to the surface of the erythrocytes cross linking the cells together causing these clumps. This is highly suggestive of an immune mediated reaction to antigen on the individual's red blood cells. Rouleaux formations are red blood cells stacked together as a result of their natural discoid shape and large surface area causing them to have an affinity for each other. They typically resemble a stack of coins or cookies. Evan's syndrome is an autoimmune condition characterized by an immune attack on erythrocytes, platelets, and occasionally leukocytes as well. You would not be able to diagnose this on a slide agglutination test alone. Vitamin K antagonist toxicity with rodenticide causes a coagulopathy but should not cause hemagglutination.

A 7-year old female spayed English Springer Spaniel presents for difficulty breathing and lethargy. Physical exam shows pale mucous membranes and increased respiratory effort. You collect blood for a complete blood count and a chemistry panel and you place a drop of blood with a drop of saline on a glass slide. After swirling the sample around, you can grossly see what is shown in the picture. What's your diagnosis? a) Vitamin K antagonist toxicity b) Immune mediated hemolytic anemia c) Evan's syndrome d) Rouleaux formations e) Hemolysis

b) ACTH stimulation test Explanation The correct answer is ACTH stimulation test. The chemistry profile above is highly suggestive of hypoadrenocorticism. An ACTH stimulation test would give a definitive diagnosis for Addison's disease if the plasma cortisol concentration is low after ACTH administration. A bile acids test is not indicated since liver function is not in question. Thoracic radiographs may show microcardia, hypoperfused lungs, and rarely megaesophagus. ECG abnormalities would be consistent with hyperkalemia, which includes wide, flat, or absent P waves, widened QRS complexes, tall spiking T waves, and bradycardia.

A 7-year old female spayed Standard Poodle presents with weakness and lethargy. A chemistry panel shows a Na+ = 130 mEq/L (142-152 mEq/L), K+ = 6.5 mEq/L (3.9-5.1 mEq/L), BUN 55 mg/dl (8-28 mg/dl), creatinine 1.9 mg/dl (0.5-1.7 mg/dl). The test to run for a definitive diagnosis would be which of the following? a) Electrocardiogram b) ACTH stimulation test c) Thoracic radiographs d) Bile acids test

c) constipation Explanation The correct answer is constipation. Lethal white foals have aganglionosis of the intestines which leads to hypomotility, megacolon, constipation, colic, and death.

A Paint horse mare gives birth to an all white foal (see image). What clinical sign would you expect to see in a foal with lethal white syndrome? a) Ataxia b) Regurgitation c) Constipation d) Anhydrosis

A) hypovitaminosis A Explanation The correct answer is hypovitaminosis A. The functions of vitamin A are related to epithelial maintenance, vision, and skeletal development. In birds, problems with the skeleton or vision are rarely seen with vitamin A deficiency. Vitamin A deficiency can manifest as squamous metaplasia of the oral mucous membranes or glands. Glands may be entirely converted to squamous epithelium with keratin material and can look like abscesses or pustules but are essentially keratin cysts. They should be differentiated from lesions of pox, Candida, and Trichomonas. Lesions of the conjunctiva, nasolacrimal duct, upper GI tract, and upper respiratory tract can occur. Presenting signs may include severe dyspnea or respiratory signs.

A budgerigar is showing signs of squamous metaplasia of the oral mucosa, conjunctiva, and upper airways. It has developed associated bacterial sinusitis (see image). In a pet bird, what are these clinical signs most suggestive of? a) Hypovitaminosis A b) Hypovitaminosis D c) Iodine deficiency d) Hypocalcemia e) Hypervitaminosis D

E) estrus Explanation Think CORN FLAKES with ESTRUS. Look for greater than 90% CORNIFIED superficial cells (angular, sharp edges like , tiny pyknotic nuclei or no nuclei) when you think canine estrus, and NO NEUTS. In contrast, DI-estrus vaginal smears will have more than 10% nucleated, round-edged parabasal and intermediate cells. Look for the reappearance of some neutrophils (variable numbers). Full cornification usually coincides with receptivity. Serum progesterone can predict the LH surge and help estimate ovulation. RULE OF THUMB: Breed bitch as soon as she will allow a male to mate or as soon as you see greater than 90% cornified superficial epithelial cells in a vaginal smear. Typically breed every 2-4 days until bitch enters diestrus for maximum fertility success.

A canine vaginal smear looks like the image below through a microscope. At what stage of the estrous cycle is this dog? A - Cannot tell from this slide B - Anestrus C - Proestrus D - Diestrus E - Estrus

d) infectious bronchitis Explanation The correct answer is infectious bronchitis. This is caused by a coronavirus. It is spread by aerosol and ingestion and usually affects all exposed birds. The clinical signs and necropsy findings are as described in the question. The disease can be clinically indistinguishable from mild forms of Newcastle disease, laryngotracheitis, and infectious coryza. Virus isolation is needed to obtain a definitive diagnosis.

A chicken operation has recently been ravaged by a respiratory disease affecting almost all of the chickens in the flock. The chickens are coughing and sneezing and many have facial swelling. You necropsied many of the chickens and found mucoid exudate in the bronchi, thickened air sacs, and in a few of the chickens, interstitial nephritis was present. Which of these diseases is likely? a) Aspergillus b) Fowl cholera c) Infectious bursal disease d) Infectious bronchitis

a) bleeding and weakness Explanation Think uncontrolled bleeding and collapse with RAT POISON. It interferes with vitamin K and leads to uncontrolled bleeding in animals that eat rat poison or rats that died from eating rat poison.

A client brings in her dog who ate a box of rat poison in the last 2 days. What symptoms would be expected? A - Bleeding, weakness B - Seizures, vomiting C - Unconscious, rapid heartrate D - Severe pain, depression

c) 99% Explanation The correct answer is approximately 99%. The negative predictive value is the proportion of test-negative animals that are truly disease negative (unaffected) in this population. In the 2X2 table, where a= Disease +, Test +; b= Disease -, Test +; c= Disease +, Test -; d= Disease -, Test -. The NPV is d/(c+d), or disease -, test - animals DIVIDED by all of the test - animals. The answer to the question has to consider the prevalence of mastitis in the herd, which here is 5%. As the prevalence declines, NPV will increase. The negative predictive value gives a proportion of the negative tests that are truly negative. The value is the number of true negatives divided by the sum of the true negatives and false negatives. In this herd, the proportion of test negative animals that actually is negative is specificity x (1-prevalence) or (0.9)x(0.95) = 0.855 (d). The proportion of false negatives in the herd is (1-sensitivity) x prevalence, or (0.1)(0.05) = 0.005 (c). Negative predictive value = d/(c+d) = 0.855/(0.855+0.005) = 0.994.

A farmer comes to you with a new test for detection of mastitis in his heifers. He claims that both the sensitivity and specificity of his test is 90%. Mastitis has a prevalence of 5% in his herd. The negative predictive value (NPV) is approximately _________. a) 3% b) 35% c) 99% d) 72%

a) gossypol Explanation Gossypol is a natural constituent of many types of cotton. It acts as an insecticide and protects the plant. The polyphenol binds to iron in cell constituents. It may cause kidney damage, inhibit dehydrogenase enzymes, and uncouple phosphorylation in the cell. Acute gossypol toxicity in calves can be severe.

A group of dairy calves were fed a home-made grain mix that had a high percentage of cottonseed (photo shows seed and oil). Cottonseed is a good source of protein. A few days after being started on this new grain mix, the calves began having problems including dyspnea, and weakness, followed by death in several calves. What is the toxic principle acting here? a) Gossypol b) Nicotine c) Cyanide d) Cardiac glycosides e) Tannins

E - Neutrophilia, lymphopenia, eosinopenia Explanation You would expect to see neutrophilia, lymphopenia, and eosinopenia. A stress leukogram may be caused by either endogenous release of corticosteroids due to stress (like taking a big test), or hyperadrenocorticism (Cushing's disease) or exogenous medication with corticosteroids. Typically you see INCREASED neutrophils, and DECREASED lymphocytes and eosinophils. Effects on total WBC vary - expect leukocytosis in dogs, variable effects in cows. Monocyte effects also vary

A stress leukogram is characterized by: A - Neutropenia, lymphocytosis, eosinophilia B - Neutrophilia, lymphocytosis, eosinopenia C - Neutrophilia, lymphopenia, eosinophilia D - Neutropenia, lymphopenia, eosinopenia E - Neutrophilia, lymphopenia, eosinopenia

f) Sulfadimethoxine (Albon) Explanation This is an image of Isospora from a cat. Isospora are parasitic coccidia that can cause diarrhea as this cat is showing. Treatment for coccidia is usually with sulfonamides such as sulfadimethoxine or trimethoprim sulfa. For the other drugs listed: Droncit- Primarily for cestodes (tapeworms) Revolution- For fleas, heartworms, hookworms, roundworms, and ear mites Strongid- Primarily for roundworms and hookworms Clavamox- A broad spectrum antibacterial Metronidazole- Primarily for anaerobes, also used for giardia

An 8-week old Abyssinian cat recently obtained from a cattery presents to you for an examination and the owner reports that the cat has had diarrhea. On fecal float, you find multiple eggs like the one shown in the photo (see image). What should you treat the cat with? a) Praziquantel (Droncit) b) Pyrantel (Strongid) c) Metronidazole (Flagyl) d) Amoxicillin and clavulanate (Clavamox) e) Selamectin (Revolution) f) Sulfadimethoxine (Albon)

d) laminitis Explanation The correct answer is laminitis. Black walnuts contain Juglone (naphthoquinone) which results in laminitis. Do not use black walnuts for horse bedding.

Black walnut toxicity causes what condition in horses? a) Hypersalivation b) Pulmonary edema c) Colic d) Laminitis

a) dilated cardiomyopathy Explanation The correct answer is dilated cardiomyopathy. Taurine is an essential amino acid for cats because they cannot synthesize it. Taurine deficiency causes dilated cardiomyopathy (DCM). Since DCM is relatively uncommon otherwise in cats, taurine deficiency should be suspected in any cat with DCM.

Cats with taurine deficiency develop which of the following? a) Dilated cardiomyopathy b) Myocarditis c) Restrictive cardiomyopathy d) Hypertrophic cardiomyopathy

d) squamous cell carcinoma Explanation The correct answer is squamous cell carcinoma. White cats or cats with areas of white fur on the face or ears are predisposed to developing squamous cell carcinoma from UV light. These lesions are usually ulcerative and appear around the nose, ears, or eyelids.

Coat color and sun exposure likely predisposed this cat to developing the tumor seen in the photo. a) Basal cell tumor b) Mast cell tumor c) Melanoma d) Squamous cell carcinoma

d) Ascaris Explanation Ascarids in pigs (roundworms) resemble ascarids in dogs and cats and also ascarids in horses. Ascarid eggs look a little like a fried egg with a big yolk. Click here to compare: Canine ascarid egg. Here are images of several other key parasite eggs. Trichuris (whipworm) Ancylostoma, Uncinaria (hookworm) Tapeworm (resemble hookworm eggs, but larger) Strongyloides have small, thin-shelled (20-35 × 40-55 micrometers) embryonated eggs (larval worm visible inside). Strongyloides ova must be differentiated the embryonated ova of lungworms (Pigs, Metastrongylus, 33-42 × 51-63 micrometers). These are the key lungworms in different animals: Dictyocaulus in cattle, deer, donkeys and horses Protostrongylus and Muellerius in sheep and goats Metastrongylus in pigs Oslerus (Filaroides) in dogs Aelurostrongylus and Capillaria in cats.

During a fecal examination of a 2 month old piglet this organism is seen. What is the diagnosis? A - Strongyloides B - Trichuris C - Eimeria D - Ascaris E - Ancylostoma

d) 33% of PCV Explanation Normal animal hemoglobin (Hb, g/dl) is about one third the PCV (33%). So, if a cat has a PCV of 30%, then the Hb will be roughly 10 g/dl. If a dog has a PCV of 45% then the Hb should be roughly 15 g/dl. Remember that hemoglobin is a protein in the red cells that helps to transport oxygen.

Hemoglobin concentration is roughly what percentage of red blood cell packed cell volume (PCV) in a normal animal? A - 50% of PCV B - 25% of PCV C - 10% of PCV D - 33% of PCV

C) uncommon Explanation Dental caries (cavities) are UNcommon in dogs and RARE in cats. This may be due to differences from humans in oral flora and diets that are mostly free of easily fermentable carbohydrates (ie: pets don't drink soda pop every day). Also, dogs have slightly alkaline saliva. In cats there is a poorly understood problem called Feline odontoclastic resorptive lesions, (FORL, or "neck lesions") where tooth material is resorbed around the "neck" of a tooth. Possibly infectious, but the actual cause is not yet known.

How common are dental caries (cavities) in dogs? A - Common B - Seen in 35% of adults older than 5 years C - Uncommon D - Seen in 75% of adults older than 5 years

b) 2-6 months Explanation If the testicle(s) are not in the scrotum by 2-6 months, then the animal is cryptorchid. Normally testes descend by 6-8 wks in dogs, prenatally in cats). Cryptorchidism is COMMON (1-2% dogs, right side 75%; In horse more common on LEFT) Remember that cryptorchid dogs are 10X to 14X more likely to develop sertoli cell tumors and seminomas. Also see increased risk of testicular torsion. The treatment is CASTRATION. Discourage breeding.

How long should you wait before you can definitively say a dog is cryptorchid? (Has an undescended testicle) A - Birth-2 months B - 2-6 months C - 7-12 months D - Cannot say

a) 2 Explanation Most dogs have 2 heat cycles per year (range 1-3), except for basenjis which have one estrus per year, in the Spring. Dogs are UNseasonally monoestrus. The interestrus interval in dogs is generally 7 months (range 3 1/2 to 13 months). Click the following link for a table of reproductive cycle features, most animals.

How many periods of estrus (heats) per year are typical in the dog? A - 2 B - 3 C - Depends on day length D - Depends on frequency of exposure to male E - 1

D - Multiply PCV by one third (0.33) Explanation Normal animal hemoglobin (Hb, g/dl) is about one third the PCV (33%). So, if a cat has a PCV of 30%, then the Hb will be roughly 10 g/dl. If a dog has a PCV of 45% then the Hb should be roughly 15 g/dl. Remember that hemoglobin is a protein in the red cells that helps to transport oxygen.

How might you roughly calculate the hemoglobin concentration in a blood sample from a normal dog if you know the red blood cell (RBC) packed cell volume (PCV, %)? A - Double the PCV B - Divide PCV by half C - Multiply PCV by one quarter (0.25) D - Multiply PCV by one third (0.33)

a) 4 times Explanation A 4-fold increase in serum titer is typically diagnostic for an active infection. Often two samples are needed to fully evaluate an animal's antibody response to infection. The first sample is taken at the onset of clinical signs, usually before there's been time for a big antibody response. The second sample is taken 1-3 weeks later, when the immune system has had time to develop an antibody response. A one-time positive sample can mean active or previous infection or exposure. There are a few diseases for which any antibody titer is significant and only one sample is necessary. Equine infectious anemia falls into this category, as any positive exposure to the disease is reportable.

How much of an increase in serum titer would be expected over a 3-week time period during or after an active infection? A - 4 times B - 2 times C - 32 times D - 16 times E - 8 times

C - Decrease kVp, decrease mA, decrease time Explanation To make a film lighter, decrease kilovoltage (kVp), milliamperes (mA) or time (seconds). Decreasing milliampere-seconds (mAs) decreases the number of photons hitting the film, which exposes it less. Lower kVp decreases photon energy (penetrating power of the x-rays through tissue). Shorter time generates fewer electrons which also decreases exposure and therefore decreases darkness on the x-ray film once it is developed.

How would you change exposure settings to make an x-ray film lighter? A - Decrease kVp, increase mA, incease time B - Increase kVp, decrease mA, increase time C - Decrease kVp, decrease mA, decrease time D - Increase kVp, increase mA, increase time

b) 50 Explanation 50 drops/min. Drip rate =(Volume of solution in ml X drops/ml)/time in minutes. 300 ml X 60 drops/ml=18,000 drops. 6 hours X 60 min/hour= 360 minutes Drip rate= 18,000 drops/360 min=50 drops/min

If an IV set dispenses 60 drops/ml, what is the IV drip rate (drops per minute) needed to give a cat 300 ml of Lactated Ringer's solution (LRS) over 6 hours? A - 60 B - 50 C - 100 D - 10

B) Treat all calves for lice Explanation This is a blood sucking genus of louse, and can cause severe anemia. The anemic calves become thin and more susceptible to diseases like pneumonia. You can tell this is a louse and not a tick or a mite because lice are insects with 6 legs and ticks and mites are arachnids with 8 legs.

In January you examine a group of dairy calves which range in age from 2 to 7 months, with a complaint of hair loss and pruritus. The calves are thin and mucous membranes are pale. One has developed bronchopneumonia, and is also febrile and depressed. You do a skin scraping and find the parasite shown in the image, which your technician identifies as Hematopinus sp. The CBC shows the calves to be severely anemic. What treatment recommendation should you now make to the dairy owner? a) Treat all calves with hematinics b) Treat all calves for lice c) Vaccinate all calves against Mannheimia hemolytica d) Treat all calves for mange e) Treat all calves with long acting tetracycline

a) guinea pig, rat Explanation A copulatory plug is a found after mating in the vagina of guinea pigs, chinchillas and small rodents like rats, mice, gerbils and hamsters. Some bats, marsupials and primates also have a copulatory plug. These plugs are coagulated ejaculate that fall out of the female's vagina several hours after mating. Current hypothesis suggests that the plug prevents other males from successfully breeding the same female in a mixed-sex group of polygamous animals.

In which animals is it normal to find a copulatory plug after mating? A - Guinea pig, Rat B - Pig, Cat C - Rabbit, Poultry D - Sheep, Goat E - Ferret, Mink

E) equine, feline Explanation These stacked feline red blood cells are called rouleau formation, a normal finding in many CATS and HORSES. The white cell in the center of the picture is a basophil. Follow this link to see normal equine rouleau formation. (Note also the characteristic equine eosinophil at the top). For normal goats, think of marked poikilocytosis. Remember Camelids (Llamas, camels, alpaca) have ellipsoid red blood cells (RBCs). Remember that it is normal for birds and reptiles to have nucleated RBCs.

In which pair of animals is the appearance of these red blood cells a normal finding? A - Avian, Reptile B - Porcine, Bovine C - Rodent, Lagomorph D - Ovine, Caprine E - Equine, Feline

C) 45% Explanation About half, 45%, of canine mammary tumors are malignant. Note that this is DIFFERENT than cats. About 90% of feline mammary tumors are malignant!

Roughly what percentage of mammary tumors in dogs are malignant? A - 10 B - 30 C - 45 D - 90

c) change feed and treat Explanation The correct answer is to change feed and begin treatment of the animals affected with woody tongue, as the response is often good. Sodium iodide and antibiotics are effective. Given the presentation and clinical signs these animals have probably begun to ingest very rough and stemmed (scabrous) feed items which have injured their mouths. Upon injury, the normal inhabitant Actinobacillus lignieresii invades the soft tissues and causes the characteristic woody tongue granulomatous inflammation. These animals don't have rabies, and there is no need to cull them. Change feed before additional animals are affected. Do not use aminoglycosides as they have an extremely long withdrawal period.

Several beef cows present with a history of decreased appetite and excessive salivation. On physical exam, their tongues are firm on palpation, nodular, and painful (see image). You diagnose actinobacillosis. What is your recommendation to the owner? a) Isolate animals at once b) Sell affected animals for meat c) Change feed and treat d) Begin therapy with an aminoglycoside e) Isolate affected animals and submit one of them for necropsy

e) increase energy intake Explanation About one lb/head/day of good quality grain should be introduced by mid gestation for sheep and goats carrying multiple fetuses. The prognosis for animals already showing clinical signs is poor and treatment is expensive. A C-section can be done, IV glucose administered slowly by drip. This should be followed by rumen transfaunations and feeding 15 to 30 ml propylene glycol every 12 hours, as well as feeding high quality feed.

Several does in a large goat herd, all of which are in late gestation, have not been able to rise to the standing position. They are being fed good quality grass and alfalfa hay. It is December and the weather is cold. They have reduced feed intake and the most severely affected individuals appear blind and depressed, and two have died. On post-mortem examination, your only finding is that they have fatty livers and 4 fetuses each. The physical exam is otherwise not very revealing except that all have significant ketonuria. What steps should be taken to prevent more does from developing this disorder? a) Feed anionic diet b) Add magnesium oxide to feed c) Calcium gluconate IV d) IM dexamethasone e) Increase energy intake

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

Severe combined immunodeficiency is a lethal autosomal recessive trait in Arabian foals. Heterozygotes are clinically normal. If the heterozygote carrier rate for the genetic mutation is 8%, what is the expected frequency of Arabian foals that are homozygous for the mutated allele? a) 25% b) 0.64% c) 0.064% d) 2% e) 0.16% f) 4%

d) different sized cells

What does anisocytosis mean in a red blood cell evaluation? A - Irregularly-shaped cells B - Abnormally small cells C - Same sized cells D - Different sized cells

c) vomiting Explanation The correct answer is vomiting. Xylazine frequently causes vomiting in cats. In fact, veterinarians use Xylazine when they wish to induce emesis in cats. It can also cause decreased PCV, mydriasis, and diuresis.

What is a common side effect of xylazine administration in cats? a) Anuria b) Polycythemia c) Vomiting d) Miosis e) Seizures

d) bacillary hemoglobinuria Explanation Also known as redwater, bacillary hemoglobinuria is caused by germination of Clostridium Novyi type D spores in the liver after anaerobic damage by migrating liver fluke larvae. Cl. Novyi was formerly called Cl. hemolyticum. Vaccination can prevent this disease.

The image shows an infarct in the liver discovered on post mortem exam of a mature beef cow which died one hour before in a western mountain pasture, after being observed to appear normal one day earlier. There is also dark red urine in the bladder. The pasture contains native plants, some pine trees, and a marshy area with water plants. The cows are unvaccinated and were never wormed. Given this history and the lesion found, the most likely cause of death is _________. a) Death camas toxicity b) Blue-green algae toxicity c) Viral hepatitis d) Pine needle poisoning e) Bacillary hemoglobinuria

a) Monthly administration of ivermectin Explanation The findings at slaughter are consistent with an infection of Ascaris suum. This is the roundworm of pigs. These worms can cause intestinal obstruction in large infestations. They can also migrate into the bile ducts and liver, causing the fibrotic liver lesions described in this case. Antemortem diagnosis is made by fecal flotation and clinical signs. Treatment options are wide and include ivermectin, fenbendazole, pyrantel, levamisole and other ascaracides. Endemically infected farms should employ on-going medication programs with routine benzimidazoles or ivermectins. Medication is aimed at prevention of mature intestinal infections by medicating finisher pigs at monthly intervals. In outdoor pig systems, careful attention must be paid to stock management, with field rotations, light stocking densities and regular anthelmintic treatment. Clearing sites of ascarid eggs is not practical unless floor surfaces can be flame treated. Ascaris suum eggs have thick coats and are highly stable and infectious in outdoor environments for several years. Praziquantel is used to treat tapeworm infections but is not effective against roundworms.

The viscera from a group of 100 kg pigs are presented at a slaughter facility. The pigs were raised in a semi-outdoor management farm system with groups of 30-100 kg pigs kept on the same site. At slaughter, multifocal fibrotic lesions are seen in their livers and noticeable nematodes are present within the small intestine. You perform a fecal flotation on a fresh sample from the younger pigs. The results are shown in the image below. What treatment or management recommendation is most appropriate for this problem? a) Monthly administration of ivermectin b) Depopulate and replace the herd c) Disinfect the pasture d) Quarterly treatment with praziquantel e) Examine the food sources of the pigs

d) shedding of virus via saliva Explanation The correct answer is shedding of virus via saliva. The main mode of transmission is via saliva. It requires prolonged, close contact. Cats may shed the virus for months to years. Transmission may also occur through reuse of instruments and blood. Virus is shed in saliva, tears, urine, and feces.

What is the main mode of transmission for feline leukemia virus? a) Shedding of virus via feces b) Fomite transmission c) Aerosol transmission d) Shedding of virus via saliva

d) tooth root abcess Explanation The correct answer is tooth root abscess. Commonly the first molar teeth are involved. Clinical signs include weight loss, quidding (dropping half chewed feed), halitosis, swelling, and unilateral purulent nasal discharge.

What is the most common cause of maxillary sinusitis in a horse, as seen in the necropsy image below? a) Foreign body b) Brachygnathia c) Guttural pouch mycosis d) Tooth root abscess e) Dentigerous cyst

b) via mosquitoes Explanation Mosquito vectors are the primary mode of transmission for WNV between birds and other hosts (horses, humans). There are infrequent documented cases of the disease being spread by feces or saliva. No mites have been documented to transmit the disease. Birds do not have a placenta.

What is the primary mode of transmission of West Nile Virus (WNV) between birds? a) Via placenta b) Via mosquitoes c) Via feces d) Via saliva e) Via Cnemidocoptes mites

b) FeLV and rabies vaccines Explanation An estimated 1 to 10 in 10,000 cats develop injection site sarcomas following vaccination with FeLV and Rabies vaccines.

Vaccine-associated sarcomas in cats are primarily linked to with which two vaccines? A - Feline panleukopenia and FIV vaccines B - FeLV and rabies vaccines C - Feline calici/herpes and panleukopenia vaccines D - FeLV and feline calici/herpes vaccines E - Rabies and feline panleukopenia vaccines

c) 7.5g/dl Explanation It is 7.5 g/dl. Serum total protein is made up of globulins (like antibodies) plus albumin. Typically, a blood chemistry report will show you the total protein and the albumin. You can calculate the globulin by subtracting the albumin concentration from the total protein concentration.

What is the total serum protein level in a dog with an albumin of 4.0 g/dl and a globulin level of 3.5 g/dl? A - 1.5 g/dl B - 3.5 g/dl C - 7.5 g/dl D - Cannot calculate with this information

d) high Ca, High P Explanation Excessive intake of vitamin D is associated with an increase in 25-hydroxyvitamin D3 levels. At high levels, 25-hydroxyvitamin D3 competes with 1,25-dihydroxyvitamin D3 for its receptors on the intestines and bone causing increased absorption of Ca and P from the intestinal tract and resorption of bone causing increased levels of circulating Ca and P. A common source of confusion is that this is in contrast to PTH which causes high Ca but generally causes unchanged or normal phosphorus because it also enhances renal phosphorus excretion.

What profile would you expect in a dog with hypervitaminosis D? a) High Ca, Low P b) Low Ca, Low P c) Low Ca, High P d) High Ca, High P

b) penis protrusion Explanation Acepromazine can cause penis protrusion in large animals, especially horses. Remember that GIANT breeds and SIGHT hounds can be very sensitive to acepromazine. Acepromazine is sometimes used as an anti-emetic (ANTI-vomiting) drug.

What side effect is often seen in horses tranquilized with acepromazine? A - Hives B - Penis protrusion C - Collapse D - Vomiting

C) ant baits Explanations Ant baits contain inorganic arsenic and are sometimes eaten by pets, especially cats. Expect GI presentation- Vomiting, diarrhea, hematochezia, weakness, prostration. Rx with DIMERCAPROL, deep IM (painful shot). See arsenic in wood preservatives (ie: pressure-treated lumber) and in thiacetarsemide, a Heartworm adulticide, now superceded by the safer and more effective melarsomine dihydrochloride.

Where would a dog or cat be likely to encounter arsenic around the house? A - De-icer crystals B - Anti-mildew paint C - Ant baits D - Silver-polish E - Snail baits

a) horse Explanation Horses cannot vomit or regurgitate, normally. Vomiting is an OMINOUS sign if you ever see it in a horse.

Which animal cannot normally regurgitate or vomit? A - Horse B - Cow C - Pig D - Ferret

a) no breathing

Which choice correctly describes apnea? A - No breathing B - Difficult breathing C - Heart murmur D - Atopic allergy

D - Guaifenesin Explanation Guaifenesin is an anti-tussive (anti-cough) and decongestant medication that also works as a muscle relaxant. It is often used to support a smooth anesthesia induction and recovery in horses. Naloxone is a reversal agent for opiate drugs (In horses, Butorphanol (Torbugesic®) is a commonly used opiate). Gas anesthesia (like halothane) would not work to mask a horse down into anesthesia because you would expect problems restraining the animal during the excitement phase of induction. Halothane has largely been replaced by newer inhalant anesthetics, like isoflurane and sevoflurane Phenobarbital is a long-acting barbiturate used to control epilepsy/seizures, not induction of anesthesia.

Which choice is often used in combination with ketamine or thiopental to induce anesthesia in horses? A - Halothane B - Phenobarbital C - Naloxone D - Guaifenesin

D) horse, cow, goat, pig, dog Explanation Horse, Cow, Goat, Pig, Dog. Here is a list of gestation length for the major animal types, in order: Llama 1 year (350d), Horse 11 mo (330d), Cow 9 mo (~280 d, same as PEOPLE), Sheep/goats 5 mo (150d), Pig 4 mo (114d), Dog/ Cat 2 mo (60d), Ferret 1.5 mo (42d.). Basic questions on estrus cycle and gestation come up over and over, so commit them to memory for the major animals at LEAST (Cow, Horse, Dog, Cat, Sheep/Goat, Pig). In general, the BIGGER the beast, the LONGER the gestation ie: Mice are about 20 days, elephants are TWO YEARS (660 days)!

Which choice lists these animal types in order of gestation length, from longest to shortest pregnancy? A - Cow, Horse, Pig, Dog, Goat B - Cow, Horse, Pig, Goat, Dog C - Llama, Pig, Sheep, Ferret, Cat D - Horse, Cow, Goat, Pig, Dog

A - Towards the nose

Which direction is rostral? A - Towards the nose B - Towards the belly C - Towards the right side D - Towards the tail

a) xylazine

Which drug causes vomiting in cats? A - Xylazine B - Phenobarbital C - Ketamine D - Diazepam

e) metabolic acidosis Explanation A decreased CO2 on blood gas analysis indicates hyperventilation, which can be due to the compensatory response to metabolic acidosis, stress, pain, hyperthermia, or anxiety. Laryngeal paralysis and other upper airway obstructions, traumatic brain injury, high spinal cord injury, and administration of opioids can all cause an increased CO2.

Which of the following can cause a low CO2 on the blood gas of a dog presenting for emergency triage? A -Laryngeal paralysis B -Metabolic acidosis C -Traumatic brain injury D -High spinal cord injury E -Administration of opioids

a) alfalfa hay Explanation Compared to other types of hays, alfalfa tends to be higher in calcium, protein, and energy.

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

d) pasteurella multocida Explanation The correct answer is Pasteurella multocida. The bacterium is a gram negative rod. It causes fever, mucoid discharge from the mouth, diarrhea, petechia, ecchymoses, increased pericardial and peritoneal fluid, and death. The chronic form of the disease usually causes localized disease. Diagnosis is based on identifying the organism from samples in conjunction with clinical signs. Vaccines are available for prevention of the disease. Sulfa antibiotics are used for treatment.

Which of the following is the causative agent of fowl cholera? a) Chlamydophila psittaci b) Reticuloendotheliosis virus c) Mycoplasma gallisepticum d) Pasteurella multocida

A) pulse oximeter Explanation The pulse oximeter continuously measures blood oxygen saturation (SaO2), the percentage of hemoglobin molecules in arterial blood saturated with oxygen. SpO2 just means the SaO2 measurement as determined by PULSE oximetry. Pulse oximetry determines the absorption of light as it passes through tissues. The device is usually placed on the tongue, but the toe web, flank skin, ears, or lips can also be used. Two wavelengths of light are used, one absorbed by oxygenated hemoglobin (arterial) and one absorbed by de-oxygenated hemoglobin (venous). The results are compared to expected parameters and the pulse oximeter shows %(SaO2). Most also display heart rate, those with a graphic display also show an waveform that corresponds to arterial blood flow. So, pulse oximetry monitors multiple parameters - (SaO2),heart rate and blood flow. The waveform is evidence of blood flow, and indirect evidence of cardiac rhythm. Normal values should be above 95%, which corresponds to a partial pressure of oxygen of 80 mmHg.

Which of the following monitors is used to continuously measure oxygen saturation (SaO2) in anesthetized and critical care patients? A - Pulse oximeter B - Oscillometry C - Electrocardiograph D - Plethysmograph

b) brucella melitenis Explanation B. melitensis is a severe pathogen in humans, as are B. abortus from cattle, B. suis from pigs and B. canis from dogs.

Which of the following zoonotic pathogens is most likely to be acquired via raw goat milk? a) Bacillus anthracis b) Brucella melitensis c) Brucella abortus d) Clostridium difficile e) Brucella suis

b) Thiopental Explanation The correct answer is thiopental. Thiopental is an ultra-short acting barbiturate. Recovery depends on redistribution to tissues, including fat. Because sighthounds have very little fat, they have prolonged recoveries and greater complications with these drugs.

Which of these drugs should not be used in Greyhounds? a) Propofol b) Thiopental c) Morphine d) Ivermectin

b) timothy hay Explanation The correct answer is timothy hay. Of these choices, the only feed with low potassium is timothy hay. A low potassium diet is the most important nutritional modification in the treatment of HYPP. Regular exercise and feeding smaller, frequent meals can also reduce clinical signs. This disease is inherited in an autosomal dominant fashion, and owners should be discouraged from breeding affected animals.

Which of these would be appropriate for a horse with hyperkalemic periodic paralysis (HYPP)? a) Alfalfa hay b) Timothy hay c) Brome hay d) Beet molasses

a) non-screen film Explanation Non-screen film is primarily sensitive to x-rays, not light, requires LONG exposure times and produces radiographs with superb detail. Non-screen films are a good choice for intra-oral exams, dental studies, nasal radiographs and x-rays of bony extremities.

Which one requires a longer exposure time? A - Non-screen film B - Gridless film C - Screen film D - Film type does not matter

a) the hoof Explanation The hoof is the most distal. Distal means away/farther from the trunk of the body, or farther from whatever reference point you are using.Proximal means closer/nearer the trunk of the body, or nearer to whatever reference point you are using. Plantar means the means the bottom of the hind foot, closest to the ground. (ever heard of plantar warts on the BOTTOM of human feet?) Palmar means the bottom of the fore foot, closest to the ground. The top of either foot is referred to as the dorsal side.

Which part is the most distal? A - The hoof B - The elbow C - The hip joint D - The carpus

C) disrupts gram positive gut flora Explanation Rabbits, hamsters and other rodents are very sensitive to enterotoxemia. Most antibiotics disturb their normal gut flora, particularly the beneficial gram-positive bacteria which digest high-fiber food and keep pathogenic clostridial organisms from over-growing. Antibiotic-related clostridial enteropathies have been associated with CLOSTRIDIUM difficile in hamsters. (remember- DIFFICULTY with ABX = C. difficile in hamsters). If you see dark-red hamster intestines, think ABX-related clostridial overgrowth. In general, remember ETC is OK ( Enrofloxacin (Baytril®), Trimethoprim Sulfa (TMS), Chloramphenicol). These 3 "ETC" antibiotics are ok in rabbits, guinea pigs, hamsters and other rodents.

Why are most antibiotics contraindicated in rabbits and hamsters? A - Highly permeable blood-brain barrier B - Their little hearts just can't take it C - Disrupts gram positive gut flora D - Highly sensitive to renal toxicity

A - Vertically in a cold room with low humidity (40-60%) Explanation X-ray films need to be stored in a vertical position, in a cold room with low humidity. Very low humidity can lead to static electricity production which causes artifacts on the film (linear dots, tree

X-ray films are best stored in which way? A - Vertically in a cold room with low humidity (40-60%) B - Vertically in a warm room with low humidity (40-60%) C - Horizontally in a warm room with high humidity (70-85%) D - Horizontally in a cold room with low humidity (40-60%)

a) uterus is hanging out Explanation In cattle, a prolapse almost always means a uterine prolapse, where the uterus has pushed itself inside out and is hanging outside the cow.(note: there is such a thing as vaginal prolapse, but it is much less common). When the penis cannot retract into the prepuce, the problem is called paraphimosis. A proptosis means "popping out or protruding". The most common emergency proptosis you will see in practice is a ocular proptosis (sometimes called an eye prolapse, too).

You and the vet are called to a dairy farm at 4 a.m. for a "prolapse". What kind of problem is this likely to be? A - Uterus is hanging out B - Penis cannot retract into prepuce C - Eyeball popped out of socket D - Mismating

E) Buccal aspect-upper molar arcade, Lingual aspect-lower molar arcade Explanation Use your rasp to blunt the OUTSIDE of the UPPERS (buccal/cheek) side and the INSIDE of the LOWERS (Lingual/tongue side). Horses are "anisognathic" which is a fancy way to say the lower jaw is NARROWER than the UPPER jaw.

You are called to a farm to help do a routine dental exam and float the teeth of an 8-year old Standardbred mare. What parts get filed down with the rasp when a horse gets its teeth floated? A - Lingual aspect-upper molar arcade, Buccal aspect-lower molar arcade B - Buccal aspect-upper molar arcade, rostral points of wolf teeth C - Lingual aspect-upper molar arcade, Lingual aspect-lower molar arcade D - Buccal aspect-upper molar arcade, Buccal aspect-lower molar arcade E - Buccal aspect-upper molar arcade, Lingual aspect-lower molar arcade

b) selenium deficiency Explanation The correct answer is selenium deficiency. The pale muscle and clinical signs are classic for vitamin E and selenium deficiency. This is important to remember! Other things that should be on your differential list for this case include cardiotoxic plants.

You are working with a farmer who is having trouble with calves between the age of 2 weeks and 6 months. They are alert, but weak, dyspneic and die suddenly. On necropsy they have pale cardiac and skeletal muscles. What is the farmer's problem? a) Lightning strike b) Selenium deficiency c) Sorghum toxicity d) Copper deficiency

c) coliform mastitis Explanation This is a case of severe acute coliform mastitis, and the absorbed endotoxin (LPS) is causing many of the systemic signs observed. The cow needs to be aggressively treated with IV fluids, NSAIDS, and supportive nursing. The gland should be frequently milked out. The use of both intramammary and systemic antimicrobial drugs to which most coliforms are susceptible is still controversial, but is often done in cows in a severe state of illness as in this case. While this cow may have secondary hypocalcemia, treatment with calcium needs to be approached cautiously, as endotoxic animals have very sensitive myocardium and arrest may occur if calcium is given IV. If given, preferred routes of calcium administration would be subcutaneous or oral.

You examine a very ill 4-year old Holstein dairy cow on a large commercial dairy. She freshened one week ago and was producing well, until she was found down and unwilling to rise this morning when you were called. T=103F or 39.4 C, HR=90, and RR=35. The scleral vessels are dark are enlarged, her rumen is fairly empty and the motility is poor, and she appears too weak to rise. Rectal exam reveals an involuting uterus which can be retracted, discharging a brownish red mucoid non-odorous lochia through the vagina. The left rear quarter of her udder is swollen, hot, painful, and discolored (see image), and contains a serum-like secretion with clumps of fibrin in it. What is your diagnosis? a) Metritis b) Grain overload c) Coliform mastitis d) Hypocalcemia (milk fever) e) Displaced abomasum

b) anthrax Explanation The correct answer is anthrax. Anthrax is caused by Bacillus anthracis. The black blood from the orifices, incomplete rigor mortis, and acute death is very characteristic of the disease in cattle. Lesions occur in the reticuloendothelial system and vasculature. Do not perform a necropsy on the animal as you would potentially release spores into the environment. You should notify the authorities if you suspect the disease.

You go to a ranch to evaluate the sudden death of a bull. There is black, bloody discharge from all orifices. There is incomplete rigor mortis despite being dead for a day. What is your most likely diagnosis? a) Grass staggers b) Moldy sweet clover toxicity c) Anthrax d) Tetanus e) Botulism

d) methylene blue Explanation Nitrate toxicosis causes methemoglobinemia, in which the blood appears chocolate brown. As a result, the oxygen carrying capacity and delivery is greatly reduced and the animal may die. Methylene blue is usually administered IV as a 1% to 4% solution, with a total dose of 4 to 15 mg/kg body weight to cattle, for treating nitrate toxicosis. Nitrates are found in high levels in many plants and some water sources. The nitrate is converted in the rumen to nitrite and then absorbed into the blood, which causes oxidation of the heme iron to the +3 ferrous state (called methemoglobin). Methylene blue restores the iron in hemoglobin to its normal (reduced) oxygen-carrying state. This is achieved by providing an artificial electron acceptor for NADPH methemoglobin reductase (RBCs usually don't have one; the presence of methylene blue allows the enzyme to function at 5A? normal levels). The NADPH is generated via the hexose monophosphate shunt.

You have diagnosed nitrate poisoning in a group of yearling cattle which were grazing Sudan grass (see photo). Which of the following is the most effective treatment? a) Calcium gluconate b) Digitalis c) Vitamin B12 d) Methylene blue e) Sodium thiosulfate

c) 47mL once a day Explanation 47 ml, once a day. A cc is cubic centimeter, which is the same volume as a milliliter, (ml). SID means once a day. 9.6% concentration contains 96 mg amprolium per ml solution. 1000 lb cow = 454 kg, (1000lb / 2.2lb/kg=454 kg). The dose for this cow will be 454 kg x10 mg/kg =4540 mg. To get the dose in ml divide 4540 mg by 96 mg/ml 4540 mg / 96mg/ml =47ml Eimeria (and isospora) are intestinal protozoal parasites (also called coccidia).

You must treat a 1000 lb cow infected with Eimeria bovis (an intestinal parasite) using 9.6% amprolium oral solution. The dose is 10mg/kg PO SID for 5 days. How much amprolium do you give this cow, and how often each day? A - 4.7 cc, once a day B - 96 cc, twice a day C - 47 ml, once a day D - 9.6 ml, once a day

d) Atipamezole Explanation Atipamezole (trade name: Antisedan), an alpha-2 antagonist, is the reversal agent for medetomidine (trade name: Dormitor). Medetomidine is an alpha-2 agonist. Xylazine would be another example of an alpha-2 agonist. Yohimbine is its reversal agent. Other alpha-2 agonists are clonidine, detomidine, dexmedetomidine and romifidine 2-pralidoxime is a reversal agent for cholinesterase inhibitors. Flumazenil is a reversal agent for benzodiazepines Atropine is a muscarinic antagonist of acetylcholine and may be dangerous to use after administration of alpha-2 agonists. This is because alpha-2 agonists cause marked vasoconstriction and high afterload on the heart. Giving atropine and increasing the heart rate can place further stress on the heart. You do not want to set in motion peripheral vasoconstriction and compensatory bradycardia brought on by the alpha-2, then increase the heart rate against that high afterload. This could make for an unhappy heart in the event underlying subclinical heart disease is present.

You need to perform a CBC and take thoracic radiographs on a somewhat fractious cat. You sedate the cat with an intramuscular injection of medetomidine. While on the X-ray table, you become concerned that the cat is not doing well and you decide you want to reverse the effects of medetomidine. What should you give the cat? a) 2-pralidoxime b) Atropine c) Flumazenil d) Atipamezole e) Xylazine

a) via tick vector Explanation This is a case of Babesia gibsoni. Babesia sp. are protozoa that parasitize erythrocytes, causing anemia. Many different species exist. B. canis and B. gibsoni are two organisms commonly known to infect dogs, both organisms have Ixodid tick vectors. Babesia gibsoni, as seen here, is a small ring shaped parasite. Bites from other dogs during dog fights is also thought to be an important mode of transmission, possibly explaining the increased incidence of the disease in pit bulls and staffordshire terriers.

You note the abnormality seen on the blood smear below of a dog presenting to you for weakness and fever. What is the likely route that the dog was infected? a) Via tick vector b) Via ingestion (fecal-oral) c) Via transmammary route d) Via inhalation e) Via skin penetration f) Via flea vector

e) urate Explanation The correct answer is urate. Animals with portosystemic shunts are very predisposed to developing urate uroliths due to their inability to metabolize purines appropriately.

You perform an abdominal ultrasound to evaluate a Yorkshire Terrier with a suspected liver shunt. After finding the shunt vessel, you complete the ultrasound and find several calculi in the bladder. What is the most likely type of stone? a) Xanthine b) Struvite c) Calcium oxalate d) Cysteine e) Urate

d) this is normal in a horse Explanation Healthy horses and cows have clear to light yellow plasma. Icteric horses have very yellow plasma. Healthy dogs and cats have clear plasma. These differences are due to dietary differences between the species. Hemolyzed plasma would be pink. Lipemic plasma would be milky/opaque. Spinning should not affect the plasma color.

You spin down some blood from an EDTA tube to measure the PCV and total solids in a horse. The plasma is light yellow in color. What might this mean? A -Centrifuge did not properly spin down the sample B -Animal has icterus C -Sample hemolyzed D - This is normal in a horse E - Patient is hyperlipemic