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This is infectious bovine rhinotracheitis (IBR) with pustular vulvovaginitis, caused by bovine herpesvirus 1

A herd of 25 Holstein heifers present with fever (104 to 106 °F, 40 to 41.1°C, N=100-102.5 F, N=37.8-39.7 C) lethargy, and purulent nasal discharge. They also have loud harsh coughs. Physical exam reveals crackles over the trachea, but not the lungs. Fibrinonecrotic plaques are randomly dispersed over the nasal and ocular mucosa, but no oral ulcers are present. Urine and feces appear normal. Several affected heifers have an arched back and are straining because of a fibrinonecrotic vaginitis. Which one of the following choices is the most likely cause of this condition? A - Herpesvirus B - Togavirus C - Rhabdovirus D - Orbivirus E - Morbillivirus

Proximal enteritis, or duodenitis-proximal jejunitis, is a clinical syndrome characterized by large volumes of gastric reflux resulting from excessive fluid and electrolyte secretion into the small intestine and small intestinal inflammation and edema. Laminitis is an important potential sequela. The cause is unknown but several bacteria and toxins including Clostridium difficile, Clostridium perfringens, Salmonella, and fumonosin B1 mycotoxins have been implicated. Ulcerative duodenitis is a disorder of foals resulting in fever, colic, diarrhea, and delayed gastric emptying. Lawsonia intracellularis causes proliferative enteropathy in foals and weanlings, a disease characterized by hypoproteinemia, diarrhea, chronic ill thrift, and ventral edema. Right dorsal colitis is typically a result of non-steroidal anti-inflammatory drug toxicity and results in hypoproteinemia and colic. Cantharidin toxicity (blister beetles, Epicauta spp.) causes a wide range of clinical signs predominated by profuse diarrhea, stranguria and pollakiuria, and colic.

An adult horse with clinical signs of voluminous gastric reflux, depression, colic, and fever is most likely suffering from which condition? A - Ulcerative duodenitis B - Proliferative enteropathy C - Proximal enteritis D - Right dorsal colitis E - Cantharidin toxicity

Hepatopathy There is a reported incidence of hepatopathy in 0.05% of dogs treated with carprofen (Rimadyl®). Geriatric dogs, or dogs with pre-existing chronic diseases like inflammatory bowel disease (IBD), renal or hepatic insufficiency may be at a greater risk of toxic side effects. Carprofen is contraindicated in animals with bleeding disorders, like Von Willebrand's disease. GI effects like gastric upset and gastric ulcers are LESS common with carprofen than with other NSAIDS, but still can occur.

Carprofen (Rimadyl ®) is a nonsteroidal anti-inflammatory (NSAID) commonly-used in dogs with arthritis. What is the most important side effect about which to be concerned? A - Hepatopathy B - Protein-losing nephropathy C - Seizures D - Secretory diarrhea E - Hypersensitivity

Vagus (CN 10) Damage to the recurrent laryngeal nerve (a branch of the Vagus (CN 10)) causes laryngeal hemiplegia - a paralysis of the abductor muscle (dorsal cricoarytenoid muscle) controlling the glottic cleft in the larynx. This allows the vocal fold (usually left side) to evert into the lumen of the larynx, obstructing airflow, leading to a roaring sound, and most importantly, slowing the horse. If you have trouble remembering which cranial nerve is which, try this memory aid: 1. On -Olfactory 2. Old -Optic 3. Olympus -Oculomotor 4. Towering -Trochlear 5. Tops -Trigeminal 6. A -Abducens 7. Fat -Facial 8. Vested -Vestibulocochlear 9. German -Glossopharyngeal 10. Viewed -Vagus 11. Some -Spinal accessory 12. Hops-Hypoglossal

Damage to the left recurrent laryngeal nerve is associated with "roaring" in horses. The left recurrent laryngeal nerve is a branch off of which cranial nerve? A - Glossopharyngeal (CN 9) B - Facial (CN 7) C - Trigeminal (CN 5) D - Hypoglossal (CN 12) E - Vagus (CN 10)

Campylobacteriosis, Tritrichomonas (Tricomonas) foetus A breeding soundness exam preputial wash samples may be cultured for two venereal diseases of cattle, bovine genital campylobacteriosis (Campylobacter fetus sp. venerealis) and bovine trichomoniasis (Tritrichomonas (Trichomonas) foetus). Both organisms can cause cause early embryonic loss in cattle and have similar presentations.

During a breeding soundness exam of a bull, preputial wash samples are typically cultured for which two organisms? A - Campylobacteriosis, Tritrichomonas (Trichomonas) foetus B - Chlamydophila abortus, Leptospira hardjo C - Ureaplasma diversum, Coxiella burnetii D - Brucella abortus,Mycoplasma bovis E - Toxoplasma gondii,Neosporosis

Antigenic drift is most important in the epidemiology of equine influenza. Point mutations in the genes for hemagglutinin and neuraminidase cause changes in these surface proteins that can lead to the development of new virus strains not recognized by antibodies to earlier strains. Because influenza is an RNA virus without proofreading ability, mutations can occur more rapidly with flu than mutations seen in DNA viruses like equid herpesviruses and adenoviruses.

In which equine virus is antigenic drift the most important in the development of novel strains? A - Influenza virus B - Herpesvirus-4 C - Herpesvirus-1 D - Adenovirus E - Papillomavirus

Fenbendazole. This is a whipworm egg (Trichuris spp., looks like an American football). Rx with antihelmintics like fenbendazole (preferred treatment), febantel, praziquantel, pyrantel pamoate. Can use milbemycin oxime as a preventive for chronic recurring cases, but must check dog with a heartworm test first. You may also see whipworms in ruminants and whipworms in pigs. Click here for guidelines on parasite control in ruminants. Click here for a table of approved antihelmintics in dogs and cats.

On a fecal examination of a 7 year old dog this organism is evident. Which one of the following drugs is the best treatment? A - Piperazine B - Diethyl carbamizine C - Ivermectin D - Metronidazole E - Fenbendazole

A century ago, Mycobacterium bovis (bovine tuberculosis) used to be a common zoonotic health threat, transmitted through milk to children through their emerging teeth at the gums. Today, human cases of M. bovis are emerging more in binational communities with ties to Mexico who consume unpasteurized milk products (like fresh queso). Temperature of pasteurization is set by the toughest, most heat-resistant organism, which is Coxiella burnetii, the cause of Q fever. If the temperature is high enough, for long enough to kill Coxiella, it will also kill the other organisms. Brucella and Listeria can also be transmitted in milk. E. coli is typically a contaminant from unsanitary milking conditions.

Prior to the 1950s, heat pasteurization of milk was done principally to prevent transmission of one organism to people. Today, that organism is re-emerging in bi-national communities with ties to Mexico who consume unpasteurized milk products. What is the organism? A - Mycobacterium bovis B - Enterotoxigenic Escherichia coli O157:H7 C - Mycobacterium avium subspecies paratuberculosis D - Mycobacterium tuberculosis E - Mycobacterium avium

Cutaneous stephanofilariasis, dermatitis along ventral midline. Cattle. This is a circumscribed dermatitis along the ventral midline of a cow with cutaneous stephanofilariasis, caused by Stephanofilaria stilesi a filarial parasite of cattle. Cutaneous stephanofilariasis has been reported throughout the North America but is more common in the western and southwestern U.S. The intermediate host is the horn fly, Haematobia irritans which ingests filarial larvae when it feeds on skin lesions. Refs:Pasquini's Guide to Bovine Clinics, 4th ed. p.180 and the Merck Veterinary Manual online edition.

The following lesion is typically found on the ventral midline of which animals? A - Camelids B - Sheep and goats C - Pigs D - Cattle E - Horses

Bacterial contamination. Simonsiella are bacteria that normally inhabit the pharynx and have a large, ladder-like appearance. Their presence indicates contamination from the oropharynx. Bacteria, if present within neutrophils or macrophages, would be a significant finding. Refs: Cote, Clinical Veterinary Advisor-Dogs and Cats, 3rd ed. pp. 146-8 and the Merck Veterinary Manual online edition. Image courtesy, Nottingham Vet School.

The following cytology is from a bronchoalveolar lavage in a dog. Which one of the following choices is the most likely diagnosis? A - Actinomyces pneumonia B - Bacterial bronchopneumonia C - Fungal bronchopneumonia D - Eosinophilic pneumonitis E - Bacterial contamination

Treat the ventricular-tachycardia with a lidocaine drip and address hyperactivity/seizures with diazepam (Valium ®) or methocarbamol. If response to diazepam inadequate, consider barbiturates like phenobarb or pentobarb (given S-L-O-W-L-Y). This is a classic presentation of severe chocolate toxicity, due to toxic methylxanthine alkaloids (ie: theobromine, theophylline, caffeine). Common after Halloween, Christmas and Valentine's Day holidays, see EXCITEMENT, SEIZURES, ARRHYTHMIAS. The seizure and ECG which shows ventricular tachycardia (V-tach) are the key pieces of information here: Most chocolate toxicities are milder- hyperactivity, vomiting, urinating, diarrhea. If see in first hour BEFORE signs occur, (and dog not seizing), induce vomiting with Apomorphine (0.03 mg/kg IV), Ipecac (1-2 ml/kg PO) or hydrogen peroxide (1-5ml/kg PO). If animal is sedated because of seizures, consider gastric lavage. If vomiting is controlled, give activated charcoal to decrease absorption of toxic alkaloids and an osmotic cathartic like Na-sulfate (1g/kg PO) to promote elimination.

The night after Valentines day, an obese male neutered Schnauzer is presented with a combination of vomiting, urinary accidents and diarrhea. On physical exam there is muscle rigidity and chocolate wrappers visible in the diarrhea. The dog has a seizure on the exam table. An ECG is shown below. T=103.2 F (39.6 C)..[N=99.5-102.5 F, N=37.2-39.2 C] RR=40 brpm....[N= 15-34] HR=136 bpm....[N=60-120] Which one of the following choices is the best treatment plan? A - Apomorphine, gastric lavage, Na-bicarbonate IV B - Activated charcoal, sodium sulfate, methocarbamol IV C - Diazepam, lidocaine drip D - Phenobarbital, glycopyrrolate E - Ipecac, theophylline, digoxin

Listeriosis is most likely in this bull. Infection with Listeria monocytogenes usually presents with MULTIFOCAL brainstem signs as seen by dysfunction of multiple cranial nerves, most often V, VII-X, and XII. Circling is thought to be more than just CN VIII damage because of the intensity associated - affected animals will sometimes continuously circle till they collapse. This suggests that other areas of the brain such as the basal ganglia and the descending reticular formation are also affected. Thromboembolic meningoencephalitis (TEME) causes brainstem and cerebellar signs but the CSF would be neutrophilic and xanthochromic. The xanthrochromia is due to vasculitis/thrombosis in the CNS. TEME is more common in feedlot calves; respiratory disease, septicemia, and joint disease may also be seen. Animals with otitis media/interna are alert and responsive, and have signs of vestibular dysfunction, but are not paretic. The bull could have rabies, but the multifocal nature of this bull's problem and the localization of lesions to the brainstem favor a diagnosis of listeriosis. Patients with nervous coccidiosis are usually centrally blind, and have cerebral rather than brainstem signs. It is most often seen in calves soon after the development of diarrhea.

This 3 year old Charolais bull weighing 2100 lbs was found at pasture walking in circles. He has been fed silage enriched with 5% dried chicken litter in addition to the winter pasture. [image] T = 104.6°F (40.3°C)..[N=101.5-103.5 F, N=37.8-39.7 C] Pulse rate = 46 beats per minute....[N=55-80 bpm] Resp. rate = 21 per minute....[N=10-30 brpm] He is depressed, anorectic and drooling, with a head tilt to right. The right ear and eyelid both droop. The bull is ataxic with predominantly right sided proprioceptive deficits. A sample of cerebrospinal fluid (CSF) taken at the lumbosacral space has normal color, no turbidity but has an increased mononuclear cell count and an elevated protein concentration. Which one of the following choices is the most likely diagnosis? A - Nervous coccidiosis B - Listeriosis C - Thromboembolic meningoencephalitis D - Rabies E - Otitis media/interna

Physeal closure

This colt presents for evaluation of its angular limb deformity. For the best prognosis, this problem should be surgically addressed prior to which event? A - Physeal closure B - Sexual maturity C - Six weeks of age D - Weaning E - Eruption of the third incisors

Born post-term but small Dysmature foals are born post-term but small. Also called "small for gestational age", these foals are thought to have suffered placental insufficiency in-utero. A postmature foal is a post-term foal that with normal axial skeletal size but is thin to emaciated. Most commonly born to mares ingesting endophyte-infested fescue. Gestation length in mares ranges from 310 days to more than 370 days.

What is a dysmature foal? A - Born post-term, normal axial skeletal size but emaciated B - Born post-term but small C - Born pre-term, but with paradoxically normal respiratory function D - Born to mare that ate endophyte-infested fescue E - Born pre-term with ciliary dyskinesia

This is hemivertebra, a wedge-shaped vertebra, which can be an asymptomatic finding, or may present with scoliosis, kyphosis, and paresis, ataxia. Typically thoracic. Think of screw-tailed dogs (ie: bulldog, pug). Inherited in German shorthaired pointers

What is wrong with this picture? A - T3-L3 intervertebral disc disease B - Cartilaginous exostoses C - Hemivertebra D - Pulmonary emphysema E - Diskospondylitis

Small intestinal dilation

Which one of the following would NOT be a clinical sign of anterior abdominal peritonitis in a cow? A - Small intestinal dilation B - Rumen hypomotility C - Arched back D - Scant firm stool E - Decreased milk production

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, isoproterenol. If poor response, may need a pacemaker.

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, N=37.2-39.2 C] HR=60 bpm............[N=60-120] 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

It is 89%. Remember - you are comparing TWO TESTS here. PVP means "Of the turtles my test says are positive (27), how many are truly positive?" (27-3=24, this # goes in the "a" box) Here is how you do it: First, draw a 2x2 table, and label the boxes a,b,c,d. PVP = a/(a+b). Click here to see a Basic 2X2 table. Now, add in the TOTAL number of animals (100), the total positive by YOUR test (27) and the total negative by YOUR test (73), like this diagram: 2x2 with totals. Now the (slightly) tricky part. Add in the numbers that YOUR test got WRONG according to the gold standard test. (3 false pos in box b, 10 false neg in box c): Click here to see 2x2 with b and c cells. Last, subtract to fill in your "d" box (73-10=63) and do the math to calculate PVP = a/(a+b)=24/27=0.89 or 89% : Click here to see the final 2x2 with all cells filled and PVP calculated. FYI: You can calculate sensitivity a/(a+c), specificity d/(b+d), Predictive Value POS (PVP) a/(a+b) and Predictive Value NEG (PVN) d/(c+d) with the same 2x2 table.

You serologically test 100 Siberian box turtles for galloping halitosis. 27 turtles test seropositive and 73 test seronegative. However, molecular testing reveals 3/27 of the seropositive turtles are disease free and 10/73 of the seronegative turtles are diseased. The entire fur-bearing turtle industry depends on your answer: What is the Predictive Value Positive (PVP) of your serologic test? A - 95% B - 89% C - 86% D - 73% E - 70%

Ingestion of Acer rubrum (Red maple) is most likely the cause of hemolytic anemia and the resultant pathology in this horse. Wilted or dry leaves and bark of red maple trees contain oxidants which damage red blood cell (RBC) membranes, resulting in the formation of Heinz bodies and eccentrocytes. Acute intravascular hemolysis, hemoglobinemia, methemoglobinemia, hemoglobinuria, and methemoglobnuria follow. Clinical signs of toxicity include: weakness, depression, tachypnea, tachycardia, icterus, cyanosis, and brown discoloration of blood and urine. Post mortem findings include: icterus, splenic hemosiderosis, splenomegaly, swollen dark red-blue black kidneys with red-brown tubular casts, and a swollen brown liver. Toxicity is often fatal. If the horse survives the hemolytic crisis, renal failure may develop due to pigmenturia. Treatment is supportive care: IV fluids, oxygen, and blood transfusions. Click here to see an image of Acer rubrum. Click Here to see a Merck table of Poisonous Range Plants of Temperate North America. Click here to see icteric mucous membranes caused by hemolysis. Refs: Blackwell's 5 Minute Consult: Equine 2nd ed., p. 22-3, Pasquini's Guide to Equine Clinics, 3rd ed., p. 139, Forero, Livestock-Poison Plants of CA, U of CA, Davis, ANR, p. 31,Latimer - Duncan and Prasse, Vet Lab Med, CLin Path 5th ed., pp. 389-91 (case study), and p 17 (EQ RBCs with Heinz bodies), and the Merck Veterinary Manual online edition.

A 10 year old Quarterhorse gelding pastured in the northeastern United States is presented for weakness and depression. The owner reports that the horse's urine is an unusually dark brown color. On physical exam, the horse is tachycardic and tachypneic. The mucous membranes are a dark yellowish brown. The horse's plasma has a pink tinge. A CBC, blood smear, biochemistry panel, and urinalysis indentify intravascular hemolytic anemia, hemoglobinemia, methemoglobinemia, and hemoglobinuria. Erythrocytes are seen on the blood smear with Heinz bodies and eccentrocytosis. Ingestion of which one of the following plants is most likely to cause of this spectrum of clinical signs in this case? A - Tetradymia spp (Horsebrush) B - Quercus spp (Oak) C - Acer rubrum (Red maple) D - Veratrum spp (Skunk cabbage) E - Xanthium spp (Cocklebur)

Immunosuppression, anticoagulants, blood transfusion Immunosuppression, anticoagulants and blood transfusion. This is the clinical picture of Immune-mediated hemolytic anemia (IMHA). The basis of acute treatment includes: 1. Immunosuppressive therapy (Prednisone 1-2 mg/kg PO, SC or IM, q12h; or Dexamethasone Na phosphate, 0.15-0.25 mg/kg IV q12h) 2. Anticoagulant therapy (heparin) 3. Packed RBC transfusion is indicated if anemia is accompanied by tachycardia, tachypnea, bounding pulses, weakness. Chronic therapy is based on immunosuppression with prednisone, for example, on tapering doses for 3-6 months, as long as hematocrit is stable. Be aware that thrombocytopenia, thromboembolism and disseminated intravascular coagulation (DIC) are three associated conditions to watch for in a dog with IMHA.

A 10-year old female spayed Irish Setter is presented with a 2-day history of progressively worsening lethargy, weakness and inappetence. Physical exam shows pale mucous membranes, tachycardia, bounding pulses and discolored urine. A blood sample is shown below. What are the key elements of acute treatment for this dog? A - Cyclophosphamide, IV crystalloids B - Vasodilators, positive inotropes, oxygen C - Immunosuppression, anticoagulants, blood transfusion D - Vitamin K, hyper-immune plasma, antiserum E - Antibiotics, activated charcoal, high fat nutritional support

The prognosis for long term survival is poor. 50% of affected dogs will survive for a year, with a 30% local recurrence rate. Melanoma of the digit is an aggressive, infiltrative tumor, with substantial metastatic potential and a poorer prognosis than cutaneous melanoma or other tumors of the digit. Some reports indicate that melanomas are not very responsive to radiotherapy, especially if used alone. However, it is utilized for palliative therapy and is recommended following resection, especially when complete excision is not possible. The efficacy of chemotherapy for subungual melanomas is unclear, but some patients have responded well. Therapy with a DNA vaccine has shown promise in some cases. Good info here: Brockley LK, MA Cooper MA, & Bennett PF. 2013. Malignant melanoma in 63 dogs (2001-2011): the effect of carboplatin chemotherapy on survival. New Zealand Vet Journal, 61(1): 25-31. In contrast, the prognosis is good for dogs with digital squamous cell carcinoma (SCC). 95% of dogs with digital SCC survive 1 year after amputation and 75% survive 2 years after amputation. SCCs have a low rate of metastasis; most have not metastasized at the time of diagnosis. Chest radiographs and aspiration of local lymph node(s) for cytology are necessary to accurately assess prognosis.

A 12 year old spayed female black Scottish terrier is presented with a 3 week history of limping on the right fore. The lateral digit is swollen and the nail is deviated ventrally, with ulceration of the nail bed. A lytic bone lesion of the 3rd phalanx is visible on radiograph and cytology of the mass suggests neoplasia. Chest radiographs are clear. Following amputation of the digit, histopathology indicates that the mass is a subungual melanoma. Which of the following choices contains the best advice for the owner? A - Prognosis is good with complete resection at distal locations B - 50% survive 1 year, 30% local recurrence C - Chemotherapy is indicated D - Radiotherapy is indicated E - Best outcome with radiotherapy and chemotherapy used together

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. short legs and long UNsegmented pedicles on sarcoptes. In CONTRAST look for long legs and short UNsegmented pedicles on Chorioptes.

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. What is the diagnosis? A - Psoroptic mange B - Trombiculidiasis C - Cutaneous onchocerciasis D - Chorioptic mange E - Sarcoptic mange

Under 10% Less than 10% of dogs with osteosarcoma will have detectable metastatic lesions at initial diagnosis. However, most dogs will develop pulmonary metastases even if the lungs are clear at the time of amputation. Baseline left humerus- There is a mixed osteolytic and osteoproductive lesion in the proximal left humerus. There is an area of geographic lysis caudally, and increased opacity from the surrounding proliferative bone. This dog was given limb-sparing radiation treatment and radiographs were repeated (not shown). Post radiation therapy- The areas of proliferative bone surrounding the proximal humerus and extending to the soft tissues caudally have increased in opacity. There are additional areas of lysis in the proximal humerus compared to the previous exam. The area of the osteosarcoma lesion is also greater than previously seen.

A 12-year-old Newfoundland is presented with left thoracic limb lameness. Pain localizes to the left shoulder and proximal humerus. Based on the radiographic findings, history, and signalment, osteosarcoma is high on the differential list. There are no metastatic lesions visible in three thoracic radiographic views. What percentage of dogs with osteosarcoma will have visible pulmonary metastatic lesions at initial diagnosis? A - Under 10% B - More than 85% C - Roughly 75% D - Roughly 50% E - Roughly 25%

Closed reduction & Ehmer sling Traumatic coxofemoral luxations comprise 90% of all luxations in small animals. Closed reduction can be attempted when the luxation duration is less than 48 hours and there are no other hip injuries. If closed reduction fails, then an open reduction technique such as using sutures or toggle pins is indicated. However, if reduction ultimately is not successful, femoral head osteotomy (FHO), total hip replacement, or triple pelvic osteotomy (TPO) can be performed.

A 12-year-old West Highland White Terrier disappeared from its home for six hours and returned lame on his left pelvic limb. Based on the pelvic radiograph made during the same day, which one of the following choices is the best treatment? A - Closed reduction and Ehmer sling B - NSAIDs and rest C - Decompression and Kirschner-Lemur apparatus D - Femoral head osteotomy and acetaminophen E - Tibial tubercle transposition and Robert-Jones bandage

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.

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 a classic description of exercise-induced pulmonary hemorrhage (EIPH)-Very common (43-75% of flat racers). Hemorrhage from lungs possibly may occur in ALL Thoroughbreds. Note that only ~ 10% of horses with EIPH may show epistaxis- look instead for a Hx of exercise intolerance. On trans-tracheal wash (TTW) see alveolar macrophages containing hemosiderin (dark pigment granules left from phagoscytized RBCs). To maximize your chances of seeing blood in trachea, do endoscopy AFTER exercise. Two other big rule outs for epistaxis are: 1. Ethmoid hematoma and 2. Guttural pouch mycosis.

A 2-year old thoroughbred mare has a 1-month history of poor race performance. The mare slows down markedly near the end of races with labored breathing, excessive swallowing and a bilateral epistaxis which resolves with time. She coughs after exercise, but otherwise acts normally and has a good appetite. With the horse calm and well rested, no obvious abnormalities are visible on endoscopic exam. A transtracheal wash shows the following image. What should the owner be told? A - This may be a case of bastard strangles B - The horse should improve on antihistamines C - We need to biopsy for ethmoid hematoma D - Prognosis is poor-suspect gastric ulcer reflux E - This is a very common problem in thoroughbreds

Osteochondrosis of the caudal humeral head is the cause of the intermittent lameness. Radiographic interpretation Left shoulder- On the lateral radiograph, there is flattening of the caudal aspect of the humeral head with a linear mineral density that is separated from the joint surface. There is mild sclerosis of the caudal humeral head. Osteophytes are present on the caudal glenoid as well as in the inter-turburcular groove. On the ventrodorsal projections, osteophytes are additionally visible on the medial and lateral aspects of the glenoid. Right shoulder- On the lateral radiograph, the caudal humeral head is flattened and irregular with mild sclerosis of the subchondral bone. There are small osteophytes present on the caudal and distal glenoid as well as the inter-turburcular groove. This dog had bilateral shoulder osteochondrosis. (Radiographs of right shoulder not shown). Hypertrophic osteodystrophy is a metaphyseal disorder of the long bones in large and giant breeds of dogs. Radiographic signs are radiolucent lines parallel to the epiphyseal growth plates, and periosteal proliferation at the metaphysis. Click here to see normal canine shoulder radiographs.

A 2-year-old spayed German shepherd is presented with recurrent left thoracic limb lameness that is aggravated by exercise. Which one of the following choices is the most likely diagnosis? A - Panosteitis B - Osteochondrosis C - Osteosarcoma D - Hypertrophic osteodystrophy E - Hypertrophic osteopathy

The diagnosis is foreign body ingestion. Click here to see multiple dorsoventral projections of the snake. 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).

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

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. 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.

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 - Dorsal displacement of soft palate D - Pharyngeal lymphoid hyperplasia (PLH) E - Epiglottic entrapment

Neonatal foals given oral iron supplements at birth can develop toxic injury to their liver and subsequent hepatic encephalopathy. Foals are born with a high serum iron level and absorb iron more readily than adult horses.

A 4-day-old foal is presented with clinical signs of depression, icterus, head pressing, and disorientation. Serum biochemistry reveals increased levels of gamma-glutamyltransferase, alkaline phosphatase, and unconjugated bilirubin. On further questioning, the owner mentions that he gave the foal an oral nutritional supplement when it was a day old but was not sure what was in it. What could this supplement have contained to cause these clinical signs? A - Iron B - Copper C - Vitamin E D - Vitamin A E - Selenium

Many dogs relapse within a year Many dogs relapse within a year. This is the clinical picture of Immune-mediated hemolytic anemia (IMHA). Owners need to know that many dogs will relapse within a year and that chronic treatment and monitoring is indicated. The basis of chronic therapy is based on immunosuppression (with prednisone, for example), on tapering doses for 3-6 months, as long as hematocrit is stable. Dogs with IMHA usually die of anemia or thromboembolism. Mortality is estimated at 40-60%. Be aware that thrombocytopenia, thromboembolism and disseminated intravascular coagulation (DIC) are three associated conditions to watch for in a dog with IMHA.

A 4-year old female spayed Doberman pinscher is presented with a 2-day history of progressive weakness and inappetence. Physical exam shows icteric, pale mucous membranes and tachycardia. Two blood samples from the exam are shown below . What message should be communicated to the owner? A - Infectious, need to check other dogs in house B - Grave prognosis C - Many dogs relapse within a year D - Zoonotic, may indicate tick-related problem E - 50% of cases are heartworm positive

Facial nerve Think of facial nerve paralysis (CN 7) with a unilaterally droopy face. Remember the facial nerve is motor to the muscles of facial expression (explaining the right side drooped ear, lip and eyelid) and innervates the lacrimal and salivary glands. Loss of innervations can lead to a dry eye, and possibly to exposure keratitis if animal losses ability to close eyelid from damage to facial nerve innervation of the orbicularis oculi muscle. Idiopathic in 75% of canine cases (25% of cats). Can also see these signs with middle ear damage (from otitis media), from facial nerve trauma (ear surgery in dogs, or pressure from halter buckles in anesthetized horse), or neoplasia. Follow this link to see a horse with facial nerve damage: note the nose pulled to horse's left. (means facial nerve damaged on right). Think more of a dropped jaw with trigeminal nerve neuropathy (CN 5-dogs, horses).

A 5 year old female spayed Cocker Spaniel is presented with a strange expression. Her right ear and lip appear to droop. There is ptosis O.D. (right eye) and the dog is drooling on the exam table. What anatomic structure is damaged? A - Right side inner ear B - Left side inner ear C - Trigeminal nerve D - Facial nerve E - Left side medulla, motor tract

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.

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, N=37.2-38.5 C] 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

The history, plus a lab pattern of low platelets, increased bleeding time and normal aPTT, PT and TT tests suggests thrombocytopenia. Idiopathic thrombocytopenia (often immune-mediated) is the most common cause of spontaneous bleeding in dogs. Twice as common in females; cockers, poodles and old English sheepdogs are predilected, but can occur in any breed. Of the common causes of coagulation disorders, only disseminated intravascular coagulation (DIC) also presents with thrombocytopenia. Follow this link to see a table of the four most important coagulation disorder patterns

A 6 year old female spayed cocker spaniel is presented with a 2 day history of lethargy. Upon physical exam mucosal petechiae and ecchymoses and an ocular hemorrhage O.D. is noted. A coagulation profile shows the following: Thrombocytes= 49,720..[N=200,000-900,000] Buccal mucosal bleeding time (BMBT), increased Activated partial thromboplastin time (aPTT), normal Prothrombin time (PT), normal Thrombin time (TT), normal What is the diagnosis? A - Anticoagulant rodenticide toxicity B - Disseminated intravascular coagulation (DIC) C - Hepatic insufficiency D - Idiopathic thrombocytopenia E - Von Willebrand's disease

This is avascular/aseptic necrosis of the femoral head (Legg-Perthes). Typically a young dog (4-11 mo.) problem of small and miniature breeds. Think of a Yorkie, Miniature poodle or Chihuahua presenting with a hind lameness and these radiographic findings. Manchester terriers have a genetic predisposition- do not breed affected animals. Unknown etiology. Typically Rx with NSAIDS, femoral head and neck osteotomy.

A 6-month old Manchester terrier is presented with a 4-week history of hindlimb lameness. A DV radiograph is shown below. What is the diagnosis? A - Congenital sacroiliac malformation/degeneration B - Lumbosacral subluxation C - Osteochondrosis D - Aseptic necrosis of the femoral head E - Coxofemoral luxation

Sacroiliac subluxation Think of sacroiliac subluxation or sprain in an athletic jumping horse with: --Intermittent hindlimb lameness localized in the croup (rump) --Evidence of back pain --Swelling over the tuber sacrale (hunter's bumps) --Crepitance felt rectally in the sacroiliac area. Horses with hunter's bumps can be sound if the injury has completely healed, but lameness can be observed if the injury is recent or has never resolved. Sometimes confused with stifle lameness. Coxofemoral luxation is rare in horses due to a deep acetabulaum and the presence of the accessory ligament of the hip, unique to horses. Overlapping vertebral spinous processes is a problem of thoracic and lumbar vertebra under the saddle area, seen in short-backed eventing horses (hunter/jumpers, dressage). Back muscle and ligament strain is the #1 cause of back pain in horses, accounting for 33% of cases. Most commonly associated with the longissimus dorsi muscle, sublumbar illiopsoas muscles and the supraspinous ligament and also seen in eventing horses.

A 6-year old Standardbred jumper is presented with a 3-month history of poor performance and intermittent shifting hindleg lameness. On physical exam, there is poor muscling of the gluteal muscles and some asymmetry to the croup (rump). The horse has a 7 cm. swelling over the hindquarters on the left dorsal side and shows pain and a reluctance to ventroflex the back when midline pressure is applied. On rectal palpation crepitation and shifting can be felt dorsally as the horse walks slowly forward. What is the diagnosis? A - Sacroiliac subluxation B - Coxofemoral luxation C - Fibrotic ossifying myopathy D - Overlapping vertebral spinous processes E - Croup myopathy (longissimus dorsi, supraspinous ligament)

Serum IgM capture ELISA for West Nile Virus. Think of the equine encephalidities in a febrile horse, especially in the fall months. Because serum antibody tests for EEE, WEE and VEE are low, West Nile virus encephalitis is the big remaining rule out. Look for variable and nonspecific signs like depression, low-grade fever and anorexia in combination with neurologic signs like head-pressing (image), ataxia (often hind-end weakness or paralysis) and visual impairment. IgM capture ELISA is the test of choice. Remember that in most states and provinces, you must REPORT a horse with clinical signs of encephalomyelitis, even if the test results are not in yet. With equine infectious anemia (EIA), think of recurrent fever, weight loss, dependent edema, petechial hemorrhages (image) and icterus. Think of ataxia and atrophy with equine protozoal myeloencephalitis (EPM) due to Sarcocystis neurona.

A 6-year old quarterhorse gelding is presented in September in North America with a three-day history of depression, poor appetite, fever and worsening gait. The owner says the horse seems weak on his hind legs, stumbles and sometimes presses his head against the wall of his stall. The horse is ataxic and hypermetric in all four legs. Serum antibody titers to EEE, WEE, and VEE are low. A Western Blot test of CSF for antibodies to Sarcocystis neurona is negative. Which one of the following diagnostic tests should be performed next? A - CSF tap and test for Japanese encephalitis B - MRI to rule out nigropallidal encephalomalacia C - Serum IgM capture ELISA for West Nile Virus D - Plasma antibody test for St. Louis encephalitis E - Serum AGID for equine infectious anemia

Oral vitamin K1. If PT or PIVKA tests elevate at 48 or 72 hours in a case-patient with suspected anticoagulant rodenticide toxicity, start oral vitamin K1 at 1.5-2.5 mg/kg q 12h or 3-5 mg/kg once daily. Continue treatment for 14 to 30 days, depending on the specific anticoagulant. Warfarin is a first generation, shorter-acting anticoagulant, brodifacuom is a second-generation long-acting anticoagulant. PT or PIVKA should be checked 48 hours after the last dose of vitamin K1. If PT or PIVKA is still elevated 48 hours after last dose (16 to 32 days postexposure), restart vitamin K1 treatment for 1 week, then recheck PT or PIVKA 48 hours after last dose. Once the PT or PIVKA is normal at 48 hours, you can stop vitamin K1 treatment. Injectable vitamin K1 has no advantage over oral vitamin K1 and can cause anaphylaxis in some animals, even when injected subcutaneously. A blood or plasma transfusion is indicated for animals that present with overt clinical signs (hemorrhage. dyspneic, pale).

A 7-year old dog weighing 24 lbs (10.9 kg) is presented after the owner caught the dog eating warfarin-containing rat poison the day before. The dog has no overt clinical signs at presentation. Baseline coagulation parameters are normal [Prothrombin time (PT), Activated partial thromboplastin time (aPTT) and Proteins induced by vitamin K1 absence or antagonism (PIVKA)]. The dog is confined to limit exercise and monitored. At 72 hours PT and PIVKA tests are elevated. Which one of the following choices is the most appropriate treatment step? A - Oral vitamin K1, SID B - Plasma transfusion C - Blood transfusion D - Injectable vitamin K1, EOD E - Activated charcoal

This is bone spavin, the number one hock problem (tarsus) in horses, an osteoarthritis of the lower hock joints, usually affecting the distal intertarsal and tarsometatarsal articulations. Etiology not clear (several theories). If horse is lame, tends to drag toe or have "stabbing" gait in hindlimb. Tarsal hydrarthrosis (bog spavin) is a chronic synovitis of the tarsocrural joint- look for swelling and distention of the joint capsule.

A 9 year old quarterhorse mare is presented with a left hind limb lameness. She tends to drag the left toe, and has a stabbing gait in that limb (adducts hindlimb, then suddenly abducts it just before the hoof hits the ground). There is a firm swelling of the left lower hock joint (tarsus). What is the common name for this problem? A - Bone spavin B - Tarsal hydrarthrosis C - Osselets D - Ringbone E - Splints

Osteosarcoma Osteosarcoma characteristically creates boney lysis as well as boney production, and usually does not cross the joint space. Click here to see a radiograph of osteosarcoma. In general, osteosarcoma is less aggressive in cats than it is in dogs. In cats with appendicular osteosarcoma, amputation alone has a median survival time of more than 2 years. In contrast, median survival of dogs is only 4-5 months after amputation alone, and 10-12 months with amputation plus chemotherapy. Osteomyelitis most commonly involves fever, lethargy and cutaneous draining fistulous tracts. Osteomyelitis usually does cross the joint space. Click here to see a radiograph of osteomyelitis (distal PII-PIII phalange). Anterior cruciate ligament tears localize in the stifle joint causing instability ("drawer sign"), effusion, and degenerative changes. UNcommon in cats. Immune-mediated joint disease most commonly affects multiple joints. Septic arthropathy often is triggered by a penetrating bite or foreign body, leading to external swelling redness and inflammation or can be secondary to post-surgical contamination or hematogenous spread. Though highly variable in its presentation in the Southwest U.S. (desert), coccidioidomycosis may present with lameness in cats. Most commonly see systemic signs like fever, inappetence, weight loss and skin problems (draining skin lesions, SQ granulomatous masses, abscesses).

A 9 year old spayed female domestic shorthair cat is presented with a 5 month history of progressive right rear lameness. Apart from the worsening lameness, the cat acts normally and has a normal appetite. T=101.3 F (38.5 C)..[N=100-103.1 F, N=37.8-39.5 C] HR=120 bpm...........[N=100-140] RR=36 brpm...........[N=16-40] Physical examination reveals pain and swelling localized to the distal femur. Radiographs demonstrate a mixed lytic lesion in the distal femur that does not cross the joint space. What is the most likely presumptive diagnosis? A - Osteosarcoma B - Osteomyelitis C - Anterior cruciate ligament tear D - Immune-mediate joint disease E - Septic arthropathy

Avian influenza, also called fowl plague, is the most likely diagnosis. This virus can either be of low pathogenicity (most common) or highly pathogenic. Viruses of low pathogenicity typically cause subclinical or mild respiratory disease. The case above is due to a highly pathogenic strain of avian influenza. Infectious bronchitis is characterized by respiratory symptoms and is a differential for infection with an avian influenza strain of low pathogenicity. Refs: Cornell University College of Veterinary Medicine Atlas of Avian Diseases: Avian Influenza and the Merck Vet Manual 10th ed. online; Image courtesy Cornell University College of Veterinary Medicine Atlas of Avian Diseases.

A chicken farm has had several ill and dead birds over the past week. Examination of the sick chickens shows severe depression, ecchymoses and edema of the comb and wattles, green diarrhea, and some are unable to walk with absent perching reflexes. Which one of the following choices is the most likely diagnosis? A - Avian encephalomyelitis B - Avian influenza C - Infectious coryza D - Infectious bronchitis E - Mycoplasma gallisepticum

This is a classic scenario of an outbreak of pleuropneumonia, caused by Actinobacillus pleuropneumoniae.

A commercial pig farm experiences an explosive outbreak of respiratory disease with high mortality, primarily in young pigs under 6 months of age. Affected pigs show severe respiratory distress, fever up to 107°F (41.5°C), anorexia, and reluctance to move. Some animals display open-mouth breathing with a blood-stained, frothy nasal and oral discharge. On necropsy, the lungs are bilaterally dark and swollen and ooze bloody fluid from the cut surface. Which one of the following choices is the most likely diagnosis? A - Actinobacillus pleuropneumoniae B - Fusobacterium necrophorum C - Mycoplasma hyopneumoniae D - Haemophilus parahaemolyticus E - Swine influenza

Thoracolumbar T3-L3 . This is likely to be Schiff-Sherrington syndrome ie: severe spinal cord trauma T3-L3, with thoracic limb extensor rigidity and hind limb flaccid paralysis. Lesion is caudal to T2, but inhibitory neurons in lumbar spinal cord (especially L2-L4) affect neurons in the cervical intumescence ( C6-T2). With severe trauma T2-T13, inhibitory pathways are interrupted; Cervical intumescence neurons are "released" and cause extensor hypertonia in the forelimbs. Can localize by checking cutaneous trunci reflex-The lesion is usually 1-2 vertebrae cranial to the line of analgesia (where dog does not feel pinching skin).

A dog hit by a car presents with stiff hypermetric forelimbs and flaccid, paralyzed hindlimbs. Where is the lesion likely to be? A - Cranial cervical: C1-C5 B - Cervicothoracic: C6-T2 C - Thoracolumbar T3-L3 D - Lumbosacral L4-S3 E - Cannot tell without more information

Diphenhydramine hydrochloride Diphenhydramine hydrochloride. Metoclopramide crosses the blood-brain barrier, where dopamine antagonism at the medullary chemoreceptor trigger zone (CTZ) causes an antiemetic effect. This dopamine antagonism can also cause adverse extrapyramidal signs, like involuntary muscle spasms, motor restlessness and inappropriate aggression. If recognized in time, extrapyramidal signs can be reversed by restoring the dopamine-acetylcholine balance with the anticholinergic action of an antihistamine like diphenhydramine hydrochloride. The pyramidal and extrapyramidal systems are a complex series of upper motor neurons (UMN) that connect the cerebral cortex to distant body parts and influence muscular tone and control. The pyramidal system controls skilled muscle movement. The extrapyramidal system helps support the body against gravity (posture) and recruits spinal reflexes to initiate voluntary movement.

A dog that was treated for vomiting with metoclopramide is now displaying involuntary muscle spasms and inappropriate aggression. Which one of the following choices is most appropriate to help reverse the adverse effects? A - Diphenhydramine hydrochloride B - Telazol (tiletamine-diazepam combination) C - Yohimbine D - Ketamine E - Acepromazine

Circovirus, a nonenveloped DNA virus was first described in Canada in 1991 and causes postweaning multisystemic wasting syndrome (PMWS). The virus is also associated with porcine dermatitis and nephropathy syndrome caused by necrotizing vasculitis, which is more prominent in the skin, renal pelvis, mesentery, and spleen.

A farmer has a few 8-12 week old pigs with weight loss, diarrhea, and a few with expiratory dyspnea. Several pigs with similar symptoms have died recently. Mucous membranes are pale, and inguinal lymph nodes are enlarged. Which one of the following viruses is the most likely causative agent? A - Herpesvirus B - Parvovirus C - Manangle virus D - Circovirus E - Paramyxovirus

This is atlantoaxial instability. There is increased distance between the cranial aspect of the dorsal spinous process of C2 and the caudal aspect of the dorsal arch of C1 indicating instability of C1-C2. Atlantoaxial instability is usually seen in toy dog breeds under a year or two of age. Caudal occipital malformation involving the foramen magnum is seen most often in Cavalier King Charles Spaniels.

A five-month-old Yorkshire terrier is presented with ataxia in all four limbs and neck pain. There is loss of conscious proprioception in all four limbs. A radiograph of the cervical spine is shown below. Which one of the following choices is the most likely diagnosis? A - Atlantoaxial instability B - Caudal occipital malformation C - Intervertebral disk disease D - Discospondylitis E - Spina bifida

Mast cell tumor This cytology slide shows mast cells full of purple histamine granules, suggesting a mast cell tumor. Grossly, appearances are highly variable and mast cell tumors can be mistaken for skin tags or lipomas. Skin and subcutaneous masses should always be examined cytologically. These tumors can range from low grade to highly aggressive with local recurrence or lymph node metastasis. Transmissible venereal tumors are often papillary or nodular in appearance. Cytologically they are a round cell tumor with large, central nucleoli.

A five-year-old Boxer dog presents for routine vaccinations. The owner points out a small, smooth mass on the right ear. Fine needle aspiration cytology is shown below. Which one of the following choices is the most likely diagnosis? A - Mast cell tumor B - Transmissible venereal tumor C - Bacterial inflammation D - Lymphoma E - Pyogranulomatous inflammation

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, you may see "wrinkled eggs" with infectious 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. Another name for Candidiasis is thrush. Think Candida albicans, thickened mucosa, whitish, raised pseudomembranes in crop, mouth and esophagus.

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

Digital exam of rectum. Foals with meconium impaction will swish their tail from side to side, roll, and strain to defecate. A digital exam of the rectum will aid in rapid diagnosis. Meconium impaction is the most common cause of colic in the newborn foal, typically seen within 24 hours of birth. More common in colts (males) than fillies because colts have a smaller pelvis.

A foal born 12 hours ago is observed swishing its tail from side to side, straining with an arched back and rolling on the stall floor. What test is indicated to rule in the presumptive diagnosis? A - Succussion of right caudal abdomen B - Cystocentesis C - Digital exam of rectum D - Endoscopy of gastric mucosa E - Ultrasound of umbilicus/urachus

Right middle/inner ear A lesion of the right middle/inner ear could cause ipsilateral Horner's syndrome (miosis, ptosis, enophthalmos), facial nerve paralysis, and vestibulopathy. Otitis Media and Interna is the most common cause of disease in this area, but neoplasia can also occur in the middle/inner ear. A brachial plexus avulsion can also cause an ipsilateral Horner's syndrome, but not facial nerve paralysis or vestibulopathy.

A fourteen-year-old cat presents with a protruded nictitating membrane and miotic pupil on the right. There is an absent right palpebral reflex and a right head tilt. The physical, ophthalmologic, and neurological exams are normal. Where is the lesion? A - Right middle/inner ear B - Right medulla oblongata C - Right brachial plexus D - Left brachial plexus E - Left cavernous sinus

Avian pox, also known as Fowlpox. This disease is not contagious to humans. There are two forms of the disease - 1) cutaneous or dry pox has low mortality, with proliferative lesions on comb, wattles, etc, and 2) diphtheritic or wet pox that causes yellow canker lesions on mucous membranes, tongue, esophagus, or trachea. Fowl cholera causes swellings and abscesses in the comb and wattles, but also affects the respiratory tract. The mortality can be high.

A group of chickens presents with scabby, proliferative, and ulcerative lesions on the comb, wattles, eyelids, feet, and legs. Mortality is low. Which one of the following choices is the most likely diagnosis? Image courtesy, Cornell University College of Veterinary Medicine Atlas of Avian Diseases. A - Fowl cholera B - Marek's disease C - Infectious coryza D - Avian pox E - Fowl plague

Tuberculosis Tuberculosis due to Mycobacterium avium is the most common cause of these findings. M. avium is challenging to control in zoos and poultry flocks, because treatment may not be effective. A 3-month quarantine of all new additions to the aviary is strongly recommended. Histomoniasis can produce caseous lesions similar to that of tuberculosis, but usually only involves the ceca and liver of galliform birds, especially turkeys and chickens. Histomoniasis is also known as blackhead.

A sandhill crane from a local zoo dies after a period of chronic weight loss and weakness. Nodular lesions are discovered in the liver and spleen. Which one of the following choices is the most likely diagnosis? A - Tuberculosis B - Fowl cholera C - Histomoniasis D - Spirochetosis E - Lymphoid leukosis

Trixacarus caviae Trixacarus caviae causes the most severe dermatitis of all guinea pig ectoparasites. Ivermectin treatment is usually successful but is used off label. Scurvy (hypovitaminosis C) can occur in guinea pigs as they rely on dietary intake of vitamin C. Clinical signs include diarrhea, joint pain, alopecia, petechiae, weight loss, hypertriglyceridemia, hypercholesterolemia, and skeletal muscle hemorrhage.

A guinea pig is presented for seizure-like activity. On closer observation the guinea pig is not having a seizure but is actually severely pruritic. It also has hyperkeratosis and generalized alopecia. Which one of the following choices is the most likely diagnosis? A - Klossiella cobayae B - Copper deficiency C - Follicular ovarian cysts D - Scurvy E - Trixacarus caviae

Toxoplasma gondii infection can cause severe abortion storms in sheep. Clinical signs pathognomonic of T. gondii are bright to dark red cotyledons with white foci of necrosis; the intercotyledonary areas of placenta are normal. With Brucella and Histophilus ovis the abortion rate is much lower. Abortion caused by Listeria spp. is associated with the feeding of silage. Refs: Youngquist and Threlfall, Current Therapy in Large Animal Theriogenology 2nd ed. pp. 667-80, Pugh and Baird's Sheep and Goat Medicine 2nd ed. pp. 220-1 and the Merck Veterinary Manual online edition.

A herd of ewes has had an abortion storm in which 80% of animals are affected, all stages of gestation are affected, and lambs that are born are very weak. On the placentas, cotyledons have white foci of necrosis. Which one of the following choices is the primary differential diagnosis? A - Listeria monocytogenes B - Brucella C - Chlamydiosis D - Histophilus ovis E - Toxoplasma gondii

Pyelonephritis This is the clinical picture of a cow with early signs of pyelonephritis. Onset is typically insidious. The first clinical sign may be passage of blood-stained urine (hematuria) in an otherwise normal animal. As infection (usually Corynebacterium spp.or E. coli) ascends up the ureters into the kidney, the cow may display frequent attempts to urinate, anorexia, a slight fever, loss of production, colic, restlessness, tail switching, polyuria, more hematuria or pyuria. Early in the disease, enlarged ureters and involvement of the kidney may not be detectable on rectal palpation. In chronic cases, the left kidney may be enlarged, with loss of lobulation and pain. The cow may show colic, diarrhea, polyuria, polydipsia, stranguria, and anemia.

A multiparous cow that calved two months ago is presented with a history of blood-stained urine for the last week. Today, the cow is off-feed and colicky, switching her tail restlessly and urinating frequently. T=103.8 F (39.9 C)..[N=101.5-103.5 F, N=37.2-39.2 C] HR=70 bpm.............[N=55-80] RR=32 brpm............[N=10-30] A cowside dipstick test shows hematuria and proteinuria. The bladder, ureters and left kidney feel grossly normal on rectal exam. Which one of the following choices is the most likely diagnosis? A - Pyelonephritis B - Pyometra C - Polycystic kidney disease D - Leptospirosis E - Dioctophyma renale

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

A necropsy of 16 month old female guinea pig with a 2-week history of anorexia, diarrhea, lethargy and weakness reveals the following. What is the diagnosis? A - Ketosis B - Vitamin C deficiency C - Cholecalciferol toxicity D - Metastatic calcification E - Nutritional muscular dystrophy

According to the AVMA's Principles of Veterinary Medical Ethics (2008 revision) "Ethically, the information within veterinary medical records is considered privileged and confidential. It must not be released except by court order or consent of the owner of the patient. Veterinarians should secure a written release to document that request."

A person calls to to say she adopted a friend's dog and requests a copy of the dog's medical record and radiographs. The former owner is a client at your clinic. Which one of the following choices is the most appropriate action to take? A - Require original owner consent or court order to release information B - Give caller a copy of medical record only C - Give caller a copy of medical record and radiographs D - After physical exam, start a new medical record documenting previous issues E - Give a summarized record with personal identifiers (vet, owner names) blocked out

This calf has congenital hypotrichosis of Herefords, an autosomal recessive genetic problem. Hereditary hypotrichosis can be differentiated from the other disease choices because the dermis of the calf is normal in appearance. Baldy calf disease is an inherited problem of Holsteins. The calves may lose hair, have thickened skin and metabolic illnesses. Refs: Smith, Large Animal Internal Medicine, 3rd ed., p. 1849 and the Merck Veterinary Manual online edition, Image courtesy Dr. Lisle George copyright 20112.

A registered Hereford cow on pasture gave birth to this calf with a very short, curly, frosted-looking pale coat and normal-appearing skin. By two weeks of age, some of the hair is falling out. Which one of the following choices is the most likely explanation for its appearance? A - Congenital hypotrichosis B - Ichthyosis C - Baldy calf syndrome D - Zinc deficiency E - Normal appearance until 21 days of age

These are normal age related changes. Rats normally live two to three years, though some may live to five years of ag With age, the hair coat of white rats normally develop yellowing fur. They may also show a brownish, granular sebaceous secretion at the base of affected hair shafts which an owner may mistake for a skin parasite.

A three year old white rat is presented with yellowing fur and a brownish, granular sebaceous secretion at the base of affected hair shafts. What should the owner be told? A - Moisture-related dermatitis, cage needs more frequent cleaning B - Staph dermatitis, responsive to antiseptic shampoo C - Common manifestation of chorioptic mange D - Normal age-related change E - Probable ringworm, resolves spontaneously with sunlight exposure

Sick sinus syndrome. The "seizure-like" episodes, after questioning the owner further, were actually syncopal episodes. Syncope lacks muscle activity and post-ictal behavior. Older female Miniature Schnauzers tend to be overrepresented with sick sinus syndrome. The ECG here shows sinus arrest with bradycardia and tachycardia. First degree AV block is characterized by an increased PR interval. Second degree AV block consists of occasional P waves not followed by QRS complexes. Refs: Cote, Clinical Veterinary Advisor-Dogs and Cats, 3rd ed. pp. 938-40 and the Merck Veterinary Manual online edition. Image courtesy, Nottingham Vet School.

A twelve-year-old female spayed miniature schnauzer presents with a history of seizure-like episodes. Physical exam reveals an irregular heart beat. CBC and panel are unremarkable except for a mild triglyceridemia. ECG is shown below. Which one of the following choices is the most likely diagnosis? A - Sick sinus syndrome B - Atrial fibrillation C - First degree AV block D - Ventricular tachycardia E - All of these

This is the classic "valentine heart" of feline hypertrophic cardiomyopathy (HCM). Note the high RR and HR. HCM is typically seen in cats 5-7 years old, more often in males. HCM is not always symptomatic; it can be an incidental finding. Cause unknown. Look for thickened L. ventricle wall on echocardiography. Follow this link to see thickened L ventricle on necropsy May see secondary pulmonary hypertension, edema, pleural effusion. DDX includes hyperthyroidism, systemic hypertension, acromegaly, congenital aortic stenosis. Systolic murmur loudest on L betw 5th-6th suggests MITRAL valve insufficiency (left AV). Aortic insufficiency is DIASTOLIC. Tricuspid valve murmurs (right AV) are loudest on the RIGHT (See Blackwell's, p. 905, Tschauner p. 212 for excellent murmur DDX tables). Taurine deficiency is associated with dilated cardiomyopathy (DCM) in cats. Think more of LARGE BREED DOGS with DCM. When cats with HCM have clinical signs, they are generally consistent with congestive heart failure. The "valentine" radiograph helps point you to the specific diagnosis of HCM.

An 8-year old male neutered domestic shorthair cat is presented with a one-month history of progressive exercise intolerance, panting, anorexia, weight loss and vomiting. On physical exam there is moderate cyanosis and a jugular pulse. On chest auscultation there is a systolic murmur loudest on the left side between the 5th and 6th intercostal space. T=102.1 F (38.9 C)..[N=100-103.1, N=37.8-39.5 C] HR=195 bpm...........[N=100-140] RR=45 brpm...........[N=16-40] A DV chest radiograph looks like the image below. What is the diagnosis? A - Endocardial fibroelastosis B - Aortic insufficiency C - Hypertrophic cardiomyopathy D - Tricuspid insufficiency E - Taurine deficiency

This dog has osteosarcoma. This is a good reminder that osteosarcoma can occur almost anywhere, in spite of the mnemonic that osteosarcoma usually occurs away from the elbow and near the knee. There is a large, expansile, destructive osseous lesion of the distal right tibia with cortical destruction most severe at the caudal and medial margins. There is also mild, irregular periosteal proliferation and soft tissue thickening at the site. This lesion is characteristic of a primary bone tumor. The location and expansile destructive pattern are features to look for. A fungal osteomyelitis would tend to have more productive bone, and is often multifocal.

An 8-year-old female Saint Bernard is presented with right pelvic limb lameness and swelling above the hock. Which one of the following choices is the most likely form of neoplasia based on radiographic appearance and incidence of occurrence? A - Fibrosarcoma B - Lymphosarcoma C - Hemangiosarcoma D - Osteosarcoma E - Chondrosarcoma

The ECG shows a 3rd degree atrioventricular block (also called a complete atrioventricular block). Note many p waves, few QRS complexes (probably ventricular escape beats). Essentially, the atria and ventricles beat independently of each other. Short-term Rx is glycopyrrolate, an anticholinergic. Prognosis for most 3rd degree heart block patients is fair to poor. Atrial standstill occurs when the atria are completely unable to depolarize. There will be NO P waves on the ECG and no atrial fibrillation. Follow this link to ECG of atrial standstill. Note the bradycardia and LACK of P waves. In any patient with atrial standstill, it is vital to check serum potassium concentration. Hyperkalemia severe enough to produce atrial standstill is a medical emergency. By exclusion, if a patient with atrial standstill lacks high serum potassium, atrial myopathy is likely. Refs: Blackwell's 5-Min Vet Consult Canine Feline, 4th ed. pp. 136-67, 286-7, Pasquini's, Tschauner's Guide to Small Animal Clinics, vol 1, 2nd ed. p. 258-9 and the Merck Veterinary Manual online edition. Image courtesy of Dr. Terri DeFrancesco, .

An ECG in a middle-aged Pekinese dog that is shocky and weak shows the following. What is the diagnosis? A - Atrial standstill B - Third degree atrioventricular block C - Supraventricular tachycardia D - Supraventricular premature depolarization E - Sick sinus syndrome

Skin scraping & microscopic exam Like most other species, South American camelids get sarcoptic mange (scabies). A skin scrape and microscopic exam can rapidly confirm the diagnosis. Treatment is an avermectin-family drug, SQ every 2 weeks. One report suggests amitraz is also effective. If you see a severely pruritic dog that looks like this, think of canine sarcoptic mange. If you see a severely pruritic cow that looks like this, think of bovine sarcoptic mange. In contrast, some things may look like mange, but aren't. The dog in this image is NOT pruritic, he is severely affected with dermatophytosis (ringworm). A skin scrape will help tell you the difference.

An alpaca is presented in poor body condition with an unkempt coat, patchy alopecia and severe pruritis and crusting of the extremities. A photo of an affected limb is shown below. What is the most appropriate diagnostic step? A - Tell Yoda you found his brother B - Test skin crusts for contagious ecthyma parapoxviruses C - Check thyroid status and bluetongue titers D - Punch biopsy E - Skin scraping and microscopic exam

Bronchial Feline asthma classically demonstrates a bronchial lung pattern on thoracic radiographs (or broncho-interstitial). The hallmark of a Bronchial pattern is irregularly thickened walls of bronchioles that look like "donuts" end-on or "tram tracks" side-on. For an excellent visual summary of bronchial pattern, see Dr. Allison Zwingenberger's Vet Radiology site. The other 3 basic lung patterns are: 1. Alveolar pattern, characterized by "air bronchograms". 2. Interstitial pattern, characterized by decreased visualization of pulmonary vessels, cardiac and diaphragm silhouettes. 3. Vascular pattern can suggest either hypervascularity or hypovascularity. Click here to see a vascular lung pattern in the caudodorasal lung fields of a dog with severe heartworm.

An older adult cat is presented with a chronic history of coughing, wheezing, tachypnea and intermittent respiratory distress, suggesting a diagnosis of feline asthma. What thoracic radiographic pattern is most likely to be prominent? A - Bronchial B - Alveolar C - Interstitial D - Vascular E - Mixed alveolar-vascular

3.5-4 years 3.5 to 4 years. Cows DO have canine teeth but they look like incisors. REFERENCES VARY by about 6 months, because the times of tooth eruption also vary among different individual animals. 1st permanent incisors (I1-centrals) erupt at 1 to 1.5 years 2nd permanent incisors (I2-medials) erupt at around 2 to 2.5 years I3-laterals erupt at roughly 3.5 years. Permanent canines (which look like a 4th set of incisors in ruminants) come in around 3.5 to 4 years. FULL eruption of a new tooth may take another 6 months. One reference, (Pasquini) suggests this approximate, but easy-to-remember rule of thumb for FULLY erupted permanent incisors in cows: I1-2 yr, I2-3 yr, I3-4 yr

At what age do a cow's permanent canine teeth begin to erupt? A - Cows don't have canines B - 2 to 2.5 years C - 3 years D - 3.5 to 4 years E - 5-6 years

Amblyomma americanum (tick) The lone star tick, Amblyomma americanum transmits Cytauxzoonosis to cats. Disease is caused by the protozoan parasite Cytauxzoon felis infecting macrophages and red blood cells. The bobcat (Lynx rufus) is the natural host, typically experiencing subclinical infection. Clinical signs include depression, lethargy, anorexia, fever, and death without treatment. Diagnosis is made by identification of schizonts within macrophages or merozoites within erythrocytes in a blood smear. Earlier diagnosis may be made by examining aspirates of lymph nodes, spleen, or bone marrow if there is a clinical suspicion. Treatment includes supportive care and a combination of atovaquone and azithromycin. Some survivors remain persistently infected. Culex spp mosquitoes can transmit different equine viral encephalomyelitidies, like West Nile virus, Western equine encephalitis and Eastern equine encephalitis.

Cytauxzoon felis, the protozoan cause of cytauxzoonosis, is transmitted by which one of the following? A - Ctenocephalides felis, (flea) B - Anopheles gambiae, (mosquito) C - Culex spp, (mosquito) D - Phlebotomus spp and Lutzomyia spp, (Sandflies) E - Amblyomma americanum, (tick)

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.

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

Normal male crias are born with adhesions between the free end of the penis and the prepuce. As they sexually mature these adhesions gradually detach, so puberty can be seen clinically when the penis can be completely exteriorized. Castration prior to puberty may result in continued adhesions. In Peru, males are not generally used for breeding until 3 years of age. Male llamas reach puberty at approximately 21 months (range 9-31 months). Alpacas mature earlier, around 12 months of age.

During examination of a newborn male cria, adhesions between the free end of the penis and the prepuce are noted. What is the most likely explanation? A - Normal finding B - Common congenital malformation of preputial ring, associated with phimosis C - Secondary to stress in utero, 5th month D - Failure of separation of preputial diverticulum E - Sequella of hypospadias; Heritable

This is one of the 5 classic "anemia / edema " presentations of horses. (Remember "Big 3 are PEE" Purpura, EIA, EVA; 2 minors are Babesia, ehrlichia (now renamed Anaplasma). Inclusion bodies in the neutrophils of a California horse with icterus and petechiae and an undulating fever says Equine granulocytic ehrlichiosis (EGE). Originally classified as Ehrlichia equi, but is NOW called ANAPLASMA phagocytophilum due to DNA sequencing studies. EGE is a seasonal necrotizing vasculitis (edema, icterus, petechiae) seen in N. California, suspected to be tick borne. See dependent edema with Equine viral arteritis (EVA), but also should see respiratory presentation (conjunctivitis/pinkeye, rhinitis) +/- abortions. Equine infectious anemia (EIA) is rarely seen today because of testing programs, but could present this way. Less likely because 92% cases seen around the Gulf of Mexico states (Texas to Florida), Mississippi river valley AND no inclusion bodies. Purpura hemorrhagica is a type III Antigen/Antibody/Complement complex disease causing vascultis, petechia, purplish discoloration, usually afebrile, with Hx of recent Strangles (Strep equi equi) or bacterin vaccination. Equine Babesiosis presents more as a hemolytic anemia: seen in the S. USA, endemic in Southern FLORIDA

During the fall, a 5 year-old standardbred mare from northern California is presented with a 5-day history of depression, partial anorexia and undulating fever between 102-106 F (38.9-41.1 C)..[N=99-101.3 F, N=37.2-38.5 C]. Physical exam reveals mucosal petechiae and icterus. The horse has edematous hindlimbs and appears reluctant to move. Blood drawn for a complete blood count shows inclusion bodies in the neutrophils. What is the diagnosis? A - Equine Babesiosis B - Equine ehrlichiosis C - Equine viral arteritis (EVA) D - Purpura hemorrhagica E - Equine infectious anemia (EIA)

Spirocerca lupi A disease of dogs in the Southern U.S. and tropical climates, Spirocerca lupi (esophageal worms) make reactive granulomas of variable size in the esophageal, gastric or aortic walls. Spirocercosis may also lead to aneurysm in the thoracic aorta or an ossifying spondylitis of the posterior thoracic vertebrae. Typically asymptomatic, but large granulomas can cause esophageal obstruction. Large granomas may become neoplastic (osteosarcoma, fibrosarcoma). Some dogs develop spondylitis or enlargement of the extremities characteristic of hypertrophic osteopathy. All four of the other choices are gastric parasites. Ollulanus tricuspis is an uncommon gastric parasite of cats. Physaloptera spp. is a stomach worm that may cause vomiting, anorexia, dark feces in dogs and cats. Haemonchus spp., Ostertagia spp. and Trichostrongylus spp. are found in the abomasum of ruminants. Gastrophilus spp. are the larvae of horse bot flies, found in the stomach of horses.

During the necropsy of an 8 year-old mixed breed dog from the Southern United States, reactive granulomas in the esophagus containing bright red worms, 40 mm to 70 mm long are found. What is the diagnosis? A - Ollulanus tricuspis B - Haemonchus placei C - Spirocerca lupi D - Gastrophilus spp. E - Physaloptera spp.

Feline leukemia virus seropositive and seronegative cats share similar response rates to initial treatment with chemotherapy for lymphoma. Lymphoma remission rates are higher and survival times are shorter for cats with FeLV compared with FeLV negative cats. Most U.S. cats with mediastinal, multicentric, or spinal forms of lymphoma are FeLV-positive.

Feline leukemia (FeLV) status has been shown to affect many aspects of disease progression and treatment of lymphoma. FeLV seropositive cats with lymphoma are similar to FeLV seronegative cats with lymphoma in which one of the following aspects? A - Remission rates B - Treatment response C - Survival time D - Prevalence of gastrointestinal lymphoma E - Prevalence of mediastinal lymphoma

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 ascarid infestations, larvae can cause pulmonary edema, consolidation, severe respiratory distress. May see icterus. 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.

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

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.

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

Oxalates are found in Sarcobatus vermiculatus (Greasewood). Greasewood toxicity is seen primarily in sheep, sometimes in cattle, usually when large amounts are consumed over a short period of time. Oxalates occur in plants as salts of calcium, sodium, and potassium. Calcium oxalate is insoluble and is lost through the GI tract. Sodium and potassium oxalates are soluble and either 1) bind to calcium in the rumen and lost through the GI tract, or 2) are absorbed and react with calcium in body fluids. Death is attributed to hypocalcemia and/or kidney failure caused by calcium oxalate crystals in the renal tubules. Signs of oxalate toxicity include: dullness, lowering of the head, loss of appetite, separation from the herd; followed by excessive salivation with frothing, progressive incoordination; and finally, coma, irregular breathing, and death. Oxalate containing plants include: Sarcobatus (greasewood), Oxalis (sorrel), Rumex (dock), Halogeton, Amaranthus (pigweed), and Chenopodium (lambsquarter.) Oxalates are also produced by molds (Aspergillus niger) in contaminated feeds. Delphinium spp.(Larkspur) contain alkaloids. Hypericum perforatum (Klamathweed) contain hypericin. Hordeum spp.(Foxtail) cause physical injury. Solanum spp.(Nightshade) contain alkaloids. Click here to see an image of Greasewood. Click Here to see the Merck Table of Poisonous Range Plants of Temperate North America.

Oxalate is the toxic agent found in which one of the following plants? A - Hypericum perforatum (Klamathweed) B - Delphinium spp (Larkspur) C - Sarcobatus vermiculatus (Greasewood) D - Hordeum spp (Foxtail) E - Solanum spp (Nightshade)

Penicillin IM for all rabbits, 5-7 days Treat ALL rabbits with parenteral (IM) penicillin when there is an outbreak of Treponema cuniculi (tremponematosis). Tetracycline or chloramphenicol are also effective AVOID oral antibiotics in rabbits, which can upset normal gram-positive gut flora. Particularly avoid lincosamide antibiotics like Clindamycin and Lincomycin, which target gram-postive bacteria and are specifically contraindicated in rabbits and rodents

Several rabbits in a commercial meat operation have developed genital scabs, perineal ulcerations a crusty exudate around the nose and eyes. Microhemaglutination tests are positive for treponematosis. Which one of the following steps is most effective to treat this problem? A - Clindamycin PO for exposed rabbits, 8 days; Cull affected animals B - Penicillin IM for all rabbits, 5-7 days C - Amipcillin PO for affected rabbits, 10-14 days D - Amprolium-medicated feed for whole herd, 2 weeks; Increase ventilation E - Isolate affected animals, Lincomycin in water 2-3 weeks

This is a typical case of foothill abortion, also called epizootic bovine abortion. The condition is common in the coastal and Sierra Nevada foothills, and throughout much of the western United States. It is the most common cause of abortion in California beef cattle. The etiologic agent has not been identified with certainty. Research suggests that it is a delta protobacteria with DNA homology to bacteria of the vibrio genus. Pregnant cattle exposed to thymic tissues from aborted fetuses can be protected from abortion by feeding tetracycline through the early stages of pregnancy. The agent is transmitted by the soft shelled Pajahuello tick (Ornithodorus coriaceus). The disease occurs predominantly in heifers. Infection develops during the first trimester of pregnancy while abortions occur later around the 5th to 9th month. Exposed cattle develop immunity, but it is not known how long protection lasts. However, abortion does not often recur in these animals. The presence of petechial hemorrhages and lymphadenopathy in a late-term aborted fetus is suggestive of foothill abortion. Neospora is another common abortifacient of beef cattle, but does not produce lymhadenopathy or petechiae in the fetus. Leptospirosis, brucellosis, and pine needles also do not produce the same pathologic lesions as the foothill agent.

This calf was aborted at 7.5 months pregnancy in early fall. The dam was a primiparous beef animal housed on pasture in Northern California. Necropsy revealed multiple petechial hemorrhages on the palate and scleral mucus membranes of the fetus, and marked lymphadenopathy. The calf was not decomposed; the cow retained the placenta. [image] Which one of the following choices is the most likely diagnosis of the abortion in this case? A - Leptospira pomona B - Brucella abortus C - Neospora caninun D - Pine needles E - Foothill abortion agent

An experienced practitioner can reliably feel fremitus (vibration in uterine artery of the gravid uterine horn) between 90-120 days. An experienced practitioner can reliably feel the "membrane slip" of chorioallantoic membranes rectally at 30-35 days; can feel placentomes around 70-75 days. One way to remember these is that the EARLIEST occurs in REVERSE alphabetical order ie: Slip 30-35 days Placentomes 70-75 days Fremitus 90-120 days

What is the earliest stage post-breeding that an experienced practitioner can reliably feel fremitus rectally in the uterine artery of the gravid uterine horn in a pregnant cow? A - 60-75 days B - 45-60 days C - 70-80 days D - 120-150 days E - 90 -120 days

Stephanurus dentatus Stephanurus dentatus, is the swine kidney worm. Found worldwide, particularly in tropical and subtropical areas. Seen in the U.S. as a parasite of pigs raised outside in the southeastern and southcentral states. Click here to see these large worms (2-4.5 cm long) encysted in pairs along the ureters from the kidney to the bladder (courtesy of the UPenn CAL site)

What is the proper name for the swine kidney worm? A - Capillaria plica B - Stephanurus dentatus C - Dioctophyma renale D - Gnathostoma spinigerum E - Trichinella spiralis

Photosensitization This is photosensitization of non-pigmented skin. Note how the brown areas are more protected, but the skin of the white muzzle has sloughed off. Click here to see overview on photosensitization in cattle. Courtesy of NADIS. The most common causes are from toxic plants. Primary photosensitization is caused by photodynamic substances in the plant itself. Secondary photosensitization is caused by plant-related hepatic damage, which releases photodynamic substances like phylloerythrin, a breakdown of product chlorophyll. Secondary photosensitization is much more common than primary. Examples of primary photosensitizers are hypericin from Hypericum perforatum (St. John's wort) and fagopyrin from Fagopyrum esculentum (buckwheat). Causes of secondary photosensitization include common bile duct occlusion, facial eczema (pithomycotoxicosis), mycotoxic lupinosis and pyrrolizidine alkaloids.

What is wrong with this horse? A - Photosensitization B - Ulcerative dermatosis C - African horse sickness D - Ryegrass toxicity E - Equine vesicular stomatitis

Cornual Typically a cornual nerve block (branch of the trigeminal- midway between eye and base of horn, just below temporal line) will anesthetize most cows for dehorning. If that is not enough, do a ring block around the base of the horn. In contrast, for goats you need to block BOTH the cornual nerve (caudal ridge, root of zygomatic arch of frontal bone) and infratrochlear nerve (dorsomedial to eye, close to edge of bony orbit) before dehorning. This is because the goat horns lie more rostral on the skull and closer to the bony orbits than the horns of a cow.

What nerve(s) need to be blocked in order to dehorn cattle? A - Cornual B - Infratrochlear C - Auriculopalpebral D - Cornual and Infratrochlear E - Auriculopalpebral and Infraorbital

Ferrets Ferrets are susceptible to acetaminophen toxicity. Like cats, ferrets metabolize acetaminophen slowly because they are deficient in glucuronyl transferase. There are unsubstantiated web reports of pot bellied pigs reacting poorly to acetaminophen, but we have not yet seen peer-reviewed papers to verify this. There are recommended acetaminophen dosages for dogs, rabbits, rodents and guinea pigs, but high doses ARE toxic to dogs and other animals, so don't overdo it. In cats, toxicity can occur with 10-40 mg/kg. In one report, 3 of 4 dogs showed clinical signs of methemoglobinemia at 200 mg/kg, but toxicity can be seen at lower dosages with repeated exposures.

Which animal is considered to be as susceptible to acetaminophen toxicity as cats? A - Dogs B - Rabbits C - Hamsters D - Ferrets E - Rats

Spirocerca lupi A disease of dogs in the Southern U.S. and tropical climates, Spirocerca lupi (esophageal worms) make reactive granulomas of variable size in the esophageal, gastric or aortic walls. Large granulomas may become neoplastic (osteosarcoma, fibrosarcoma). Some dogs develop spondylitis or enlargement of the extremities characteristic of hypertrophic osteopathy. Typically asymptomatic, but large granulomas can cause esophageal obstruction. Spirocercosis may also lead to aneurysm in the thoracic aorta or an ossifying spondylitis of the posterior thoracic vertebrae. Habronema spp. (Habronema muscae, H. microstoma and Draschia megastoma) in horses can cause tumorlike stomach nodules and sometimes cutaneous lesions. Blastomycosis, most common in dogs, cats and humans is characterized by pyogranulomatous lesions in various tissues. Placental infection in horses with Coccidioides immitis have been described, leading to abortion and osteomyelitis.

Which choice is associated with osteosarcoma and hypertrophic osteopathy? A - Spirocerca lupi B - Coccidioidomycosis C - Habronema spp. D - Blastomycosis E - Ollulanus tricuspis

Typically, expect an increased anion gap with: Diabetic ketoacidosis Renal insufficiency Ethylene glycol toxicity Lactic acidosis from grain overload or strenuous exercise Anion gap is typically measured as positive cations (Na+, K+) minus negative anions (TotalCO2-, Cl-). You can also calculate AG using HCO3- in place of TCO2 Anion gap =(Sodium + Potassium) - (TCO2 + Chloride) Decreased anion gap is UNcommon. Think hemodilution, hypoalbuminemia, hypercalcemia.

Which diseases are classically associated with a high anion gap (AG)? A - Eosinophilic enteritis, Hypothyroidism, Gastrinoma B - Prostatic adenocarcinoma, Pleural effusion, Lymphangiectasia C - Diabetes mellitus, Pancreatitis, Proliferative enteritis D - Hypercalcemia of malignancy, Hypoadrenocorticism, Displaced abomasum E - Grain overload, Ethylene glycol toxicity, Renal insufficiency

Potassium-sparing diuretics (Spironolactone, Amiloride) Potassium-sparing diuretics (spironolactone, amiloride) are aldosterone antagonists sometimes used with furosemide as part of the treatment plan for congestive heart failure (CHF). Aldosterone, the mineralocorticoid produced in the adrenal cortex, acts on the distal convoluted tubules (and collecting ducts) of the nephron to retain Na+ and water, secrete K+ and increase blood pressure. Clinically, look for increased aldosterone secretion (increased blood pressure) with CHF. In contrast, see decreased aldosterone secretion (and decreased blood pressure) with hypoadrenocorticism.

Which diuretic is a competitive antagonist for aldosterone sometimes used in treatment of congestive heart failure? A - Thiazides (chlorothiazide, hydrochlorothiazide) B - Furosemide C - Osmotic diuretics (Mannitol, DMSO) D - Carbonic anhydrase inhibitors (Acetazolamide) E - Potassium-sparing diuretics (Spironolactone, Amiloride)

A heel block (also called the palmar digital block) will anesthetize the bulbs of the heel, mimicking the effect of a palmar digital neurectomy, the last-ditch treatment to lengthen the athletic life of a horse with caudal heel pain (navicular disease). Remember that neurectomy will eliminate pain, but not disease- you do it when there has been no improvement from medical Rx after 6-12 weeks. Refs: Pasquini, Jahn and Bahr, Guide to Eq Clin: LAMENESS vol. II, pp. 62-4 and X8 and the Merck Veterinary Manual online edition.

Which nerve block predicts how a horse with caudal heel pain (also called navicular disease) may respond to digital neurectomy? A - High 4-point block B - Local infiltration of suspensory ligament C - Fetlock block D - Pastern block E - Heel block

Right displace abomasum & abomasal volvulus Right displaced abomasum (RDA) and abomasal volvulus are difficult to clinically differentiate on physical examination. Both result in areas of tympanitic resonance ("pings") on the right side of the cow, confined to an area under the last five ribs in the upper half of the abdomen. It is thought that RDA precedes the development of abomasal volvulus. Cows with abomasal volvulus are usually more dehydrated and more systemically ill than cattle with RDA. Surgical treatment is required to correct both conditions. Ruminal tympany will result in generalized left sided distension and "ping" of the dorsal abdomen left of midline. Cattle with left displaced abomasum will most commonly "ping" on the left side between ribs 9 and 13 in the middle to upper third of the abdomen. Cecal dilation most commonly results in a right sided "ping" of the dorsal paralumbar fossa. Pneumoperitoneum results in a low pitch "ping" of the upper flank on both sides of the abdomen. It occurs commonly postsurgically; if present without previous surgery it can be a result of bacterial peritonitis.

Which of the following are the most difficult to clinically differentiate from one another in adult cattle? A - Right displaced abomasum and abomasal volvulus B - Left displaced abomasum and vagal indigestion C - Ruminal tympany and abomasal volvulus D - Pneumoperitoneum and left displaced abomasum E - Cecal dilation and left displaced abomasum

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 course 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. Click here for a useful review of Local Anesthesia and Analgesia by Dr. Lyon Lee, Oklahoma State CVM; pp. 12-14.

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

Abdominal wall adjacent to prepuce Abdominal wall adjacent to prepuce. obstructive urolithiasis, the formation of "stones" that result in partial to complete blockage of the urinary tract, is a common problem in male small ruminants. Surgical interventions include tube cystostomy, the placement of a rubber tube in the bladder that exits through the abdominal wall adjacent to the prepuce. During the surgical procedure to place the tube, uroliths are surgically removed from the bladder and the urethra is flushed. The tube allows urine to bypass the urethra temporarily, allowing inflammation of the urethra to decrease. The tube is typically removed after 10-14 days.

Which one of the following best describes the exit site of a tube cystostomy in sheep and goats? A - Abdominal wall adjacent to prepuce B - Perineal area approximately 6 cm distal to anus C - Urethral process D - Ureteral orifice E - Internal urethral orifice

This is an aural abscess, which can occur secondarily to vitamin A deficiency. Captive terrestrial box turtles are most at risk, usually due to diets containing little vitamin A. Other presentations of hypovitaminosis A include froth from nose (a sign of respiratory disease) and renal disease.

Which one of the following choices can be an underlying cause for the problem seen in this turtle? A - Septicemic cutaneous ulcerative disease (SCUD) B - Pasteurella multocida C - Nutritional secondary hyperparathyroidism D - Mycoplasmosis E - Vitamin A deficiency

Diet changes such as a high fiber food or food designed to treat renal disease may be effective in restoring normocalcemia in the feline patient with Idiopathic hypercalcemia. Prednisolone, fluid therapy, furosemide may be used in more severely affected patients and when dietary therapy is ineffective. Bisphosphonates may be utilized if increased osteoclastic activity is present.

Which one of the following choices is the best initial treatment in the patient with a moderate elevation of calcium caused by idiopathic feline hypercalcemia? A - Injectable fluids B - Prednisolone C - Diet change D - Bisphosphonates E - Furosemide

Enteric bacteria migrate up the bile duct from the intestines and create an infection in the liver and biliary tract in most cases of canine cholangiohepatitis. Feline cholangiohepatitis is more common than the canine form and has three main etiologies. 1. Acute neutrophilic (suppurative) 2. Chronic (lymphoplasmacytic or mixed) 3. Lymphocytic (nonsuppurative)

Which one of the following choices is the most common etiology of canine cholangiohepatitis? A - Neoplastic biliary obstruction B - Idiopathic C - Ascending infection D - Liver fluke migration E - Toxicity

Neoplastic This dog has multiple neoplastic nodules. Three well defined, 2-3 cm soft tissue masses are observed on the lateral and DV projections. Multiple smaller, poorly defined soft tissue nodules are also observed on the right lateral projection. There is a severe alveolar pattern in the dependent portion of the left caudal lung lobe. This may represent a poorly defined mass. A small amount of gas is present in the esophagus dorsal to the carina. The cardiovascular structures appear within normal limits. Remember that a right lung nodule will show up better on a left lateral projection. With the animal in left lateral recumbency, the right lung is better inflated. This provides better air-soft tissue contrast to highlight the nodule. This dog was diagnosed with pulmonary carcinoma via a fine needle aspirate of the large nodule. Click here to see normal canine thoracic radiographs.

Which one of the following disease processes is most likely in this 9-year-old golden retriever with a cough? A - Degenerative B - Traumatic C - Vascular D - Neoplastic E - Infectious

Cephalexin, Chloramphenicol, Clindamycin Think of the "3 C's" against anaerobes (plus Flagyl®). Chloramphenicol (CAPL), Cephalexin (and all other cephalosporins), Clindamycin (Antirobe®) and Metronidazole (Flagyl®) are all used against anaerobes. A common use of Antirobe®, for example, is for treatment of abscesses or bites wounds in cats. Enrofloxacin (Baytril®), and Aminoglycosides (ie: Gentamycin, Amikacin, Neomycin) are two to think of which DO NOT fight anaerobes. (better for gram negatives).

Which set of antimicrobials is best indicated for use against anaerobes? A - Cephalexin, Chloramphenicol, Clindamycin B - Enrofloxacin, Aminoglycosides, Chloramphenicol C - Clindamycin, Metronidazole, Gentamycin D - Amikacin, Neomycin, Cephalosporins E - Amikacin, Enrofloxacin, Metronidazole