NAVLE questions of the day
B. Remove Via endoscopy Endoscopy would be the safest route of removal in this case. The cap is large enough to be lodged in the intestinal tract if allowed to pass. With endoscopy, you can get it out gently and quickly, with minimal anesthesia and no suturing. This is preferable to gastrotomy which would require incisions in both the abdominal wall and the stomach.
A client presents a 25-pound dog (11.4 kg) who was just observed swallowing a bottle cap. Which one of the following choices would be the safest approach for this dog A - Administer motility modifiers to encourage passage B - Remove via endoscopy C - Administer a proton pump inhibitor to stimulate gastric acid secretion D - Administer silicon coated magnet to keep it in stomach until dissolution E - Remove via gastrotomy
endoscopy would be the safest route of removal in this case. the cap is large enough to get lodged in the intestinal tract if allowed to pass With endoscopy you can get it out gently and quickly, with minimal anesthesia and no suturing. This is preferable to gastronomy which would require incisions of both the abdominal wall and stomach
A client presents a 25-pound dog (11.4 kg) who was just observed swallowing a bottle cap. Which one of the following choices would be the safest approach for this dog. A - Administer motility modifiers to encourage passage B - Administer silicon coated magnet to keep it in stomach until dissolution C - Remove via endoscopy D - Remove via gastrotomy E - Administer a proton pump inhibitor to stimulate gastric acid secretion
A - Bone Spavin This is bone spavin, an osteoarthritis/degenerative joint disease of the distal hock joints, usually affecting the distal inter tarsal and tarsometatarsal articulations. the number one hock problem (tarsus) in horses if the horse is lame due to bone spavin, it tends to drag toe or have "stabbing gait in the affected hindlimb. occasionally you may see thickening of the soft tissues over distal hock joints. the problem can be unilateral or bilateral with various degrees of lameness typical tx: intra-articular steroids and hyaluronic acid, phenylcutazone as needed, continue with work. over time distal hock joints are likely to ankylose (fuse) on their own and lameness ends. additional treatments include shockwave, biphosphonates, alcohol arthrodoesis, cunean tenectomy or neurectomy tasal hydrarthrosis (bog spavin) is a chonic synovitis of the tarsocrural joint - look for swelling and distension of the joint capsule
A nine-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). Hock flexion of the left hind significantly exacerbates the lameness for 5-6 strides. A radiograph of the hock is taken, shown below. What is the common name for this problem? A - Bone spavin B - Tarsal hydrarthrosis C - Splints D - Osselets E - Ringbone
E - Left side of the neck Left side of the neck. The esophagus runs down the left side of the horse's neck. The nasogastric (NG) tube can be seen and palpated here as it passes down the neck. It is NOT possible to see or safely palpate it in the larynx or oropharynx. It is critical to confirm proper placement prior to administration of fluids or medications through the NG tube. Other methods to confirm that the NG tube is in the stomach: 1) Blow into the end and have an assistant auscult the stomach with a stethoscope. 2) Most patients cough if the tube is placed into the trachea; however, this is NOT fool-proof. Sedated or very sick patients, or those in which a very small diameter tube is used, may not cough. 3) Negative pressure upon aspiration is a sign of being in the stomach. However, can also get negative pressure if the tube is up against soft tissue (in the lung or esophagus) so is not definitive. Do NOT attempt to suck fluid out of the stomach - personnel can become very sick from the possible contents. Refs: Pasquini, Anat. Dom. Animals, 11th ed. p. 263 and Bassert and Thomas, McCurnin's Clinical Textbook for Vet Techs, 9th edition, pp. 673. Image courtesy of Nora Grenager, VMD, DACVIM.
At what location can palpation and visualization confirm proper nasogastric tube placement in the horse? A - Oropharynx B - Right jugular groove C - Larynx D - It is not possible to confirm this way E - Left side of the neck
megaesophagus Megaesophagus is present on this radiograph. It can be idiopathic or secondary to several disorders. It is a frequent finding with myasthenia gravis. Other causes of megaesophagus include esophagitis, esophageal stricture or diverticulum, heavy metal toxicity, polymyositis, lupus, hypoadrenocorticism. A thorough neurologic examination, complete bloodwork including adrenal testing, and possibly contrast studies of the esophagus should be performed in this patient. Regurgitation is actually present in this dog. This occurs very soon after eating, while vomiting usually occurs a few hours later. Attention to details of the history is important to help direct diagnostics.
Persistent right aortic arch Gastric foreign body Megaesophagus Mediastinal mass Pulmonary bullae
A. Penicillin Erysipelas is susceptible to penicillins, as well as tetracyclines (usually), lincomycin and tylosin. Chloramphenicol and nitroimidazoles (including metronidazole) are not approved for food animal use
You are asked to examine some feeder pigs that have stopped eating yesterday. The group is lying down and seems lethargic. They have fevers of 105-106F (40.6 -41.1 C), firm dry feces, and the skin has rhomboid-shaped red blotches scattered on it. What treatment should be recommended? A. Penicillin B. Metronidazole C. Chloramphenicol D. Streptomycin E. Gentamicin
A - IV fluids with added sodium bicarbonate This calf is typical of those suffering from nonspecific calf diarrhea, most often associated with enteropathogenic E coli, rotavirus, or cryptosporidium. The calf develops hypovolemia and metabolic acidosis and requires sodium-containing IV fluids which contain additional alkali such as sodium bicarbonate. One can assess that the calf is severely acidotic given that it is lethargic and unable to stand. While oral fluids may also be useful, at this stage, the calf will require IV fluids.
A 10-day old commercial dairy calf has diarrhea that is white in color (see photo). The calf is dehydrated, hypovolemic, weak and unable to stand. T=100F (37.8 C), HR=100, and RR=20. No other abnormalities are found on physical examination. Based on these findings, what is the treatment of choice? A- IV fluids with added sodium bicarbonate B- IV fluids containing only saline C- Oral fluids containing sodium bicarbonate D- Oral fluids containing high levels of both sodium and chloride E- IV fluids containing 50 meq/L of potassium
B- Feline infectious peritonitis The correct answer is FIP. This poor cat is infected with the dreaded wet form of feline infectious peritonitis. Good job if you nailed it! If you think about the pathogenesis of the virus, then these clinical signs make a lot of sense. With FIP, the classical lesion is pyogranulomatous vasculitis due to antigen-antibody complexes depositing in the venular endothelium, which results in pleural and peritoneal effusion. The CBC findings are common for FIP but not too specific. In greater than 50% of cats with the wet form of FIP, there will be hyperproteinemia. In greater than 70% of cats with the dry form of FIP there is hyperproteinemia.
A 2-year old female DSH cat presents for weight loss, anorexia, dyspnea, and lethargy. She was previously treated with antibiotics but is still febrile on physical exam. You detect pleural effusion and notice that the abdomen is distended. On CBC there is a non-regenerative anemia, neutrophilia, and lymphopenia. On chemistry there is hyperproteinemia and a slight elevation in liver enzymes. What is your primary differential? A- Feline calicivirus B- Feline infectious peritonitis C- Feline immunodeficiency virus D- Feline leukemia virus
B. falconi syndrome Fanconi syndrome is an inherited disease in Basenjis. The disease involves renal tubular defects causing an abnormal loss of electrolytes and solutes leading to hypophosphatemia, hypokalemia, and metabolic acidosis. DM is less likely because serum glucose is normal. The lab abnormalities present in this dog are not consistent with pyelonephritis. Pyometra is not a viable choice as the signalment describes a male.
A 4-year old male castrated Basenji presents for polyuria, polydipsia, and weight loss. Blood work shows P=2.5 (2.9-5.3 mg/dl), K= 3.1 (3.9-5.1 mEq/L), total CO2= 12 (17-25 mmol/L). The remainder of the blood work is within normal limits. Urinalysis shows 3+ glucose. Which of the following is your most likely differential diagnosis? A. Pyometra B. Fanconi syndrome C. Pyelonephritis C. Diabetes mellitus
Osteosarcoma The correct answer is osteosarcoma. Chondrosarcoma, fibrosarcoma and hemangiosarcoma can all be primary bone tumors but are much less common in dogs than osteosarcoma. Annotations: Yellow: Amorphous periosteal proliferation Orange: Geographic lysis and expansile appearance of the mid-radius Blue: soft tissue swelling
A 6-year old male neutered Weimaraner presents for right forelimb lameness. Radiographs are shown below and show a mixed productive and destructive lesion affecting the right distal radius with accompanying soft tissue swelling. The lesion does not cross the joint. What is the most common primary bone tumor in the dog? Fibrosarcoma Multiple myeloma Chondrosarcoma Hemangiosarcoma Osteosarcoma
E. Tensilon response test The correct answer is a Tensilon (edrophonium) response test. Hopefully, you were able to identify the mass in the cranial mediastinum on the chest radiograph, as this was one of the keys to this case. This, in conjunction with the dog's other signs, are suggestive that this dog has a thymoma and associated secondary myasthenia gravis. Tensilon (edrophonium) is a rapidly acting anticholinesterase that reverses signs of myasthenia within minutes in most dogs. A chest CT would be a valid test to confirm the presence of the mediastinal mass and might be an appropriate test before surgery but would not bring you closer to a diagnosis if you already have identified the mass. An MRI of the brain would assess a CNS cause of the dog's signs, which are unlikely, given the other findings. Similarly, a myelogram would assess if a spinal cord lesion caused the dog's signs, but the rest of the findings in this case should point you in a different direction.
A 9-year old male Queensland Heeler presents with a four day history of progressive tetraparesis. Physical exam showed him to be weakly ambulatory with support. As part of your initial workup, you take chest X-rays which are shown below. Which of the following next steps is the most appropriate test to confirm your clinical suspicion about the cause of the dog's signs? A. Myelogram B. MRI of the brain C. CT scan of the thorax D. Bronchoalveolar lavage and culture E. Tensilon response test
infectious bronchitis This is caused by a coronavirus. It is spread by aerosol and ingestion and usually affects all exposed birds. The clinical signs and necropsy findings are as described in the question. The disease can be clinically indistinguishable from mild forms of Newcastle disease, laryngotracheitis, and infectious coryza. Virus isolation is needed to obtain a definitive diagnosis.
A chicken operation has recently been ravaged by a respiratory disease affecting almost all of the chickens in the flock. The chickens are coughing and sneezing and many have facial swelling. You necropsied many of the chickens and found mucoid exudate in the bronchi, thickened air sacs, and in a few of the chickens, interstitial nephritis was present. Which of these diseases is likely? Aspergillus Infectious bronchitis Infectious bursal disease Fowl cholera
B- BUN and creatinine levels Lily plant toxicosis is extremely serious and can cause rapid and fatal acute renal failure in cats. If ingestion is suspected, decontamination and aggressive fluid therapy, and monitoring of renal values are recommended immediately. In this case, since 2 days have passed, inducing emesis and administering activated charcoal would not be helpful. What you can do is check renal values (BUN and creatinine) and treat for acute renal failure. Ruling out an intestinal obstruction in a cat with this history is reasonable but not the best of the choices given.
A client calls and says her cat was chewing on her lily plant two days ago and is now acting very sick. You tell her to bring the cat in immediately so that you can perform which of the following? A- Abdominal radiographs to diagnose intestinal obstruction B- BUN and creatinine levels C- ALT, AST, GGT, and total bilirubin levels E- Induce emesis and administer activated charcoal
B - Amblyomma spp. ticks Amblyomma spp. are vectors for Ehrlichia ruminatium (formerly Cowdria ruminatium), the causative agent of heartwater disease in ruminants. The clinical progression of this case and the pericardial effusion seen on necropsy (as identified by the blue arrow) are classical for acute heartwater disease. Animals may just be found dead with peracute disease. Definitive diagnosis typically requires necropsy with microscopic evaluation of stained brain tissue. This disease is endemic in parts of Africa and the Caribbean but is considered a foreign animal disease in the mainland Americas. Dermacentor spp. are vectors for Babesia caballi in horses, Anaplasma marginale in cattle, Rickettsia rickettsii (Rocky Mountain spotted fever), Powassan virus, as well as the agents of Q fever and tularemia, among other infectious diseases throughout the world. Face flies (Musca autumnalis) are an important vector for eyeworm (Thelazia spp.) and Mycoplasma bovis, one agent of infectious bovine keratoconjunctivitis of ruminants. Horseflies (Tabanid spp.) can be vectors for bovine leukosis virus, the cause of enzootic bovine leukosis and lymphosarcoma.
A dead goat is presented to a veterinarian in the Caribbean. The farmer reports that the goat hadn't been eating well yesterday, then this morning was breathing hard and walking with a strange high-stepping gait.She eventually went down and started paddling with her head twisted back just before death. Necropsy reveals the following finding (blue arrow) adjacent to the heart:He is worried about his other goats. What vector is responsible for transmitting the infectious agent most likely responsible for this goat's condition? A - Musca autumnalis (the face fly) B - Amblyomma spp. ticks C - Dermacentor spp. ticks D - Tabanids (e.g., the horse fly) E - Damalinia caprae lice
B - Mediastinal Lymphoma On the lateral thoracic radiograph, there is a mass in the cranial mediastinum with mild dorsal displacement of the trachea. The most likely diagnosis for a mediastinal mass in a dog with hypercalcemia is lymphoma. Radiographic interpretation: The cardiovascular structures are normal in size and shape. No abnormalities are seen within the pulmonary parenchyma. On the lateral projection there is a mass in the cranial mediastinum with mild dorsal displacement of the trachea. The mediastinum is widened on the v/d projection, and is wider than the vertebral column. The pleural space and musculoskeletal structures are normal.
A five-year-old female spayed Australian shepherd is presented for poor appetite and lethargy. Bloodwork reveals hypercalcemia. Urinalysis is normal. Abdominal ultrasonography is unremarkable. Thoracic radiographs are shown below. What is the most likely diagnosis? A - Metastatic lung disease B - Mediastinal lymphoma C - Hypertrophic osteopathy D - Hepatic parathyroid hormone-related protein releasing tumor E - Idiopathic hypercalcemia
C - Cushing's disease (PPID) The correct answer is Cushing's disease. The coat condition described is what horses with glucocorticoid excess develop; it is referred to as hirsutism. They will also be predisposed to infections including laminitis and skin diseases such as Dermatophilus. They are also frequently polyuric, polydipsic, and polyphagic.
A horse presents to you for chronic, recurrent laminitis and skin disease. You notice on your exam that the horse has a particularly thick, long, wavy, and matted coat. The owner mentioned that this developed many months ago. What is a likely diagnosis? A- Hypothyroidism B- Pheochromocytoma C- Cushing's disease (Pituitary Pars Intermedia Dysfunction) D- Diabetes insipidus
E. Septic Arthritis There is diffuse soft tissue swelling of the left pelvic limb There also appears to be intracapsular soft tissue swelling of the left tibiotarsal joint causing the joint space to widen asymmetrically. an osseous fragment is noted at the medial aspect of the joint The articular margins of the tibiotarsus and the tarsometatarsus appear lytic and irregulat Egg-binding signs are nonspecific but lameness is not a key finding typically. Sometimes the bird will adopt a penguin-like posture. Egg - Binging is more often seen during the spring and summer.
A rescued Pekin duck is presented for non-weight bearing lameness of the left pelvic limb and fever. Which one of the following choices is the most likely diagnosis? A - Panosteitis B - Normal radiographs C - Bumblefoot D - Egg binding E - Septic arthritis
E - Multiple Myeloma This is a multiple myeloma (MM), a malignancy of plasma cell origin. Malignant plasma cells arise from bone marrow and produce immunoglobulins (Ig), resulting in hyperglobulinemia. Hyperglobulinemia causes hyper viscosity and many of the clinical signs seen with MM. Clinical signs include lethargy, weight loss, bone pain or fractures, CNS signs, capillary bleeding, visual disturbances (due to retinal hemorrhage), organomegaly, and heart murmurs (due to hyper viscosity) Dx requires two or more of the following" - monoclonal gammopathy on serum electrophoresis - bence jones proteinuria - lytic bone lesions on radiographs - plasma cell infiltration of the bone marrow
A ten-year-old male neutered West Highland white terrier is presented with a recent history of polyuria/polydipsia, lethargy, and weight loss. Physical exam reveals a grade 2/6 systolic heart murmur and mild muscle wasting along the lumbar spine. Significant lab abnormalities include pancytopenia, hyperglobulinemia, hypercalcemia, and isosthenuria. Bone marrow cytology is shown below. What is the diagnosis? A - Osteosarcoma B - Systemic lupus erythematosis C - Babesia canis D - Aplastic anemia E - Multiple myeloma
Furosemide and enalapril The radiograph here shows a severe symmetrical alveolar pattern in the perihilar region extending to the right and left caudal lung lobes. The heart is tall on the lateral view causing dorsal elevation of the trachea. This, in conjunction with the physical findings, is compatible with congestive heart failure (CHF) secondary to mitral valve regurgitation. The dog also has hepatic congestion evident by enlargement on the radiograph. Treatment for CHF include diuretics (furosemide/Lasix, hydrochlorothiazide, spironolactone), arterial vasodilators (enalapril, benazepril, amlodipine, hydralazine), positive inotropes (pimobendan), and venodilators (nitroglycerine). Clavamox and enrofloxacin are antibiotics which could be used to treat pneumonia, but that is not this dog's problem. Immiticide is the treatment for heartworm. Atenolol is a beta blocker and not part of the management of mitral regurgitation or CHF. Atropine or a pacemaker would be indicated for conduction problems. Annotations: There is marked elongation of the cardiac silhouette on the lateral views (yellow line) resulting in dorsal displacement of the trachea (red area), consistent with left ventricular enlargement. A large focal bulge is noted at the caudodorsal aspect of the cardiac silhouette consistent with left atrial enlargement. (Purple circle) A focal soft tissue opaque bulge is also noted in the region of the left auricle on the DV view. (Pink circle) There is concurrent mild widening of the cardiac silhouette on the lateral views consistent with right-sided cardiomegaly (orange line). The cranial lobar pulmonary veins are larger than the corresponding arteries. There is mild distension of the caudal lobar pulmonary arteries and veins with right caudal lobar pulmonary vein slightly larger than the corresponding artery. (green lines) There is a marked diffuse unstructured interstitial pattern to early alveolar pattern (blue circle), most severe in the dorsal aspects of the right caudal and left caudal lung lobes. The liver is mildly enlarged, extending beyond the costal arch with rounded caudoventral margins. (brown circle)
An 11-year old female Pomeranian presents to you for coughing and exercise intolerance. On exam: Wt: 9.25 lbs, T: 101.2F (38.4 C), HR: 132 bpm, RR: Panting, mucous membranes are pink. She has mild tracheal sensitivity and a grade III-IV/VI left apical holosystolic murmur and grade II/VI right apical holosystolic murmur. Femoral pulses are strong and synchronous, with a regular rhythm. She has harsh lung sounds bilaterally. On abdominal palpation, you note hepatomegaly. You find bilateral luxating patellas. You take chest radiographs (see image) and decide to treat the dog based on these findings. Which medication plan is most appropriate? Furosemide and enalapril Clavamox and enrofloxacin Immiticide (Melarsomine) Atropine and a temporary pacemaker Oxygen and atenolol
Disruption of function of the plumage Feathers serve a critical waterproofing and insulatory function which is disrupted by oil and can rapidly result in hypothermia. Other concerns for oiled birds include GI irritation from ingestion of oil during preening, hemolytic anemia, and pneumonia due to inhalation of oil. Treatments include heat, supportive care, and activated charcoal. Once stabilized, frequent high pressure, warm, mild detergent baths and clean warm water rinses until water beads freely off of the feathers is important. Birds should be placed in warm air flow until dry and they should be maintained on self-skimming ponds for several days after washing to ensure full waterproofing.
Contact dermatitis Hepatotoxicity Nephrotoxicity Disruption of function of the plumage Lead toxicity
C. Melanoma The correct answer is melanoma. Melanoma is one of the most common tumors in horses (about 10% of all neoplasms) and gray horses are at high risk of around 80%. They can occur anywhere but appear most frequently in the perineal region or ventral tail as is evident in this horse. In horses, they are usually darkly pigmented (as opposed to dogs where amelanotic melanomas occur somewhat commonly). In horses, most are slowly growing but can be locally invasive. Many treatments are out there, but there is no standard of care treatment. Depending on location and extent, consider surgical removal, benign neglect, chemotherapy (systemic or intralesional) and immunotherapy.
During your examination of an 18-year old horse, you observe what is shown in the photograph. Based on the location and appearance of this lesion, what is the most likely diagnosis? A. Habronema B. Squamous cell carcinoma C. Melanoma D. Cuterebra E. Sarcoid
0.16% You do not need to know anything about the disease in this question in order to get the correct answer. You are told that the disease is recessive and has a carrier rate of 8% Because the trait is recessive, homozygotes will be the only individuals affected. In order for a foal to be born homozygous for the trait, BOTH parents MUST be carriers. The chances of both parents being carriers is 8% x 8% (or 0.08 x 0.08) = 0.0064 or 0.64%. If both parents are carriers, the offspring has a 1 in 4 chance of inheriting two mutant alleles (50% chance for each allele from each parent). Since the chances of both parents being carriers is 0.64% and the chance of having a homozygous offspring in that case is 1 in 4, the overall expected frequency of diseased foals is 0.0064 x 0.25= 0.0016 or 0.16%
Severe combined immunodeficiency is a lethal autosomal recessive trait in Arabian foals. Heterozygotes are clinically normal. If the heterozygote carrier rate for the genetic mutation is 8%, what is the expected frequency of Arabian foals that are homozygous for the mutated allele? 0.16% 0.64% 0.064% 25% 2% 4%
