NAVLE EXAMS WITH ACTUAL CORRECT QUESTION AND VERIFIED DETAILED RATIONALES ANSWERS WITH CO, Exams of Nursing

Download NAVLE EXAMS WITH ACTUAL CORRECT QUESTION AND VERIFIED DETAILED RATIONALES ANSWERS WITH CO and more Exams Nursing in PDF only on Docsity!

NAVLE EXAMS WITH ACTUAL CORRECT

QUESTION AND VERIFIED DETAILED RATIONALES

ANSWERS WITH COMPLETE SOLUTION 2023

ALREADY GRADED A+LATEST UPDATED 2024

A - Infectious bronchitis

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

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

A - Infectious bronchitis B - Fowl cholera C - Infectious bursal disease D - Aspergillus

C - Bronchoscopy

On radiographs of the thorax, there is an alveolar pulmonary pattern in the left cranial and right middle lung lobes, with patchy increased opacity in the remaining lobes. The trachea is narrowed at the thoracic inlet, with an apparent linear intraluminal opacity. There is dilation of the pharynx with air, and there is gas within the esophagus and GI tract. The tracheal narrowing may indicate edema, mucus, or foreign material in this region.

A four-month-old Jack Russell terrier puppy was playing outdoors. Later that evening the owner noticed that the puppy was wheezing and coughing. Based on the radiographs, what would be the best step to take next?

A - Edrophonium challenge test B - Barium swallow C - Bronchoscopy D - Trans-tracheal wash E - Dental prophylaxis

A - Fanconi syndrome

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

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

A - Fanconi syndrome B - Pyometra C - Diabetes mellitus D - Pyelonephritis

D - 1 hour

Dystocia in the sow is present when one hour or more has passed between piglets. Intervention should be swift to prevent death of piglets from anoxia. Dystocia is not common in swine but when it occurs, it is often due to uterine inertia, similar to other animals that produce multiple offspring.

When a sow is giving birth, what is the shortest time interval between passage of piglets that indicates dystocia?

A - 4 hours B - 1/2 hour C - 2 hours D - 1 hour E - 15 minutes

A - Bacillary hemoglobinuria

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

The image shows an infarct in the liver discovered on post mortem exam of a mature beef cow which died one hour before in a western mountain pasture, after being observed to appear normal one day earlier. There is also dark red urine in the bladder. The pasture contains native plants, some pine

trees, and a marshy area with water plants. The cows are unvaccinated and were never wormed. Given this history and the lesion found, the most likely cause of death is _________.

A - Bacillary hemoglobinuria B - Pine needle poisoning C - Blue-green algae toxicity D - Viral hepatitis E - Death camas toxicity

E - Capillaria contorta

Capillari contorta is the only one of these parasites that infects the crop. It is highly pathogenic and can cause a range of signs from weakness to emaciation to death. The intermediate host is the earthworm. Rx is hygromycin B with a 3-day withdrawal time. Other Rx options include coumaphos for replacements or layers.

Recently, several chickens in a free-range flock have died. Many others have not been eating as well, look unthrifty, and are less active than they used to be. Necropsy of one of the chickens that died reveals marked thickening and inflammation of the crop and esophageal mucosae. The following parasite eggs are identified in a sample from the litter in the henhouse. What is the most likely parasite affecting this flock?

A - Heterakis gallinarum B - Ascaridia galli C - Syngamus trachea D - Davainea proglottina E - Capillaria contorta

E - Tooth root abscess

Commonly the first molar teeth are involved. Clinical signs include weight loss, quidding (dropping half chewed feed), halitosis, swelling, and unilateral purulent nasal discharge.

What is the most common cause of maxillary sinusitis in a horse, as seen in the necropsy image below?

A - Foreign body B - Guttural pouch mycosis C - Dentigerous cyst D - Brachygnathia E - Tooth root abscess

dog with lymphadenopathy and joint pain

dog may have a good prognosis, but the prognosis in horses with neuroborreliosis is poor

TICK BORNE DISEASE

Lyme borreliosis -- classic case & pearls

older cow with weight loss and icterus

prognosis may be good with prompt treatment

TICK BORNE DISEASE

Anaplasmosis -- classic case & pearls

cat with hepatosplenomegaly, lethargy, and seizures

prognosis is poor, but survivors may develop immunity

TICK BORNE DISEASE

Cytauxzoonosis (bobcat fever) -- classic case & pearls

dog with icterus and splenomegaly

Babes divergent can cause serious illness in splenectomized humans

TICK BORNE DISEASE

Babesiosis -- classic case & pearls

dog with lethargy, lymphadenopathy, and epistaxis

co-infection with Anaplasma spp. or Babesia spp. may occur

TICK BORNE DISEASE

Ehrlichiosis -- classic case & pearls

C - Monthly administration of ivermectin

The findings at slaughter are consistent with an infection of Ascaris suum. This is the roundworm of pigs. These worms can cause intestinal obstruction in large infestations. They can also migrate into the bile ducts and liver, causing the fibrotic liver lesions described in this case. Antemortem diagnosis is made by fecal flotation and clinical signs. Treatment options are wide and include ivermectin, fenbendazole, pyrantel, levamisole and other ascaracides.

The viscera from a group of 100 kg pigs are presented at a slaughter facility. The pigs were raised in a semi-outdoor management farm system with groups of 30-100 kg pigs kept on the same site. At slaughter, multifocal fibrotic lesions are seen in their livers and noticeable nematodes are present within the small intestine. You perform a fecal flotation on a fresh sample from the younger pigs. The results are shown in the image below. What treatment or management recommendation is most appropriate for this problem?

A - Disinfect the pasture B - Examine the food sources of the pigs C - Monthly administration of ivermectin D - Depopulate and replace the herd E - Quarterly treatment with praziquantel

E - Ancylostoma spp.

Hookworms (Ancylostoma spp.) may cause cutaneous larva migrans in people. Note that roundworms (Toxocara spp, Toxacaris spp., Baylisascaris spp.) are also zoonotic, causing visceral and ocular larva migrans in people.

Which parasite can cause cutaneous larva migrans in people?

A - Habronema spp. B - Trichuris spp. C - Spirocerca sp. D - Trichostrongylus spp. E - Ancylostoma spp.

You should perform a fecal float and smear. This cat probably has severe diarrhea and has been straining. Dysautonomia is possible but very rare. Panleukopenia does not usually result in a rectal prolapse, but is a cause of diarrhea.

A 5-month old kitten presents to you with a rectal prolapse, as shown in the photo. What is the most common cause of rectal prolapse in a kitten?

A - Panleukopenia B - Trauma C - Dysautonomia D - Gastrointestinal parasites

C - Mediastinum

This cat has a cranial mediastinal mass. There is a small amount of pleural effusion causing widened fissure lines and retraction of the lung lobes. There is a focal widening of the cranial mediastinum on the ventrodorsal projection, which is apparent as a soft tissue opacity flattening the margin of the cranial lung lobe on the lateral projection. The trachea is mildly elevated and narrowed in this area. This cat was diagnosed with lymphoma. Most cats with mediastinal or multi centric lymphoma are positive for feline leukemia virus (FeLV).

Where is the location of the main lesion in this cat?

A - Lung parenchyma B - Pulmonary vessels C - Mediastinum D - Left ventricle E - Right atrium

E - Corynebacterium pseudotuberculosis

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

A 7-year old doe presents with abscessation of the supramammary lymph nodes. What is the most likely diagnosis?

A - Caprine arthritis and encephalitis virus B - Trueperella pyogenes C - E. coli D - Mycoplasma mycoides E - Corynebacterium pseudotuberculosis

B - Ultrasound the metacarpus

Ultrasound of the metacarpus is recommended to further evaluate the soft tissues of the metacarpus. This appearance of a "bowed tendon" is typical of acute superficial digital flexor tendinitis. Ultrasound is necessary to confirm and evaluate the extent and severity of the lesion.

Which diagnostic would be most appropriate to recommend?

A - Digital radiographs of the distal limb B - Ultrasound the metacarpus C - Nuclear scintigraphy (a.k.a. bone scan) D - Diagnostic perineurial anesthesia (a.k.a. nerve blocks) E - No further diagnostics needed - diagnosis is clear

D - Cardiomegaly

The cardiac silhouette is markedly enlarged and rounded, occupying the entire width of the thorax on the d/v projection. The pulmonary vasculature is normal in size, and there is no evidence of interstitial or alveolar pulmonary pattern.

What is the primary abnormality in these thoracic radiographs of a 5-year-old Siamese cat?

A - Alveolar pattern B - Enlarged, tortuous pulmonary vasculature C - Mediastinal mass D - Cardiomegaly E - Interstitial pattern

A - Pasteurella multocida

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

Which of the following is the causative agent of fowl cholera?

A - Pasteurella multocida B - Mycoplasma gallisepticum C - Chlamydophila psittaci D - Reticuloendotheliosis virus

E - No illness

Ruminants are not affected by ingestion of Centaurea spp (yellow star thistle or Russian knapweed) and can be used to control the spread of these weeds. Chronic ingestion of Centaurea spp. causes nigropallidal encephalomalacia in horses (liquefactive necrosis of the neurons in the globes pallidus and substantia nigra).

This plant, yellow star thistle, is a substantial source of forage for a herd of goats. What would be the most likely problem seen in the goats?

A - Hemorrhagic gastroenteritis B - Hepatic fibrosis and megalocytosis C - Diffuse fibrosing alveolitis D - Nigropallidal encephalomalacia E - No illness

A - Alprazolam 1 hour before problematic event

Administration of alprazolam 30-60 minutes prior to storms is one example of an appropriate medication regimen for thunderstorm phobias. Other anxiety-evoking events can include gunshots, owner departure, visits to the veterinarian, car rides, exposure to other dogs or strangers on a walk, and visitors to the house. Anti-anxiety medications (e.g. alprazolam or diazepam) are useful for their rapid onset of action. Can use in combination with other psychotropic drugs such as SSRIs or TCAs when managing concurrent behavioral issues such as separation anxiety.

A 2-year-old male neutered Labrador retriever is presented with a history thunderstorm and fireworks phobia. The dogs clinical signs include pacing, tremors, house soiling, and vocalization. Which one of the following choices is an appropriate medication regimen for a dog or cat exhibiting noise-related phobia/anxiety?

A - Alprazolam 1 hour before problematic event B - Medications should not be given

C - Fentanyl patch as needed D - Zolpidem on the day of a predicted fireworks show E - Melatonin and coenzyme Q twice a day

D - 99%

The negative predictive value is the proportion of test-negative animals that are truly disease negative (unaffected) in this population. In the 2X2 table, where a= Disease +, Test +; b= Disease -, Test +; c= Disease +, Test -; d= Disease -, Test -. The NPV is d/(c+d), or disease -, test - animals DIVIDED by all of the test - animals.

In this herd, the proportion of test negative animals that actually is negative is specificity x (1- prevalence) or (0.9)x(0.95) = 0.855 (d). The proportion of false negatives in the herd is (1-sensitivity) x prevalence, or (0.1)(0.05) = 0.005 (c).

Negative predictive value = d/(c+d) = 0.855/(0.855+0.005) = 0.994.

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

A - 35%

B - 3%

C - 72%

D - 99%

B - Demodex

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

A 2-year old female spayed Leonberger presents to you with hair loss around the face and eyes. A deep skin scraping is shown in the picture below. What is your diagnosis?

A - Otodectes B - Demodex C - Sarcoptes D - Staphylococcus E - Fungal pyoderma

D - Classical swine fever

Classical swine fever (CSF). Virology is required to confirm and differentiate from other causes of febrile hemorrhagic diseases. The best tissues to submit are tonsils, maxillary or submandibular lymph nodes, mesenteric lymph nodes, spleen, ileum, and kidney.

Over the past 2 weeks, several pigs in a herd have been febrile and depressed. Many were constipated, then had diarrhea. A few were incoordinated and one had seizures. A few have died. Necropsy revealed petechial hemorrhages on the kidneys and larynx, and a hemorrhagic urinary bladder. Of the following choices, which one is most consistent with a presumptive diagnosis?

A - Glassers disease B - Erysipelas C - Swine dysentery D - Classical swine fever E - Streptococcus suis infection

C - Hypoglycemia

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

A 6-year old male neutered terrier mix weighing 10kg presents to you after having ingested 3 pieces of sugar-free gum containing xylitol. What bloodwork abnormality are you expecting to find?

A - Hypernatremia B - Hyponatremia C - Hypoglycemia D - Hypocalcemia E - Hyperglycemia

B - Methylene blue

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

You have diagnosed nitrate poisoning in a group of yearling cattle which were grazing Sudan grass (see photo). Which of the following is the most effective treatment?

A - Sodium thiosulfate B - Methylene blue C - Digitalis D - Calcium gluconate E - Vitamin B

classic case: snake with mid-body swelling and regurgitation of prey

pearls: NOT zoonotic to mammals

REPTILES

Cryptosporidiosis -- classic case and pearls

classic case: boa with chronic weight loss and progressive neurologic signs

pearls: was seen more often in pythons in the 19080s and is now seen more in boas

REPTILES

Inclusion body disease -- classic case and pearls

classic case: small black specks on snake

pearls: can be treated with predatory mites that feed on snake mites

REPTILES

Snake mites -- classic case and pearls

classic case: red eared slider with swollen eyes and thickened lips

pearls: may also be linked to aural abscesses in turtles

REPTILES

hypovitaminosis A -- classic case and pearls

classic case: snake with bloody feces and lethargy

pearls: classic disease in exhibits where snakes and turtles are mixed

REPTILES

Amoebiasis -- classic case and pearls

D - Surgery

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

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

A - Manual deobstipation B - Lactulose and Cisapride C - Thoracocentesis D - Surgery

E - It is an intact male

This is the penis of an intact male which demonstrates unique because of the backward-projecting cornfield spines on the glans due to the presence of circulating androgens. Penile spines are ABSENT in neutered male cats. The presence of penile spines can help to diagnose cryptorchid cats. Spines should disappear within 6 weeks of castration. Penile spines help toms fertilize queens by breaking through copulatory plugs. This is helpful in species in which sperm competition inside the female can be fierce.

What does this finding mean in a cat?

A - Nasopharyngeal polyp, cat will be fine after surgical removal B - Lingual polyp, can remove, but recurrence is common C - Cuterebra infestation D - Female in estrus E - It is an intact male

A - Dilated cardiomyopathy

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

Cats with taurine deficiency develop which of the following?

A - Dilated cardiomyopathy B - Restrictive cardiomyopathy C - Myocarditis D - Hypertrophic cardiomyopathy

A - 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 irregular.

A rescued Peking 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 - Septic arthritis B - Panosteitis C - Normal radiographs D - Bumblefoot E - Egg binding

D - Atrial fibrillation

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

A 3-year old Thoroughbred presents for evaluation after pulling up late in a recent race. You perform an ECG, which is shown below. What is the rhythm?

A - Ventricular tachycardia B - Normal sinus rhythm C - Atrial tachycardia D - Atrial fibrillation E - Ventricular premature complexes

E - Bladder apex

This dog has transitional cell carcinoma in the bladder wall. This is a large, irregularly bordered, broad- based, mineralized mass at the apex of the urinary bladder. There is loss of the wall layering adjacent to this mass. There is blood flow detected within this mass. The trigone is within normal limits.

A 14-year-old male neutered Labrador retriever is presented with a two day history of hematuria with clots. Based on the ultrasound images shown below, where in the urinary tract is the location of the

problem?

A - Trigone B - Descending ureter C - Proximal urethra D - Prostate E - Bladder apex

A - Ich

This clinical presentation is consistent with Ich (or "white spot disease"). Dx -- light microscopic visualization of the parasite at 40X or 100X. As seen here, it is large (0.5-1.0 mm), round, covered in cilia, with characteristic micronucleus. It classically rotates or moves in an ameboid-like manner. Rx -- formalin or copper sulfate in the water every 2-3 days for at least 3 weeks. An OTC formulation of formalin and malachite green is effective but cannot be dispensed by vets due to regulatory concerns.

Many fish in a mixed tank of freshwater tropical fish, including guppies, neon tetras, and gold sevrums look like the neon tetra shown below. What is the presumptive diagnosis?

A - Ich B - Whirling disease C - Velvet disease D - Epizootic ulcerative syndrome (EUS) E - Epitheliosis

B - Butorphanol and theophylline

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

A 10-year-old male Pomeranian presents to you with a 3-month history of wheezing and marked respiratory distress. The owner reports that he has been coughing sporadically as if trying to clear his

throat of a hairball. The owner is a regular smoker. On your examination, the dog displays moderate expiratory difficulty. You submit blood work and take radiographs including inspiratory and expiratory lateral projections of the dog, which are shown below. Which of the following are commonly used to treat the likely condition?

A - Surgical repair of the defect B - Butorphanol and theophylline C - Amoxicillin, nebulization, and coupage D - Furosemide and prednisone E - Meloxicam and fluconazole

B - Avian tuberculosis

It is a chronic, granulomatous bacterial infection that is slow to spread and is characterized by gradual weight loss. M. tuberculosis is prevalent worldwide and is spread by infective feces. It is ZOONOTIC in immune-compromised people. Dx -- difficult. Rx -- none

A client with a small backyard flock presents a chicken carcass for necropsy. She says the bird had lost significant weight, was slow to move around, and was limping. Necropsy reveals various-sized granulomatous lesions distributed throughout the spleen, liver, intestines, and bone marrow, as seen below. What is the presumptive diagnosis?

A - Ulcerative enteritis B - Avian tuberculosis C - Candidiasis D - Colibacillosis E - Infectious coryza

A - Increase energy intake

About one lb/head/day of good quality grain should be introduced by mid gestation for sheep and goats carrying multiple fetuses. The prognosis for animals already showing clinical signs is poor and treatment is expensive. A C-section can be done, IV glucose administered slowly by drip. This should be followed by

rumen transfaunations and feeding 15 to 30 ml propylene glycol every 12 hours, as well as feeding high quality feed.

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

A - Increase energy intake B - Calcium gluconate IV C - Add magnesium oxide to feed D - IM dexamethasone E - Feed anionic diet

C - Trigeminal neuritis

Idiopathic trigeminal neuritis involves cranial nerve V (CN V) and is characterized by acute onset of flaccid jaw paralysis. Affected animals cannot close their mouth and have difficulty eating and drinking. In some cases, unilateral or bilateral Horner's syndrome, facial paresis, and decreased facial sensation are present. Most common in dogs, rare in cats.

A six-year-old female spayed golden retriever is presented for acute onset of flaccid jaw paralysis. The dog is unable to close her mouth, has difficulty eating and is drooling. There is no history of trauma. What is the most likely diagnosis?

A - Masticatory myositis B - Facial nerve paralysis C - Trigeminal neuritis D - Myasthenia gravis E - Meningoencephalitis

classic case: middle aged mid to large breed dog with dullness, weight gain, lethargy, hypothermia, dry coat, bilaterally symmetric, nonpruritic alopecia with rat tail; rare -- myxedema with "tragic" facial expression or stupor; signs can be vague and variable

pearls: congenital is rare, see disproportionate dwarfism etc. at birth; prognosis for adult-onset is good to excellent; euthyroid sick = other diseases lead to low T4; HYPERthyroidism is RARE in dogs and common in cats

CANINE ENDOCRINE DISORDERS

Hypothyroidism -- classic case & pearls

Dx: screen and see lowered serum total T4; measure lowered free T4 and increased TSH in dogs; TSH stimulation test rare; thyroid imaging; RULE OUT non thyroidal illness syndrome; routine labs show increased cholesterol, mild non regenerative anemia

Rx: oral T4 (levothyroxine); IV T4 if in myxedema coma

CANINE ENDOCRINE DISORDERS

Hypothyroidism -- Dx & Rx

classic case: polyuria/polydipsia/polyphagia, weight loss; if diabetic ketoacidosis (DKA) -- vomiting, inappetence, lethargy

pearls: fructosamine estimates blood glucose over previous 2 weeks if concerned the hyperglycemia is stress-induced; good prognosis

CANINE ENDOCRINE DISORDERS

Diabetes mellitius -- classic case & pearls

Dx: elevated serum fructosamine; routine lab work shows hyperglycemia, +/- increased ALP, urinalysis shows glucosuria +/- low USG and ketonuria

Rx: at home -- long acting insulin, dietary changes; if ketoacidosis -- regular insulin and IV fluid therapy with electrolytes in the hospital

CANINE ENDOCRINE DISORDERS

Diabetes mellitius -- Dx & Rx

classic case: the 4 P's -- polyuria, polydipsia, polyphasic, and panting; truncal alopecia, pot-bellied appearance, thin skin; can be iatrogenic, adrenal-dependent (ADH), or pituitary-dependent (PDH)

pearls: can be difficult to differentiate between ADH and PDH; good prognosis with medical Rx for PDH, variable for ADH

CANINE ENDOCRINE DISORDERS

Hyperadrenocorticism -- classic case & pearls

Dx: depends on type of HAC; low or high- dose dexamethasone suppression test; ACTH stimulation test (r/o iatrogenic), urine cortisol-to-creatinine ratio, endogenous ACTH (increased with PDH); routine lab work shows stress leukogram, increased ALP and cholesterol; adrenal ultrasound

Rx: for PDH -- trilostane, lysodren, or surgical hypophysectomy or bilateral adrenalectomy; for ADH -- trilostane, lysodren or bilateral adrenalectomy

CANINE ENDOCRINE DISORDERS

Hyperadrenocorticism -- Dx & Rx

Classic case: young adult female dog with loss of condition, recurrent gastroenteritis, poor response to stress; acute circulatory collapse and renal failure when "early" signs go unnoticed

Pearls: acute addisonian crisis is an emergency! most commonly due to autoimmune failure of the adrenal cortex

CANINE ENDOCRINE DISORDERS

Hypoadrenocorticism -- classic case & pearls

Dx: history and clinical signs with hyperkalemia, hyponatremia, acidosis, azotemia and normocytic normochromic anemia; ACTH stimulation test

Rx: acute crisis -- IV saline +/- dextrose, steroids for shock; long-term mineralocorticoid replacement with desoxycorticosterone pivalate (DOCP, Percorten)

CANINE ENDOCRINE DISORDERS

Hypoadrenocorticism -- Dx & Rx

A - Dystocia, overfeeding in dry period, Ca-P imbalance in feed

Cows are also predisposed to metritis by: retained placenta, contaminated calving environment, abortion, malnutrition. In cattle, the causative bacterial organisms isolated most often are Trueperella pyogenes alone or with Fusobacterium necrophorum or other gram negative anaerobes.

Which one of the following sets of conditions predispose a cow to metritis?

A - Dystocia, overfeeding in dry period, Ca-P imbalance in feed B - Agalactia, milk fever, bovine vibriosis C - Strep. agalactiae mastitis, retained placenta, laminitis D - Milk fever, malnutrition, excess dietary zinc E - Contaminated calving environment, abortion, hypomagnesemia

D - Surgical removal of the feather cyst and follicle

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

A 6-year old Sun Conure presents for evaluation of a skin lesion. The owner reports that the bird is very sensitive on the wing near the lesion. On your exam, you note an oval swelling involving the

feather follicle as seen in the image below. What is the best treatment for feather cysts?

A - No treatment is necessary as feather cysts typically resolve spontaneously B - Squeeze and express the material out of the feather cyst C - Lance and drain the feather cyst, flush with saline D - Surgical removal of the feather cyst and follicle E - Treat with systemic antibiotics for 4-6 weeks

Classic case: large and giant breeds (doberman, boxer, Great Dane, Irish wolfhound, standard poodle, but also cocker spaniels), middle aged; early signs -- heart murmur, weak peripheral pulses, exercise intolerance; congestive heart failure -- cough, tachypnea and dyspnea, tachycardia, weakness

CANINE CARDIOLOGY

Dilated cardiomyopathy -- classic case

• dogs with occult disease can live several years
• sudden death due to arrhythmias can occur even before echocardiographic changes of DCM are seen -pimobendan -- if started prior to CHF, will delay development of CHF. can extend life during CHF, but prognosis after 1 yr is poor

CANINE CARDIOLOGY

Dilated cardiomyopathy --prognosis

• taurine deficiency-linked in American cocker spaniels, golden retrievers, boxers, and Dalmatians
• carnitine-responsive in boxers
• chagas myocarditis caused by the protozoan trypanosoma Cruz
• parvovirus due to in utero exposure, rare now
• doxorubicin-induced caused by cumulative doses greater than 180 mg/m

CANINE CARDIOLOGY

Dilated cardiomyopathy -- other causes

• breed predilections: siamese, Burmese, Abyssinian
• prognosis is poor because most present in CHF
• dx and rx similar to canine DCM
• taurine deficiency (commonly seen prior to 1987, now rare because of increased dietary taurine in most cat foods)

CANINE CARDIOLOGY

Dilated cardiomyopathy -- feline DCM

Radiography

• generalized cardiomegaly
• variable venous dilation
• pulmonary edema / perihilar infiltrate if decompensated

ECG/Holter monitor

• ventricular ectopic beats are common
• may see significant ventricular arrhythmias early in Dobermans
• AFib in advanced disease
• Holter monitoring to determine: severity of arrhythmia, if therapy indicated

Echocardiography

• left atrial and ventricular dilation
• mitral +/- tricuspid valve regurgitation
• +/- right atrial and ventricular dilation -evidence of poor contractility: prolonged end-point septal separation, decreased fractional shortening

CANINE CARDIOLOGY

Dilated cardiomyopathy -- Dx

Prior to onset of CHF

• ACE inhibitors
• pimobendan (positive inotrope / vasodilator) if heart dilation present
• anti-arrhytmics (e.g. sotalol, mexilitine) for ventricular arrhythmias

After onset of CHF

• acute therapy: oxygen, stress reduction, parenteral furosemide, pimobendan
• chronic therapy: oral furosemide, ACE inhibitors, pimobendan

CANINE CARDIOLOGY

Dilated cardiomyopathy -- Rx

D - Senecio spp. (ragwort)

Common plants containing pyrollizidine alkaloids (PA) are: Senecio vulgarisms, S. jacobea, Heliotropium europaeum, Crotolaria spectabilis. Although generally not palatable, livestock will eat these plants when baled in hay or on pasture when forage is scarce. Chronic ingestion allows accumulation of toxic levels of PA, resulting in hepatic fibrosis.

Pyrrolizidine alkaloid toxicity is caused by chronic ingestion of which one of the following plants?

A - Astragalus spp. (locoweed) B - Lupinus spp. (lupine) C - Nerium spp. (oleander) D - Senecio spp. (ragwort) E - Persea spp. (avocado)

D - Via tick vector

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

You note the abnormality seen on the blood smear below of a dog presenting to you for weakness and fever. What is the likely route that the dog was infected?

A - Via flea vector B - Via transmammary route C - Via inhalation D - Via tick vector E - Via skin penetration F - Via ingestion (fecal-oral)

A - Idiopathic

Horner's syndrome is idiopathic in ~50% of dogs (~45% in cats). It is caused by a lack of sympathetic innervation to the eye. See four ocular signs with Horner's:

1. miosis (constricted pupil)
2. protrusion 3rd eyelid (nicitans)
3. enophthalmos (sunken eye)
4. ptosis (drooped eyelid) +/- anisocoria "My 3rd Sunken Toe"

What is the most common cause of Horner's syndrome in dogs?

A - Idiopathic B - Brachial plexus avulsion C - Neck bite wounds

D - Otitis media E - Retrobulbar neoplasia

B - Right lateral recumbency abdominal radiograph

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

A 3-year old castrated male Doberman Pinscher presents for acute onset non-productive vomiting of 3 hours duration. On exam, the patient is extremely lethargic, tachycardic, has weak pulses and a distended abdomen. Following standard initial emergency treatment for suspected gastric dilation and volvulus, you would confirm the diagnosis with what imaging procedure?

A - Abdominal ultrasound exam B - Right lateral recumbency abdominal radiograph C - Left lateral recumbency abdominal radiograph D - Barium contrast abdominal radiograph E - Dorsal recumbency abdominal radiograph F - Ventral recumbency abdominal radiograph

E - Gossypol

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

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

A - Nicotine B - Cyanide C - Tannins D - Cardiac glycosides E - Gossypol

C - Antigen-antibody complex disease (Type III)

In type III reactions, antigen-antibody complexes are deposited on the endothelium, stimulating complement and a neutrophilic inflammatory response and vascular damage. Look for localized or multi systemic vasculitis. Classic type III diseases include:

• glomerulonephritis
• hypersensitivity pneumonitis (think moldy hay)
• purpura hemorrhagica (think post-strangles)
• anterior uveitis

Which type of immune reaction is occurring in this picture of a horse with limb edema secondary to a localized vasculitis?

A - None of these B - Cell-mediated immune reactions (Type IV) C - Antigen-antibody complex disease (Type III) D - Antibody-mediated cytotoxic reactions (Type II) E - Immediate hypersensitivity and atopy (Type I)

Classic case: acute onset of weakness/collapse, exercise intolerance, abdominal distention, muffled heart sounds, tachycardia, weak femoral pulses, jugular pulses, pulsus paradoxus (increase in pulse pressure during expiration and decrease during inspiration -- normally occurs, but not as easily palpable during PE), pale mucous membranes

Pearls: Prognosis

• idiopathic: good if effusion rarely recurs or if pericardectomy
• neoplastic: hemangiosarcoma and mesothelioma (poor long-term prognosis, recurrent effusions and metastatic disease are most common cause of death); chemodectoma (guarded long-term prognosis, pericardectomy can prolong survival if PE recurrent) Ultrasonography is diagnostic AND can identify underlying causes such as tumors PE in cats is usually a manifestation of heart failure

CANINE CARDIOLOGY

Pericardial effusion -- Classic case & pearls

Etiology: seen in certain dog breeds depending on underlying cause

• cardiac tumors: German shepherd, golden retriever, boxer, Labrador retriever, bulldog, Boston terrier
• Idiopathic PE: Golden retriever, Labrador retriever

ECG:

• tachycardia -electrical alternans: beat to beat alternating heart of R-wave amplitude (due to swinging motion of heart within fluid-filled sac) occurs in 50% of patients
• low R-wave amplitude

Radiography:

• rounded, globoid cardiac silhouette
• dilated caudal vena cava
• ascites due to passive congestion

Echocardiography

• fluid-filled sac surrounding heart
• cardiac tamponade: flailing right heart due to pressure from PE
• possibly a causative mass in R atrium, right auricle or heart base

Cytology of effusion:

• unless due to lymphoma or infection, it is rarely of diagnostic value
• effusion PCV of less than 10% appears to improve the diagnostic yield

CANINE CARDIOLOGY

Pericardial effusion -- Dx

Ultrasound-guided pericardiocentesis

• use closed collection system
• typically on right between 4th and 6th ribs at costochondral junction
• record ECG during procedure as arrhythmias will be seen if heart is accidentally touched with needle

Pericardectomy

• for recurrent effusions to decrease risk of tamponade
• can be curative for idiopathic PE

Treatment of neoplasia

• right auricular hemangiosarcoma: possible surgical resection
• lymphoma, chemodectoma, hemangiosarcoma, and mesothelioma: chemotherapy