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
... [Show More] 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 - correct answer A
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 5 year old domestic short-haired spayed female cat is presented with the complaints of anorexia, chronic vomiting, and weight loss.
Physical examination reveals icterus, dehydration, and fever. Thickened small intestinal loops are appreciated with abdominal palpation, and serum biochemistry shows increased bilirubin and liver enzymes.
The cat is diagnosed with extrahepatic biliary obstruction with accompanying cholangitis and inflammatory bowel disease. Which one of the following normal anatomic features may predispose cats to this triad of diseases?
A - Narrowing of the duodenum distal to the entry of the common bile and pancreatic ducts
B - Common opening of the pancreatic and common bile ducts into duodenum
C - Enlarged duodenal papilla in comparison to other species
D - Decreased proportion of alpha-smooth muscle actin in muscle fibers of the wall of the gall bladder in cats
E - Decreased diameter and increased branching of the hepatic ducts in comparison to other species - correct answer B
In cats, there is a common opening of the pancreatic and common bile ducts into the duodenum. It is thought that this may predispose them to ascending cholangitis and pancreatitis after vomiting associated with inflammatory bowel disease, resulting in extrahepatic biliary obstruction.
Other possible etiologies of EHBO include neoplasia, biliary stricture, duodenal obstruction, diaphragmatic hernia, and parasitic infection.
In all cases, there is a lack of bile entry into the intestinal tract, leading to decreased absorption of fat and fat soluble vitamins such as vitamin K, potentially resulting in coagulopathies.
Except in transient cases that are related to acute pancreatitis, surgical intervention to relieve the obstruction is required as well as appropriate supportive care, antimicrobial treatment, and vitamin K administration.
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 - correct answer B
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.
What is the main mode of transmission for feline leukemia virus?
A - Aerosol transmission
B - Shedding of virus via feces
C - Fomite transmission
D - Shedding of virus via saliva - correct answer D
The correct answer is shedding of virus via saliva. The main mode of transmission is via saliva. It requires prolonged, close contact. Cats may shed the virus for months to years. Transmission may also occur through reuse of instruments and blood. Virus is shed in saliva, tears, urine, and feces.
You are working with a farmer who is having trouble with calves between the age of 2 weeks and 6 months. They are alert, but weak, dyspneic and die suddenly. On necropsy they have pale cardiac and skeletal muscles. What is the farmer's problem?
A - Copper deficiency
B - Sorghum toxicity
C - Lightning strike
D - Selenium deficiency - correct answer D
The correct answer is selenium deficiency. The pale muscle and clinical signs are classic for vitamin E and selenium deficiency. This is important to remember! Other things that should be on your differential list for this case include cardiotoxic plants.
A 6-year old intact male domestic short haired cat presents with acute onset exophthalmos of the right eye in the past 2 days. He is painful on palpation around his eye and head. The eye can be retropulsed with minimal resistance. He has not been eating in the past day and has a rectal temperature of 103.4F (39.7 C). What is the most likely diagnosis?
A - Orbital neoplasia
B - Retrobulbar abscess
C - Anterior uveitis
D - Glaucoma - correct answer B
The answer is a retrobulbar abscess. Acute, painful exophthalmos is usually due to retrobulbar abscessation. These lesions are usually painful and may be swollen. These animals are frequently systemically ill with fever and leukocytosis. Causes of retrobulbar abscesses include penetrating wounds, foreign bodies, spread from dental or sinus infection, and hematogenous spread. Glaucoma does not cause exophthalmos, although, chronically it can cause buphthalmos which may appear similar. Anterior uveitis also does not cause exophthalmos.
You are an associate veterinarian paid a base salary of $55,000 annually, plus a 8 % bonus based on receipts above your monthly production goal of $23,000. Bonuses are paid quarterly. Your last three month's production were:
$23,000, $28,000, and $27,000.
How much is your quarterly bonus?
A - $670
B - $840
C - $720
D - $810
E - $900 - correct answer C $720
If $23,000 is the monthly production goal, then the month you brought in $23,000 does not count towards a bonus.
In the second month, $ 28,000 = $5000 above goal
In the third month $ 27,000 = $4000 above goal
Total above production goal = $5000+$4000= $9000
$9000 X (0.08 bonus rate) = $720.
Many practices use a combination system with a base salary and a production-based bonus if you bring in more than a monthly production goal, but no penalty if you are below that monthly goal, which is good if you are a new graduate, and helps in low traffic months at the clinic.
A 10-year old female spayed Siamese cat presents for a new lump the owner found a month ago. She was spayed last year before she was adopted from the shelter. The owner states that the lump has grown over the last month, and it doesn't seem to bother the cat. On exam, the 2 cm lump is located on the left 2nd mammary gland, and no other lumps are noted. The lump is freely moveable, and chest radiographs are clear. What is the chance that this tumor is malignant?
A - 5%
B - 50%
C - 20%
D - 85% - correct answer D
70-90% of all feline mammary tumors are malignant. Spaying a cat before 6 months of age reduces the risk for mammary tumors by 7 fold.
The statistics for dogs is a 50:50 chance of malignancy for a single mammary mass.
This 25 year old Quarter Horse mare is presented for evaluation in July in the northern hemisphere. She is diagnosed with pituitary pars intermedia dysfunction. Which one of the following medications would be most likely to be beneficial to this mare?
A - Isoxsuprine
B - Glucocorticoids
C - Pentoxifylline
D - Pergolide
E - Methimazole - correct answer D
Pergolide is the treatment of choice for pituitary pars intermedia dysfunction (PPID). PPID is characterized by degeneration of dopamine producing neurons in the hypothalamus that normally exert an inhibitory action on the pituitary pars intermedia, resulting in functional adenomas in the pars intermedia that produce high levels of adrenocorticotropin hormone.
Clinical signs and laboratory findings include hypertrichosis, poor muscle tone, laminitis, hyperglycemia and insulin resistance, and increased susceptibility to infection. Diagnosis is commonly made by documenting increases in plasma adrenocorticotropin hormone levels in affected animals.
An aged intact female potbellied pig presents for evaluation of abdominal distension. A large mass contiguous with the uterine wall is discovered with ultrasound exam of the abdomen. Which of the following choices is the most likely cause of this finding?
A - Uterine leiomyoma
B - Endometritis
C - Adenocarcinoma of the cervix
D - Lymphosarcoma
E - Endometrial hyperplasia - correct answer A
The most likely cause of a large uterine mass in an intact female potbellied pig is a uterine leiomyoma. These tumors do not typically metastasize so a cure may be achieved by surgical removal of the uterus.
A 10-year old German Shepherd presents to you with the complaint of licking the anal area and scooting. On examination, you find numerous ulcerated tracts in the perianal area that are draining purulent fluid. What is the diagnosis?
A - Perianal fistula
B - Clostridial colitis
C - Anal sac abscess
D - Anal sac impaction - correct answer A
The correct answer is perianal fistula. This is seen mainly in older German Shepherds, and licking the anus is a common presenting complaint. The key finding is the presence of multiple draining tracts in the perianal region that can actually be quite deep.
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) - correct answer E
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.
Oral administration of which of these drugs has been implicated as a cause of esophageal strictures in cats?
A - Doxycycline
B - Azithromycin
C - Diazepam
D - Potassium bromide - correct answer A
The correct answer is doxycycline. There is also evidence that clindamycin can cause stricture formation. For this reason, it is recommended that after pilling a cat with doxycycline, it is followed with a small volume (5-10 mls) of water.
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 - correct answer D
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.
Think more of a dropped jaw with trigeminal nerve neuropathy (CN 5-dogs, horses).
You see an 8-month old kitten with the effusive form of feline infectious peritonitis and perform euthanasia. The kitten was having severe diarrhea around the house when it became ill. The owner has a 2 year old cat at home and wants to know what this cat's prognosis is since it has been exposed to the sick kitten. Currently this cat is clinically healthy. What do you tell her?
A - You recommend a coronavirus titer to determine it the cat is actively infected
B - Her other cat may develop symptoms within the next two weeks because FIP is highly contagious
C - Feline infectious peritonitis is not contagious and because her other cat died of FIP does not mean this cat will succumb to the disease
D - Place the cat on L-lysine to prevent or suppress any infection with FIP
E - Perform a PCR on the cat's feces to see if the virus is being shed - correct answer C
Feline infectious peritonitis is not a contagious disease. It is a disease that is caused by a mutation of feline enteric coronavirus. It is unknown why in some patients this virus mutates and causes the FIP syndrome. It is most likely to occur in young or immunocompromised cats. Her other cat is not necessarily going to get FIP just from exposure. In fact, the majority of the cat population has been exposed to the feline enteric coronavirus.
Because most cats in the general population have been exposed, it makes interpretation of coronavirus titers difficult. The titers can be elevated due to prior exposure and not from FIP. The titers can only be interpreted in lieu of clinical signs, blood results, etc.
L-lysine is an anti-viral medication that may have some benefit for suppression of herpes virus but would not be a prevention or treatment choice for coronavirus. [Show Less]