NAVLE prep questions

1. 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: 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."
2. 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 duode-
num
C - Enlarged duodenal papilla in comparison to other species
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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: 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.
3. 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 SyndromeE - Pseudorabies: 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
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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.
4. 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: 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.
5. 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: 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!
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Other things that should be on your differential list for this case include cardiotoxic
plants.
6. 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: 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.
7. 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: C $720

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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.
8. 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%: 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.
9. This 25 year old Quarter Horse mare is presented for evaluation in July in
the northern hemisphere. She is diagnosed with pituitary pars intermedia

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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: 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.
10. 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: 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.
11. A 10-year old German Shepherd presents to you with the complaint of
licking the anal area and scooting. On examination, you find numerous

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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: 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.
12. 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): 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.
13. 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: A

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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.
14. 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: 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).
15. 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

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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 FIPE
- Perform a PCR on the cat's feces to see if the virus is being shed: 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.

The coronavirus is shed in the cat's feces during active infection with coronavirus.
Some infected cats do not shed the virus. The virus attacks the intestinal tract
and causes GI upset. PCR on the feces would detect coronavirus, but does not
distinguish between the enteric coronavirus and the mutated FIP form of the
virus.

16. A 10-year old male intact Doberman mix dog is presented with one testicle
that is grossly enlarged and nonpainful and the other atrophied. What
condition(s) are expected to be seen in association with this presentation?

A - Benign prostatic hypertrophy, constipation

B - Hypothyroidism
C - Increased aggression, territoriality
D - Feminization syndrome

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E - Penile hypertrophy, hirsutism: D

Feminization syndrome.

Nonpainful unilateral testicular swelling in an old dog should make you think of
neoplasia, especially an estrogen-secreting sertoli cell tumor, which can cause
feminization syndrome. See gynecomastia, penile atrophy, pendulous prepuce,
attraction of other males, blood dyscrasias, +/-bone marrow depression (via high
estrogen), bilateral alopecia.

Remember that cryptorchidism increases risk of sertoli cell tumor: About 25-29% of
sertolis develop feminization syndrome and ~ 70% of intra-abdominal testicular
tumors, regardless of type, cause feminization syndrome. May see prostate
hypertrophy with sertoli, but it is due to squamous metaplasia, not the classic (and
common) benign prostatic hypertrophy (BPH). Hypothyroidism and BPH are
common older dog conditions, but not associated with unilateral testicular
hypertrophy. Remember that sex hormones are also secreted by the zona reticularis
of adrenal cortex and can see feminization or virilism with excess secretion.
17. Tommy, a 4-year old male neutered domestic short hair, presents to you
for frequent urination. Urinalysis reveals 4+ struvite crystals. An abdominal
radiograph shows a 1 cm round calculus in the bladder. Tommy does not have
a urethral blockage, and urine culture is negative. The owner says surgery to
remove this stone is not an option due to finances. Which of the following
would be the most important treatment for Tommy?

A - Potassium citrate
B - Alkalinizing diet
C - Clavamox
D - Acidifying diet
E - Metacam: D
This cat most likely has a struvite bladder stone. This cannot be determined without
a stone analysis, but based on the signalment of the patient, the crystalluria, and
the radiograph, this is the most likely type. These types of stones typically form in
urine with a high pH. Therefore, an acidifying diet would be appropriate for stone
dissolution.

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Calcium oxalate stones are the most common type of stone to form in acidic urine.
For this type, an alkalinizing diet would be the most appropriate.

Clavamox would only be indicated if this cat had a urinary tract infection sensitive
to this antibiotic. This cat had a negative urine culture.

Metacam can be used short-term to help with pain and inflammation associated with
the cystitis from this condition but unfortunately Metacam is no longer recommend
for use in cats in the United States.

Potassium citrate is a supplement that can be given in addition to an alkalinizing

diet to prevent the formation of calcium oxalate stones. This would be
contraindicated in this case.
18. What is the primary factor associated with pregnancy toxemia in ewes and
goats?

A - Young age at parturition

B - Clostridium perfringens
C - Polioencephalomalacia
D - Inadequate nutrition
E - High sulfur, Low thiamine diet: D

Pregnancy toxemia in ewes and goats is a severe form of ketosis most associated
with inadequate nutrition and TWINS in OLDER animals. Can occur in either thin
or fat animals whose dietary intake does not meet the high energy demands of
late gestation. Animals present off-feed in late gestation, often thin. Severe cases
show neurologic dysfunction progressing to recumbency, death.

High sulfur and low thiamine are associated with polioencephalomalacia, on your
DDX for a neurologic sheep/cattle.
19. What tumor type is a cat predisposed to developing at vaccination sites?

A - Squamous cell carcinoma

B - Fibrosarcoma
C - Melanoma
D - Lymphoma: B

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The correct answer is fibrosarcoma. Vaccine-associated fibrosarcomas are very

well documented in cats.
20. Which breeds are predisposed to mitral regurgitation? (The number one
cause of congestive heart failure in dogs).

A - Cavalier King Charles spaniel, Cocker spaniel

B - Wirehaired fox terrier, Border collie
C - Great Dane, Afghan hound
D - Miniature schnauzer, German shepherd
E - Doberman pinscher, Boxer: A

Think of mitral regurgitation/insufficiency in a Cavalier King Charles Spaniel of any

age, or in old male Cockers with a Hx of cough, labored breathing, and exercise
intolerance. Remember that chronic obstructive pulmonary disease with fibrosis can
cause similar signs-primarily older animals.

Here are 4 other big cardio predispositions:

If you see an intermittently fainting Boxer, think of Boxer cardiomyopathy.

A rapid, irregular heart rate in a middle-aged, depressed, coughing, exercise-

intolerant Doberman, suggests dilated cardiomyopathy (DCM).

Think of Sick Sinus Syndrome (SSS) when you hear "Fainting Female Min.
Schnauzer". Also see SSS in dachshunds, cockers, west highland whites.

Think Tetralogy of Fallot in a young Bulldog, Keeshond, Wirehaired Fox Terrier with
cyanosis, exercise intolerance.

Remember young Min. Schnauzers and Wirehaired Fox Terriers are predisposed
to Mega-esophagus.
21. 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

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C - Strep. agalactiae mastitis, retained placenta, laminitis

D - Milk fever, malnutrition, excess dietary zinc
E - Contaminated calving environment, abortion, hypomagnesemia: A

Cows are predisposed to post-parturient bovine metritis by many things, including:

-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.

Note the name changes - Trueperella pyogenes used to be called Arcanobacterium

pyogenes and before that it was classified as Corynebacterium pyogenes.

Specific diseases associated with bovine metritis or endometritis include

brucellosis, leptospirosis, trichomoniasis, and bovine campylobacter.
22. In canine patients with primary hyperparathyroidism, a chemistry panel
would show:

A - Hypocalcemia, hyperphosphatemia
B - Hypercalcemia, hyperphosphatemia
C - Hypocalcemia, hypophosphatemia
D - Hypercalcemia, hypophosphatemia: D

The correct answer is hypercalcemia, hypophosphatemia. Patients with primary

hyperparathyroidism would have hypercalcemia and normo to hypophosphatemia
due to the law of mass action in which phosphorus decreases as calcium increases
and vice versa.

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23. A horse presents to your clinic after ingesting a large amount of grain.
What is your major concern?
A - Torsion
B - Acidosis
C - Impaction
D - Choke
E - Laminitis: E

The correct answer is laminitis secondary to endotoxemia. Laminitis, endotoxemia,

and diarrhea are commonly associated with grain overload and appropriate therapy
to evacuate any remaining stomach contents, ameliorate endotoxin and prevent
laminitis should be instituted immediately. Laxatives such as mineral oil are
commonly administered.
24. A 2-year old male castrated mixed breed dog presents for an altered gait
after being hit by a car. On physical exam, the thoracic limbs had decreased
biceps and triceps reflexes and decreased muscle tone. The pelvic limbs
had hyper-reflexive patellar and gastrocnemius reflexes and increased
muscle tone. Where is the spinal cord lesion?
A - L4-S3
B - C1-C5
C - T3-L3
D - C6-T2: D

The correct answer is C6-T2. In a dog, the spinal cord is divided into the four regions
listed above. Upper motor neuron signs include hyper-reflexia of spinal reflexes and
increased muscle tone. Lower motor neuron signs include decreased or absent
spinal reflexes and decreased muscle tone. A lesion between the C6-T2 spinal cord
segments would result in lower motor neuron signs in the thoracic limbs and upper
motor neuron signs in the pelvic limbs, as described in the patient in the question.

A lesion between C1-C5 spinal cord segments would manifest as upper motor
neuron signs in the thoracic and pelvic limbs.

Lesions between T3-L3 spinal cord segments would not affect the thoracic limbs,
but would manifest as upper motor neuron signs in the pelvic limbs.

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Lesions between L4-S3 spinal cord segments would result in normal thoracic limbs
and lower motor neuron signs in the pelvic limbs.
25. Which of the following is a causative agent of infectious bovine
keratoconjunctivitis as shown in this image?
A - Thelazia
B - Histophilus somni
C - Moraxella bovis
D - E. coli: C

The correct answer is Moraxella bovis. Thelazia is the eye worm. Histophilus
somni is a cause of many syndromes, but is rarely found in the eye. E. coli is not
an ocular pathogen.
26. An 11-year old Peruvian Paso presents with a history of progressive
weight loss. Serum chemistry shows elevation in sorbitol dehydrogenase,
lactate, alkaline phosphatase, and a decrease in albumin. A vast amount of
Crotalaria spp. is seen in the pasture. What type of toxin does Crotalaria spp.
possess?

A - Nitrate
B - Organophosphate
C - Cyanide
D - Pyrrolizidine alkaloid: D

The correct answer is pyrrolizidine alkaloid. The clinical signs described are typical
for pyrrolizidine alkaloid toxicity. Consumption of this plant typically results in
abnormalities in hepatic cell division; thus resulting in large hepatocytes known as
megalocytosis.
27. Acromegaly is associated with what 3 diseases in cats?

A - Hypoadrenocorticism, Congestive heart failure, Hepatic lipidosis

B - Hyperadrenocorticism, Pleural effusion, Lameness
C - Diabetes mellitus, Cardiomyopathy, Renal disease
D - Prognathism, Pulmonary edema, Pulmonary Hypertension
E - Vertebral spondylosis, 3rd degree heart block, Glomerulonephritis: C

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Think first of Diabetes mellitus in OLDER MALE cats (ave. 10 yr, 90% male) with
Feline acromegaly. First presenting sign may be PU/PD, polyphagia of diabetes.
WEIGHT GAIN in an unregulated diabetic cat STRONGLY SUGGESTS
acromegaly. Think also of Cardiomyopathy (~50%; see weakness, dyspnea,
systolic murmur, cardiomegaly/CHF, pulmonary edema ). Think also of RENAL
disease (~50%; see proteinuria, USpG 1.015-1.025, (and glucosuria from Dm)).

May see prognathism (long mandible), lameness (esp. cats), marked vertebral
spondylosis.
28. You diagnose a dog with mites. Which of the following mites is not
contagious to other dogs?

A - Demodex spp.
B - Cheyletiella spp.
C - Sarcoptes spp.
D - Psoroptes spp.: A

The correct answer is Demodex. Demodex mites are a natural inhabitant of skin.
Clinical signs of a Demodex infection usually occur in puppies or immune-
suppressed animals. The other mites listed are considered contagious.
29. A 7 year old female spayed Border Collie is presented with two very goopy,
gunk-covered eyes. A Schirmer tear test finds less than 10 mm/minute of
wetting, a decreased result from the normal of at least 15mm / minute of
wetting.

The owner reports that the dog has been on "some kind of medicine" for the
last 10 days, but it is actually his girlfriend's dog, and he doesn't know what
the medicine is. Keratoconjunctivitis sicca (KCS) secondary to the drug is
suspected. Which drug may be causing the KCS?

A - Amitraz
B - Trimethoprim sulfa
C - Griseofulvin
D - Itraconazole
E - Prednisolone: B

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Systemic sulfonamides like trimethoprim sulfa have been associated with

keratoconjunctivitis sicca (KCS), sometimes irreversibly.

Another drug-associated cause of TRANSIENT KCS is the combination of recent

general anesthesia and atropine.

Other causes of KCS include: Distemper, Immunologic (think ATOPY), Breed

(Pugs, Yorkies), and trauma (Proptosed eyeball).
30. Retained placenta and metritis can predispose to which one of the
following secondary conditions in horses?
A - Laminitis
B - Postpartum dysgalactia syndrome
C - Contagious equine metritis
D - Cystic endometriosisE - Colic: A

In horses, retained placenta and septic metritis can cause acute laminitis.

Other causes of equine laminitis include:

Grain overload
Overeating lush spring grasses
Insulin dysregulation
Colic, endotoxemia
Exposure to black walnut (Juglans nigra) shavings
Over-exercise on hard surfaces
Lameness on one limb requiring overdependency on opposite leg, which then
develops laminitis.
31. A 5-year old male castrated Mastiff presents for left pelvic limb lameness.
The medial aspects of both stifles are thickened. Manipulation of the left stifle
reveals cranial motion of the tibia relative to the femur and a clicking sound
from the joint on flexion and extension. What is the most likely diagnosis?

A - Left luxating patella

B - Left cranial cruciate ligament rupture with meniscal cartilage tear
C - Left cranial cruciate ligament rupture with no meniscal cartilage tear
D - Left caudal cruciate ligament rupture with no meniscal cartilage tear: B

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The correct answer is left cranial cruciate ligament rupture with meniscal cartilage
tear. The cranial motion of the tibia and medial thickening of the joint (also known
as medial buttress) is consistent with the commonly torn cranial cruciate ligament.
The clicking heard on flexion and extension is consistent with damaged medial
meniscus cartilage found in the stifle.
32. Which of the following drugs is known for stimulating appetite in small
animals?
A - Cyproheptadine
B - Acyclovir
C - Omeprazole
D - Tetracycline: A
The correct answer is cyproheptadine. Other appetite stimulants used for
stimulating food consumption include mirtazipine, diazepam and oxazepam.
33. An unweaned 2-month old calf is presented for necropsy. The calf
collapsed and suddenly died after she escaped and was chased around the
back pasture for 45 minutes by her owner.

Among other things, white myocardial and endocardial streaking in the left
ventricle of this calf's heart are discovered. What advice should be given the
farmer?

A - Put all the calves off ionophore-containing feed

B - Start the other calves on Ceftiofur (Naxcel ®)
C - Treat the other calves with vitamin E/Selenium
D - Check the mother for bovine leukosis by AGID
E - Search the calf barn for sources of lead: C

Treat the other calves with vitamin E/Selenium. Think of white muscle disease when
you see SUDDEN DEATH and endocardial PLAQUES in a young calf, lamb or kid
with a history of recent VIGOROUS EXERCISE.

Typically seen in young, fast-growing animals (ie: calves 2 weeks-6 mos). Clinical
signs may include dyspnea (due to myocardial disease), stiff gait, arched back,
weakness, recumbent but BAR (bright, alert, responsive). Sudden death may
resemble enterotoxemia, should see acute bloody diarrhea, convulsions,
opisthotonos in first days of life with enterotoxemia.
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34. A 1.5-year-old spayed female cat presents with a 7-day history of

vocalizing, rolling, and allowing a male neutered cat in the household to
mount her. The cat has gone through one similar episode 1 month ago. She
otherwise has been behaving normally and has no other health problems. You
performed an ovariohysterectomy on the cat at 3 months of age. You perform
vaginal cytology which shows some cornified epithelial cells but is
inconclusive. You measure serum lutenizing hormone of 0.2 ng/ml (normal for
an ovariectomized female is >1 ng/ml). Which of the following is the most
appropriate course of

action?

A - Order MRI of the brain to rule out a pituitary tumor

B - Measure serum testosterone levels
C - Exploratory laparotomy to remove the ovarian remnant
D - Measure serum estrogen and progesterone levels: C

This is a classic description of ovarian remnant syndrome, which is when a cat goes
into estrus after previously having an ovariohysterectomy (OVH).

This can occur anywhere from weeks to years after OVH and typically the clinical
signs consistent with estrus are sufficient to conclude that the cat is in estrus and
has ovarian tissue present. Additional diagnostic tests that are consistent with
ovarian remnant syndrome include:

Serum estrogen >70 pmol/L indicate that the cat has estrogen production from the
ovary. The problem with this test is that estrogen measurements may fluctuate and
can be unreliable. Serum progesterone >6 nmol/L after induced ovulation is
sufficient to conclude that corpora lutea formed and released progesterone. Testing
for serum LH levels can also help confirm the diagnosis. In intact queens, LH is
consistently maintained at basal levels due to negative feedback from ovarian
estradiol secretion. After OVH, this control is lost and LH concentrations increase.
LH <1 ng/mL is consistent with the presence of an ovary as it is in this case.

Surgery is the treatment of choice. Many practitioners prefer to do surgery during

estrus or diestrus when the ovarian tissue is enlarged and easier to locate.

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Remnants may be bilateral so a complete exploratory laparatomy is necessary.

Ovarian tissue is most commonly at the ovarian pedicle but can also be in the
mesentery or elsewhere.

You should be aware that ovarian remnant syndrome is NOT associated with new
graduates or inexperienced surgeons (it is not likely the fault of the initial
surgeon). It is suspected that accessory ovarian tissue separate from the ovary
within the ovarian ligament or proper ligament of the ovary may become functional
and cause this condition in most cases.
35. A 4 -year old domestic short haired cat presents for anorexia and weight
loss of 1 week. Physical exam reveals a body condition score of 7/9, jaundice
of the skin and sclera, and dehydration of 4%. Temperature is normal.
Bloodwork shows: ALT=303 (25-97 U/L) GGT=1.8 (0-6 U/L) ALP=1170 (0-45
U/L) bilirubin=3.0 (0-0.1 mg/dl) Radiographs show an enlarged liver. What is
the most important treatment for the cat's likely diagnosis?

A - Oral clavulanic acid and amoxicillin for 4 weeks

B - Oral S-adenosylmethionine for at least 1 month
C - Parenteral vitamin K injections
D - Esophagostomy tube feeding: D

The cat described likely has hepatic lipidosis. Cats that are greater than 2 years of
age and obese are at the greatest risk for hepatic lipidosis. Often these cats are
indoor-only and have had a recent stress in their life. An obese cat that is not eating
with the above symptoms is most likely to have hepatic lipidosis.

An ALP elevation that greater in magnitude than GGT is also suggestive of

hepatic lipidosis. A bile duct obstruction, cholangiohepatitis, lymphoma, and FIP
are other differentials but are less likely with the given information.
36. Which one of the following choices includes the cardinal sign of trigeminal
neuritis?

A - Masseter muscle pain associated with chewing

B - Circling and head tilt toward side of lesion, no other signs
C - Dysphagia, dysphonia and stridor
D - Inability to close the mouth
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E - Paralyzed eyelid, ear or lip on one or both sides of the face: D

Idiopathic trigeminal neuritis, cranial nerve 5, (CN 5) is characterized by acute onset

of flaccid jaw paralysis. Affected animals cannot close their mouth and have
difficulty eating and drinking. Seen occasionally in dogs, rare in cats. Cause is
unknown.

Idiopathic facial nerve paralysis, cranial nerve 7, (CN 7) results in the inability to
move the eyelid, lip, or ear and dryness of the eyes and mouth.

Masticatory myositis is characterized by pain on opening the mouth and swelling

of the muscles of mastication (acute) or atrophy of the temporalis and masseter
muscles with the inability to open the mouth due to fibrosis (chronic).

Dysphagia, dyphonia, and stridor are most often associated with dysfunction of the
vagus nerve, cranial nerve 10 (CN 10).

Circling and head tilt toward the side of the lesion with no other signs is a common
presentation of vestibulocochlear nerve, cranial nerve 8 (CN 8) lesions.

Concurrent CN 7 paralysis and Horner's syndrome (ptosis, miosis, enophthalmis)

may be present with middle- and inner-ear infections.

37. A 9 year old German shepherd is presented with unchecked bleeding from
a cut on the gums above the right canine tooth. The owner relates that the
dog has lost weight and had an episode of collapse 3 days ago, but he
recovered.

On physical exam, the gums are pale with petechiae and ecchymotic
hemorrhages. There is tachycardia and a palpable cranial abdominal mass.

A coagulation profile shows the following:

Thrombocytes= 82,533 per microliter..[N=200,000-900,000]

Buccal mucosal bleeding time (BMBT), increased
Activated partial thromboplastin time (aPTT), increased

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Prothrombin time (PT), increased

Thrombin time (TT), increased
Fibrin degradation products (FDPs), increased

What disorder of coagulation best fits this pattern?

A - Von Willebrand's disease

B - Idiopathic thrombocytopenia
C - Disseminated intravascular coagulation
D - Anticoagulant rodenticide toxicity
E - Hepatic insufficiency: C

A lab pattern of low platelets, increased bleeding time and across the board
increases in aPTT, PT, TT and FDP tests suggests disseminated intravascular
coagulation (DIC). DIC is not a disease in its own right- it is a complex hemostatic
defect characterized by enhanced coagulation and fibrinolysis, secondary to other
diseases. Fibrinolysis and depletion of clotting factors leads to hemorrhage.

Many, many diseases, all of them bad, can precipitate DIC. This case presentation
(pale, older German shepherd with Hx of collapse, bleeding and an abdominal
mass) suggests hemangiosarcoma.

Remember your "H diseases" associated with DIC:

Heartworm
Heart failure
Hemolytic anemia
Hemangiosarcoma

Hemorrhagic gastroenteritis
Hepatic disease, especially hepatic lipidosis in cats.
Gastric dilatation-volvulus (GDV), mammary gland carcinoma and pancreatitis can
also lead to DIC.
38. A tourniquet was placed at mid cannon bone on this cow's leg. Lidocaine
is being injected in the dorsal pedal vein. What is expected to happen?

A - Anesthesia distal to tourniquet

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B - Bradycardia with gradual tourniquet removal

C - Anesthesia only from mid-pastern to the toe
D - Cessation of atrial fibrillation after tourniquet removal
E - Anesthesia only of skin in the region of the injection: A

Anesthesia distal to tourniquet. This is an example of intravenous regional

anesthesia, the anesthetic method of choice for most bovine digital surgical
procedures. It has similar results to a nerve block, but is easier to do with reliable
results.

You need only one injection and no special knowledge of anatomy. 2% Lidocaine
infuses down the venous system and anesthetizes the entire lower limb distal to the
tourniquet within about 10 minutes.

The amount of lidocaine needed is typically 10-30 ml and should not exceed a total
dose of 9 mg/kg. Click here to see tourniquet sites and veins for intravenous regional
anesthesia of the distal bovine hindlimb.

Do not keep a tourniquet in place more than one hour. When surgery is complete,
slowly release the tourniquet and then retighten it. If antibiotics are indicated, infuse
them now then release the tourniquet after a few more minutes.

Some references call this a "Bier" block, after the pioneering German physician
August Bier, who reported on this form of anesthesia in 1908.

Lidocaine (and procainamide) are used to treat arrhythmias, but more for ventricular
fibrillation in small animals and not administered from the foot. Think of quinidine
sulfate to treat atrial fibrillation in symptomatic horses.
39. A flock from a turkey farm is presented with a mysterious illness.

Several dead birds are noted, mostly younger. Sick turkeys are listless, with
drooping wings, unkempt feathers, yellow droppings. Sick older birds are
emaciated. Necropsy shows a yellowish green, caseous exudate in the ceca,
cecal ulcerations and thickening of the cecal wall. What is the diagnosis?

A - Histomoniasis

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B - Necrotic enteritis
C - Avian spirochetosis
D - Coronaviral enteritis of turkeys
E - Hemorrhagic enteritis of turkeys: A

This is histomoniasis. The combination of characteristic "bulls-eye" lesions on liver

and cecal changes are pathognomonic. Caused by protozoan Histomonas
meleagridis, transmitted in eggs of cecal nematode Heterakis gallinarum. Expect a
depression/diarrhea presentation.

Expect to see more sudden death with necrotic enteritis caused by Clostridium
perfringens. Follow this link to see the so-called "Turkish towel" intestinal
pseudomembrane of necrotic enteritis.

Signs of avian spirochetosis are highly variable, may be absent: see listlessness,
shivering, increased thirst, green/yellow diarrhea with increased urates early on.

Caused by a tick-borne Borrelia. Look for characteristic enlarged, mottled spleen

with petechial hemorrhages, similar to Marble spleen disease of pheasants. Expect
depression, bloody droppings, substantial mortality with hemorrhagic enteritis of
turkeys. Follow this link to see hemorrhagic intestines. Follow this link to see
characteristic enlarged spleen.

Expect diarrheal presentation with coronaviral enteritis of turkeys but NOT the
characteristic cecal/liver lesions described on necropsy above.
40. A pig farm has several sick and dying adult pigs. Affected animals are
febrile and depressed.
Some seem constipated and others have diarrhea. A few are ataxic. A
necropsy on one of the dead pigs shows widespread petechial and
ecchymotic hemorrhages in the kidneys ("turkey egg kidneys"), bladder,
spleen, and larynx. Which one of the following choices is the most likely
diagnosis?

A - Haemophilus parasuis
B - Hemagglutinating encephalomyelitis
C - Classical swine fever

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D - Swine dysentery
E - Erysipelas: C

Hemorrhages on the kidneys and other organs are characteristic of both classical
swine fever (CSF, also called "hog cholera") and African swine fever (ASF).
African swine fever cannot be differentiated from classical swine fever based on
clinical and postmortem symptoms alone. Confirmation is based on either PCR or
ELISA antigen testing. Both are reportable diseases. Classical swine fever was
last reported in North America in the 1970s.

Erysipelas is characterized by fever, painful joints, and diamond-shaped skin

lesions.

Hemagglutinating encephalomyelitis (vomiting and wasting disease) and

Haemophilus parasuis (Glasser's disease) both occur mainly in young piglets.
41. 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: A

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

Actinobacillus pleuropneumoniae.

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42. 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?

A - Fowl cholera
B - Marek's disease
C - Infectious coryza
D - Avian pox
E - Fowl plague: D

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.
43. 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 - Ultrasound of umbilicus/urachus
C - Digital exam of rectum
D - Cystocentesis
E - Endoscopy of gastric mucosa: C

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.
44. Which one of the following choices is the most common etiology of canine
cholangiohepatitis?

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A - Neoplastic biliary obstruction

B - Idiopathic
C - Ascending infection
D - Liver fluke migrationE - Toxicity: C

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)
45. 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: C

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.

46. 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?
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A - Remission rates
B - Treatment response
C - Survival time
D - Prevalence of gastrointestinal lymphoma
E - Prevalence of mediastinal lymphoma: B

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.
47. 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: E

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.

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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.
48. An adopted adult cat from a shelter with an unknown vaccination history
tests positive for feline leukemia virus (FeLV) infection by IFA. What should
the owner be told?

A - Possible transient FeLV infection

B - Need an ELISA test in 12 weeks to confirm diagnosis
C - Cat may be vaccinated for FeLV
D - Need a Western blot test to confirm diagnosis
E - Strong chance of lifelong FeLV infection: E

97% of cats positive for feline leukemia virus (FeLV) by IFA remain persistently
infected and viremic for life.

The FeLV ELISA is more seNsitive than the IFA (fewer false Negs, so trust a NEG
test more), so it is a better general screening test with which to start. Click here for
a diagram.

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The FeLV IFA is more sPecific than the ELISA, (fewer false Pos, so trust a POS test
more) so it is a better confirmatory test for any cats with a positive FeLV ELISA.
Click here for a diagram.

THREE things to remember about FeLV and vaccinations:

1. FeLV ELISA and IFA tests measure ANTIGEN, not antibody, so FeLV vaccination
does NOT interfere with testing.
2.Vaccinate FeLV-positive cats yearly against respiratory, enteric viruses with
inactivated vaccines.
3. FeLV vaccination for FeLV-negative cats has been associated with sarcomas.
Vaccinate LOW on the LEFT hind.
49. A 5-year old Arabian mare is presented. The owner is not happy. This same
horse was treated for strangles 2 weeks ago, and now the mare is sick again.

The horse has a 48-hour history of urticarial wheals on its skin that
progressed to sharply demarcated edema of the muzzle, eyes, belly and
limbs. She reacts as if it is painful when the edema is checked. The horse
breathes heavily, with stridor, dyspnea and diarrhea. There is petechiation
and ecchymoses on the mucous membranes and the muzzle is a reddish,
mulberry color.

T=102.2 F (39 C)..[N=99-101.3 F, N=37.2-38.5 C]

HR=32 bpm..........[N=28-40]
RR=12 brpm.........[N=10-14]

What is the clinical diagnosis?

A - Potomac Horse Fever

B - Equine salmonellosis
C - Lyme disease
D - Purpura hemorrhagica
E - Equine viral arteritis (EVA): D

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History of strangles, Streptococcus equi equi followed 2 weeks later by a mixed

clinical picture(ie: afebrile, purpura, painful edema, respiratory difficulty, diarrhea
or colic) is a classic presentation for Purpura hemorrhagica.

Most common cause is sensitization to Strep equi from strangles or Strep equi
bacterin vaccine. Less commonly see after Equine influenza, or chronic suppurating
wounds. Due to immune complexes damaging vasculature.

For edema in horses, remember "Big 3 are PEE" Purpura, EIA, EVA.

Potomac Horse Fever (Neorickettsia risticii) presents as a febrile colitis/diarrhea,

with laminitis 3-5 d after diarrhea: A big rule out is Salmonella (think
septicemia/fever + diarrhea). PHF occurs in northeastern U.S. river valleys in JULY
and AUGUST.

Lyme disease presents as lameness. ie: arthritic joint(s), low grade fever, reluctant
to move. More a dog, human disease.

With Equine viral arteritis (EVA) see conjunctivitis, rhinitis. If very sick, see severe
depression, cough, ventral edema, limb edema.
50. A flock from a local broiler poultry farm is presented. Half of the flock has
died in the last 10 days. Examination of the flock shows chickens that are
gasping and coughing, extending their necks to inhale. Some have blood-
stained beaks. There are no obvious neurologic signs. The most likely
presumptive diagnosis is?

A - Infectious coryza
B - Infectious laryngotracheitis
C - Fowl pox, diphtheritic form
D - Viscerotropic Velogenic Newcastle diseaseE - Marek's disease: B

Blood in the trachea and this Hx suggest infectious laryngotracheitis (ILT). A

highly contagious herpesvirus infection, ILT is characterized by RESPIRATORY
signs (rales, severe dyspnea, coughing). In severe forms, mortality can reach
50%, typically due to occlusion of the trachea by blood, mucus or caseous
exudates. In most states ILT is REPORTABLE.

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Infectious coryza is a milder respiratory disease, with swelling around the eyes and
head, sneezing, nasal discharge.

Newcastle disease is characterized primarily by respiratory signs. Severe forms

include depression, neurologic signs or diarrhea. Look for GI hemorrhage with
most severe form, Viscerotropic Velogenic Newcastle disease (VVND), which is
REPORTABLE.

With fowlpox, only a few birds typically affected with scablike lesions around head.
Click here to see Fowlpox.

See only depression before death with Marek's disease. Some birds may have
characteristic unilateral paresis (one leg forward, one leg back). On necropsy, see
lymphoid tumors in organs and enlarged nerves.
51. What is the earliest stage post-breeding that an experienced practitioner
can reliably feel placentomes rectally in the gravid uterine horn in a pregnant
cow?

A - 40-55 days
B - 30-35 days
C - 70-75 days
D - 80-85 days
E - 90-120 days: C
An experienced practitioner can reliably feel placentomes around 70-75 days. You
can reliably feel the "membrane slip" of chorioallantoic membranes rectally at 30-
35 days and fremitus (vibration in uterine artery of the gravid uterine horn) between
90-120 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
52. Several sheep are sick at a petting-zoo that has cows, horses, pigs,
bison and white-tailed deer. One of the deer is also affected. Affected sheep
are listless and off-feed, with serous or mucopurulent nasal discharge and
rectal temperatures ranging from 105-107.5°F (40.5-42°C).

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Physical exam shows swollen muzzles with edema and congestion of the lips,
nose and face with small hemorrhages and ulcers on the mucous membranes.
The ulcers appear where the teeth contact the swollen lips and tongue. Two
affected sheep are lame. What is the diagnosis?

A - Bluetongue
B - Peste des petits ruminants (PPR)
C - Caprine arthritis encephalitis
D - Contagious ecthyma (soremouth)E - Foot-and-mouth disease (FMD): A

Swollen sore muzzles with mucous membrane erosions, high fevers and
lameness suggests infection with bluetongue virus. Bluetongue is almost
exclusively seen in sheep, though white-tailed deer, pronghorn antelope and
desert bighorn sheep in North America can be severely affected. Rare in cows.
REPORTABLE.

Bluetongue is indistinguishable from Foot and Mouth disease (FMD), so that is a

good second choice. But FMD is unlikely in the scenario above because FMD
mainly affects pigs and cattle.
53. A 3-day old female alpaca (cria) is presented in respiratory distress. The
cria's cheeks flare noticeably during inspiration, and the distress is more
pronounced during nursing, when the animal gasps and inhales milk. What
is the most likely diagnosis?

A - Lung lobe torsion

B - Wry face
C - Diaphragmatic hernia
D - Choanal atresia
E - Mitral stenosis: D

Choanal atresia is one of the most common congenital problems of South American
camelids. Choanal atresia occurs when the caudal nares (choanae) fail to open
during embryologic development. Can be unilateral or bilateral and may cause
complete or partial blockage.
54. Which nerve block would most specifically relieve lameness resulting
from fracture of the navicular bone?

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A - Low four point

B - Abaxial sesamoidean
C - Palmar digital
D - Median and ulnar
E - Tibial and peroneal: C

The palmar digital nerve block (also called a PD or heel block) would anesthetize
the palmar third of the foot, including the navicular bone. All of the other nerve blocks
can desensitize the navicular bone too, but would not be as specific as a palmar
digital nerve block.

The abaxial sesamoidean nerve block (ASNB, also called a pastern or foot block)
would anesthetize the entire foot and much of the pastern. Sometimes an ASNB is
needed to completely eliminate or diagnose navicular lameness, but it is less
specific than the PD block.

A low four point nerve block (Also called Low palmar or Volar block) would
desensitize the fetlock and areas distal to it.

The median and ulnar nerve block would anesthetize the carpus and areas distal to
it.

The tibial and peroneal nerve block would anesthetize the tarsus and areas distal
to it.
55. A cat with a previous diagnosis of diabetes mellitus confirmed by
persistent fasting hyperglycemia and persistent glycosuria is presented for a
routine check-up.

The owner relates that she ran out of injectable insulin two months ago, but
the cat seemed to do fine without it, so she stopped giving insulin shots.

On physical exam, the cat appears healthy and a dipstick test shows a blood
glucose level of 125 mg/dL (6.9 mmol/l) [normal 61-132 mg/dL (3.5-7.3
mmol/l)]. What is the most likely explanation?

A - Type I diabetes mellitus

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B - Concurrent diabetes insipidus

C - Incorrect initial diagnosis
D - Diabetic remission
E - Insulin resistance: D

Up to 20% of cats may have diabetic remission (sometimes called transient

diabetes) characterized by resolution of clinical signs weeks to months after
beginning insulin treatment. Clinical diabetes mellitus may or may not recur in the
future.

Cats with non-insulin-dependent diabetes mellitus may respond to a treatment

regimen of weight loss, diet, oral hypoglycemic drugs, and correction of
concurrent insulin antagonistic disease; that is, they can respond without
injectable insulin.

Persistent fasting hyperglycemia [blood glucose greater than 200 mg/dL (11.1
mmol/l)] and persistent glycosuria are confirmatory for diabetes mellitus, so
"incorrect diagnosis" is a wrong answer choice in this case.
56. A 4 year-old quarterhorse in California is presented with fever, lethargy,
ataxia, icterus, petechiation, and limb edema. A complete blood count shows
characteristic neutrophil inclusion bodies suggesting equine granulocytic
ehrlichiosis. Which one of the following choices is the most appropriate
treatment?

A - Penicillin
B - Euthanize. There is no effective treatment
C - Streptomycin
D - Chloramphenicol
E - Oxytetracycline: E

Oxytetracycline is an extremely effective treatment for Equine granulocytic

ehrlichiosis (Anaplasma phagocytophilum, formerly known as Ehrlichia equi), most
commonly seen in California in the United States. Dexamethasone may help
horses with severe ataxia and edema (20 mg, sid for 2-3 days).

Penicillin, chloramphenicol, and streptomycin are not effective.

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57. A number of older cows in a Texas herd are losing condition rapidly with
a corresponding drop in milk production. Two pregnant animals have aborted.

Affected animals are off feed, uncoordinated and out of breath after exertion.
On physical exam, affected cows have a rapid bounding pulse and pale
mucous membranes. One animal appears icteric with a temperature of 105°F
(40.6°C). What is the most likely diagnosis?

A - Eperythrozoon spp.
B - Anaplasmosis
C - Leptospira icterohaemorrhagiae
D - Theileriosis
E - Babesia bigemina: B

This clinical picture of anemia, icterus and collapse is that of bovine anaplasmosis,
a tick-borne obligate intraerythrocytic bacterium in the order Rickettsiales.

Babesiosis has a similar distribution and presentation, but UNlike anaplasmosis,

look for hemoglobinuria. Babesia look like little hoops or "pears" inside red cells.

Eperythrozoon is a related blood parasite, but both inside and outside the red cells.
58. Which one of the following conditions occurs in the Fall in temperate
climates, among cattle moved from poor pasture to lush pasture?

A - Rumenal hyperkeratosis
B - Vagal indigestion
C - Vena caval thrombosis and metastatic pneumonia
D - Verminous bronchitis (Husk)
E - Acute bovine pulmonary emphysema and edema: E

Acute bovine pulmonary emphysema and edema (ABPEE) is associated with Fall
onset, occurring 5-10 days after changing cattle from poorer to better, often lush,
pasture.

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Toxicity occurs because rumen micro-organisms convert L-tryptophan in lush

pasture grasses to pneumotoxic 3-methylindole, which damages respiratory
epithelial cells.

Moldy sweet potato and Purple mint can cause a clinicopathologic syndrome that is
indistinguishable from ABPEE. The toxic compounds are respectively, 4-Ipomeanol
(Moldy Sweet Potato) and Perilla ketones (Purple Mint Toxicity.
59. 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 - Persea spp. (avocado)E - Senecio spp. (ragwort): E

Senecio spp. (ragwort).

Common plants containing pyrrolizidine alkaloids (PA) are: Senecio vulgaris, S.
jacobea, Amsinckia intermedius, 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.

Poisoning is most common in horses and cattle, sheep and goats are more resistant
to toxic effects.

Persea spp. (avocado leaves) contain persin. Signs of toxicity are: noninfectious
mastitis, abrupt cessation of milkflow, heart failure.

Nerium spp (oleander) contain cardiac glycosides. Signs of toxicity are: sudden
death, weakness, diarrhea, cardiac arrhythmias.

Lupinus spp. (lupine) contain alkaloids. Signs of toxicity are: birth defects (ingestion
at 40-70 days in cattle), abortion, tremors, incoordination, head pressing, seizures.

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Astragalus and Oxytropis spp. (locoweed) contain alkaloids (swainsonine). Signs of

toxicity are: excitability, incoordination, difficulty eating, exaggerated mouth
movements, depression.

Follow this link to a Merck table with images of Poisonous RANGE plants. Follow
this link to a Merck table with images of Poisonous HOUSE plants
60. An 8 year-old spayed female DSH cat is presented for right head tilt of 24
hours duration. The cat is up to date on vaccinations. Physical exam shows
horizontal nystagmus with the fast phase to the left. The rest of the physical
exam is unremarkable. What can the owner be told regarding the cat's
treatment and prognosis?

A - Fair prognosis with corticosteroids and antibiotics

B - Good prognosis with corticosteroids and anti-emetics
C - Excellent prognosis with corticosteroid therapy
D - Excellent prognosis with corticosteroids and antibiotics
E - Excellent prognosis without medication: E
The nystagmus usually improves markedly within 72 hrs and the cat will likely
completely return to normal in the next 2-3 weeks without any medication. This cat
most likely has idiopathic vestibular disease. For severe disorientation, consider
sedatives (diazepam and acepromazine). Glucorticoids do not usually alter course
of disease. Anti-emetics usually not effective. In cats where you cannot rule out otitis
externa or media, antibiotic therapy is warranted.
61. Which lesions are most commonly associated with Marek's disease?

A - Edematous facial swelling with sinusitis

B - Hemorrhagic skin lesions
C - Nerve enlargement
D - Wrinkled eggs
E - Blood in the trachea: C

Think of NERVE ENLARGEMENT with Marek's disease; Also distortion of the pupil,
enlargement of feather follicles ("skin leukosis"=condemnation of carcass). May see
one leg forward, one leg back, a transient paralysis.

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Think infectious laryngotracheitis (ILT) if there is blood occluding trachea on

necropsy.

Remember wrinkled eggs go with infectious bronchitis.

Think infectious coryza with sinusitis, swelling under eyes.

62. 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: A

Horner's Syndrome is IDIOPATHIC in 50-93% of dogs (45% in cats).

See four things with Horner's, ALL associated with an eye:

1. MIOSIS (constricted pupil)
2. PROTRUSION 3rd eyelid (nictitans)
3. ENOPHTHALMOS (sunken eye)
4. PTOSIS (drooped eyelid), +/- anisocoria.

Remember "My 3rd Sunken Toe" (Miosis, 3rd lid protrudes, Sunken eye, Ptosis).

Diagnose Horner's syndrome by history, with 3 of 4 signs. Look for CLASSIC

INCREASED anisocoria in the dark. Other diagnostic tests depend on where
suspect primary disease.

If you can get a primary diagnosis, (ie: Guttural pouch mycosis, brachial plexus
avulsion,otitis media, etc.) must treat that.
63. Which one of the following diseases have been linked with the variant form
of Creutzfeldt-Jakob disease (vCJD) in humans?

A - Bovine spongiform encephalopathy

B - Q fever

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C - Sporadic bovine encephalomyelitis

D - Equine West Nile virus encephalitis
E - Eastern equine encephalomyelitis (EEE): A

Bovine spongiform encephalopathy (BSE) suddenly appeared in the mid 1980's in

the UK, likely due to changes in the practice of feeding meat and bone meal of
sheep origin. In 1997, it was confirmed that Creutzfeldt-Jakob disease was
associated with the bovine disease.

Sporadic bovine encephalomyelitis (SBE), caused by Chlamydia pectoris (also

called Chlamydophila pecorum), is not known to cause disease in humans.
64. An obese 7-year-old Labrador Retriever presents for annual vaccinations.
The owners claim that they have restricted his diet and try to exercise him but
he still keeps the weight on. There is alopecia on the dorsum of his tail and
he has an unusual worried facial expression. Which one of the following
choices is the most likely diagnosis?

A - Hyperadrenocorticism
B - Male pattern alopecia
C - Sarcoptic mange
D - Hypothyroidism
E - Hypoadrenocorticism: D

Tail alopecia and tragic facial expression are a classic signs of hypothyroidism in
dogs.

Other areas of bilateral alopecia that are common in hypothyroidism are the ventral
and lateral trunk, caudal thighs, ventral neck and dorsum of the nose.

Hyperadrenocorticism commonly has truncal alopecia and also presents with

obesity. It is more common in toy dog breeds.
65. A middle-aged female spayed dachshund presents with polydipsia and
polyuria but otherwise healthy and afebrile. Examination reveals a distended
abdomen with thin skin and alopecia. Which one of the following choices is
the most likely suspected diagnosis?

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A - Hepatic insufficiency
B - Stump pyometra
C - Hyperadrenocorticism
D - Urinary tract infection
E - Hydronephrosis: C

Abdominal distension (potbelly), polyuria, polydipsia (PU-PD) and cutaneous

atrophy are common symptoms of hyperadrenocorticism. About 85% of
hyperadrenocorticism cases are pituitary dependent.

Stump pyometra can also cause PU-PD, but the dog usually is ill and does not have
the cutaneous atrophy.

66. 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): C

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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.

67. 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: E

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.

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With Brucella and Histophilus ovis the abortion rate is much lower. Abortion caused
by Listeria spp. is associated with the feeding of silage.
68. 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: B

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.
69. 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: A

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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.
70. 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: E

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.

71. At what day post breeding (the earliest) can an experienced practitioner
feel the fetal membrane slip of the chorioallantoic membrane of a cow?

A - 20-25 days
B - 40-45 days
C - 30-35 days
D - 10-15 days
E - 45-50 days: C

An experienced practitioner can reliably feel the "membrane slip" of bovine

chorioallantoic membranes rectally at 30-35 days. Feel placentomes around 70-75

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days; Feel fremitus (vibration in uterine artery of the gravid uterine horn) between
90-120 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
72. An 11 year old male neutered dog is presented with a 4 week history of
worsening problems with urination. The dog appears to have abdominal
pain and strains to urinate a small volume of reddish urine.

Urinalysis: USp.G=1.028, 15-20 WBC/hpf, RBC +++, protein +, bacterial rods

+++

Which one of the following choices is the most likely diagnosis?

A - Renal calculi with secondary nephrosis

B - Struvite urolithiasis
C - Amyloidosis
D - Transitional cell carcinoma
E - Benign prostatic hypertrophy: D

This is likely to be neoplasia, specifically, a transitional cell carcinoma seen here

in the trigone of the bladder after pneumocystogram (air in bladder) and here after
injection of contrast media.

Hematuria, pollakiuria, abdominal pain and bacterial cystitis in an older dog may
also suggest urolithiasis, but if stones were visible on radiograph, they would be
less likely to sit in the trigone.

Struvite urolithiasis is common in dogs and cats.

Click here to see a radiograph of a cat with urolithiasis.

With renal calculi, look for classic "staghorns" in the kidneys on DV rads.

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With prostatic hypertrophy look for prostate displacing the bladder cranially into
the abdomen. The oval closest to the pelvis is the prostate, the larger oval cranial
to it is the bladder.
73. This 11-year-old spayed female cat is presented with generalized
weakness and unable to lift her head.

The owners have noticed her at the water bowl more often and she seems to
be urinating more in the last month.

Which blood chemistry test would be most likely to diagnose cause of her
weakness?

A - Sodium
B - Potassium
C - Chloride
D - Calcium
E - Bicarbonate: B

Potassium. This is a classic presentation of a cat with hypokalemic myopathy which

is often due to potassium loss from renal disease.

Other causes of generalized weakness and neck ventroflexion include polymyositis,

organophosphate toxicity, myasthenia gravis.
74. Last Fall several malformed calves, that looked like the image below, were
born on this ranch. This Spring, the owner could not deliver feed to the back
pasture for 3 days.

Now, 14 days later, heifers on this pasture are losing weight, off feed and
lethargic. Physical exam is unremarkable except for large linear cracks
extending to the dermis on muzzles of affected cows.

Blood chemistry and urinalysis results from a sick cow are below
Na=122 mEq/l...................[N=136-144], K=2.2 mEq/l..[N=3.6-4.9]
Ca=6 mg/dl......................[N=8.4-11.0], ALT=70 u/l..[N=6.9-35]
CK=150 u/l.......................[N=0-350], SDH=82 u/l..[N=4.3-15.3]

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Bilirubin (total)=0.6 mg/dl..[N=0-1.6], BUN=140 mg/dl..[N=10-25]

Creatinine=4.0 mg/dl.........[N=0.5-2.2], Glob=4.4 g/dl..[N=3.0-3.5]
Alb=2.2 g/dl......................[N=2.5-3.8]
USp.G= 1.010...................[N=1.030-1.045] protein +++, blood +++, numerous
granular and hyaline casts

What should be done next?

A - Check the pasture for oak trees and acorns

B - Check the pasture for pigweed or lamb's quarter
C - Analyze the ration mix for selenium/vitamin E content
D - Analyze the ration mix for lysine deficiency
E - Do serum titers for cytopathic bovine virus diarrhea virus: A

Check the pasture for oak trees and acorns. This is a classic case of acorn/oak bud
toxicosis (Quercus spp.).

The sick animals have tubular nephritis evidenced by high urinary protein, casts,
low urine specific gravity, and high BUN and creatinine.

The nephritis is caused by hungry heifers eating green oak leaves that would have
sprouted in the Spring.

The deformed calf is called an "acorn" calf. These calves are the result of a cows
on a low protein diet coupled with acorn ingestion in mid to late pregnancy (in the
Fall).

Pigweed (Amaranthus spp) and lamb's quarter (chenopodium) are sources of nitrate
toxicity. Look for a presentation involving hypoxia (muscular tremors, weakness,
brown cyanotic mucous membranes) due to methemoglobinemia.

Lysine deficiency may contribute to necrotic ear syndrome in pigs.

Selenium or vitamin E deficiency is associated with white muscle disease. Look for
stiffness and sudden death due to myocardial lesions in newborn calves.

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Think of cerebellar hypoplasia or weak calves born with congenital BVD.

75. A 7 year-old intact female poodle is presented. The owner has noted a lot
of drinking and some urinary accidents in the house in the last week and that
the dog hasn't seemed herself either.

Yesterday she vomited twice. On physical exam the dog appears depressed
and listless, has dark injected mucous membranes and a distended tender
abdomen.

T=104 F (40 C)..[N=99.5-102.5 F, N=37.2-39.2 C]

HR=100 bpm.....[N=60-120]
RR=30 brpm......[N=15-34]

What diagnosis is of most immediate concern?

A - Pregnancy
B - Intestinal foreign body
C - Hepato-splenic tumor
D - Diabetes mellitusE - Pyometra: E

The preferred answer is canine pyometra.

Pyometra is a life-threatening emergency which typically requires immediate

surgery (ovariohysterectomy) if the cervix is closed and there is no obvious
discharge. Open cervix pyometras are likely to present with a purulent discharge,
simplifying Dx, but surgical ovariohysterectomy is still recommended.

Pyometra should always be near the top of your DDX when presented with an older
intact female dog or cat with a fever and distended abdomen.
76. A 2-week old calf is presented that is dehydrated and almost emaciated
from weight loss. She has a 1 week history of watery, foamy diarrhea and
exhibits tenesmus during examination.

The calf is the only sick one in a mixed group of calves that range from 3
weeks to 2 months of age. What is the diagnosis?

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A - Colibacillosis
B - Cryptosporidiosis
C - Coccidiosis
D - Ostertagiasis
E - Coronavirus: B

Watery diarrhea in a SINGLE animal (1-4 weeks) in a group, plus emaciation

suggests Cryptosporidiosis.

Expect a more acute, lethal presentation of hemorrhagic diarrhea in 1-4 DAY old
calves with Colibacillosis, and multiple cases with the viral diarrheas like Rotavirus
- (5d-2 wks old, self limiting); Coronavirus, (4-30d).

OLDER-animal diarrheas on this list include Coccidiosis ( Older than 21 days and
in ALL ages, bloody diarrhea, tenesmus) Ostertagiasis (anorexia, poor growth,
diarrhea in less than 2 year olds on pasture- a chronic disease).
77. A 7-year old male German shepherd is presented with a history of
weakness in the hind limbs, urinary incontinence and recent obsessive
chewing around his tail area. Dorsiflexion of the tail over the back and
extension of the hind limbs elicits a painful response.

There is moderate hindlimb ataxia. He does not withdraw each hind leg when
a toe is pinched, but bears weight on the hindlimbs. Patellar reflexes are
normal. What is the clinical diagnosis?

A - Wobbler syndrome
B - Diskospondylitis
C - Hip dysplasia
D - Cauda equina syndrome
E - Radiculoneuritis: D

This is a common presentation of Cauda equina syndrome. Look for PAIN in the
lumbosacral area (elicited by tail raise, hindlimb extension), LMN hindlimbs,
especially Sciatic nerve damage at L7-S1 (lack withdrawal), +/- urinary/fecal
incontinence, +/- SELF-MUTILATION of tail, perineum, pelvic limb.

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Lesion due to compression of cauda equina at L7-S1 (lumbosacral stenosis). Can

be congenital (abn development dorsal arch L7-S1, small dogs, Border Collies) or
acquired (degenerative changes, big dogs, especially German Shepard, Rottweiler,
Boxer).

Wobbler syndrome is a cervical spinal cord disease (also called cervical vertebral
instability/ caudal cervical spondylomyelopathy). In adult form it is an intervertebral
disc disease, usually seen at C5-C6 or C6-C7 in Dobies> 5 yrs, Great Danes < 2
years.

Diskospondylitis is a good second choice on your DDX of a large middle aged dog
presenting with lumbosacral pain. Due to bacterial/fungal infection of intervertebral
disk and adjacent vertebral bodies. Look for systemic signs like fever (1/3 of
patients), weight loss, anorexia. Follow this link to see a Merck image of
diskospondylitis.
78. Two calves aged 8 weeks are presented that are both down and
extremely weak. They are depressed and lying in pools of foul-smelling
brown diarrhea with a small amount of blood. One other calf died suddenly
the night before with no signs at all.

They are found to be dehydrated, with rectal temperatures of 105.2 and 105.6
F (40.7 - 40.9 C)..[N=101.5-103.5F, N=37.8-39.7 C], respectively.

Based on the condition at the top of the differential diagnosis list, what is the
treatment plan?

A - Immunize well and sick calves and adult cattle with MLV vaccine, ABX for
sick calves
B - NSAIDS, ABX in feed & water
C - IV Fluids, NSAIDS, Frequent milk feeding, ABX if septic
D - Cull sick calves, Disinfect feeding areas, Prophylactic ABX and NSAIDs
for well
E - Isolate sick calves, Immunize, tx with ABX, cull those that do not respond
to treatment: C

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IV Fluids, NSAIDS, Frequent milk feeding and ABX if septic. FEVER + DIARRHEA
says systemic, and sudden death in another calf the night before suggests SEPTIC.
8 weeks old suggests SALMONELLA.

ISOLATE sick calves. Valuable animals may be treated with IV Banamine ®, IV

fluids, oral fluids and frequent feedings of milk.

Use of antibiotics is controversial. ABX may prolong recovery and shedding and
yield a carrier calf. There is risk of developing antimicrobial resistance. If the
animal is septic though, need ABX.

According to Pasquini's, prognosis is POOR with neonatal salmonella and deaths

can approach 100% in affected calves.

In adults, ABX may yield clinical cure, but Salmonellae can establish in biliary
system and intermittently shed into GI system, leading to environmental
contamination.
79. A 5-year-old neutered domestic shorthair cat is presented for lethargy,
vomiting and diarrhea. The owner saw the cat licking up antifreeze spilled
while he was flushing his truck's radiator yesterday. The cat is markedly
depressed and dehydrated on physical exam.

Which one of the following choices is the most appropriate treatment?

A - Ethanol 20%
B - Atipamezole, IV lactated ringer's
C - Activated charcoal
D - Pralidoxime chloride (2-PAM)
E - Calcium EDTA in 0.9% NaCl: A

More than 3 hours after ingestion, ethanol is still the treatment of choice for cats
with ethylene glycol toxicity.

Recent clinical trials suggest that Fomepizole (4 methyl pyrazole, 4-MP) can be a
more effective treatment than ethanol in cats when administered
-- At high doses (extra-label) and

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-- Within 3 hours of ingestion of ethylene glycol.

Do 4 things when you see a case of ethylene glycol toxicity:

1. Decrease EG absorption: Induce vomiting +/- gastric lavage (or both) followed by
activated charcoal, sodium sulfate within 1-2 hr of ingestion.

2. Promote diuresis: IV fluids

3. Address metabolic acidosis: Add bicarbonate in fluids 4. Prevent metabolism of
EG: 4-MP or ethanol treatment.
80. A flock from a broiler chicken operation is presented to investigate a
disease outbreak characterized by caseous accumulations in the throat and
weight loss.

Two diseases are suspected: it is either candidiasis ("thrush") or another,

similar disease. What is the other disease and how might the diagnosis be
confirmed?

A - Fowl cholera, tracheal aspirate culture

B - Trichomonosis, microscopic smear exam
C - Infectious coryza, AGID
D - Aspergillosis, fungal culture
E - Necrotic enteritis, fecal flotation: B

This is trichomonosis , caused by Trichomonas gallinae, and diagnosed by

microscopic smear exam of the caseous oral exudates. Look for trichomonads.
More a problem in PIGEONS, but can cause disease in chickens.

Try not to confuse avian Trichomonas with Tritrichomonas foetus of cattle, which
causes infertility (early embryonic death actually, 1st 2 months pregnancy). Infected
bulls are mechanical carriers to cows.

Candidiasis is a fungal disease that can look SIMILAR to trichomonas in chickens.

Follow this link to see a Merck image of Candidiasis.

Caused by Pasteurella multocida, Fowl Cholera causes sudden onset septicemia

with VARIABLE signs. (Sudden death, anorexia, depression, mucoid beak
discharge, ruffled feathers, diarrhea, increased RR.
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Aspergillosis presents as respiratory disease. See fungi on microscopic smear, may

see granulomatous lumps in lungs.

See sudden death with Necrotic enteritis, caused by Clostridium perfringens. Follow
this link to see the so-called "Turkish towel" intestinal pseudomembrane of Necrotic
enteritis.

81. A 2 year-old budgie (parakeet) is presented with a history of limping on

his left leg which has gotten progressively worse over the last 3 weeks.

He is eating and drinking ok, but has fallen off his perch twice in the last two
days. Weakness in the left leg compared to the right one is observed; He
retracts his left more slowly and more weakly when his toe is pinched.

What condition is at the top of the differential diagnosis list?

A - Pacheco's disease
B - Polyoma virus infection
C - Renal tumor
D - Trauma- broken leg
E - Hypovitaminosis A: C

Think renal tumor with progressive unilateral lameness in budgies (and poor
prognosis). The sciatic nerve passes through the renal parenchyma in birds, and
budgies are prone to neoplasia in general.

Avian Polyomavirus is a YOUNG BIRD disease characterized by lethargy, crop

stasis, death, and sometimes SUBQ hemorrhages after injections.

Pacheco's disease - think "sudden death", younger birds.

Hypovitaminosis A - think sinusitis, "bug-eyes" (exopthalmia), sublingual

abscesses, white plaques. Broken bone possible, but would expect acute onset, not
progressive. 82. What is the most common clinical sign exhibited by a horse
with cystic calculi (bladder stones)?

A - Straining to defecate

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B - Colic
C - Hematuria after exercise
D - Uremic breath and urethral ulcers
E - Inappetance: C

Bladder stones in horses are usually single, large spiculated stones composed of
calcium carbonate.

The most common clinical sign exhibited by horses with cystic calculi is hematuria
after exercise.

Hematuria is most evident toward the end of a voided urine stream. Other signs
may include stranguria, pollakiuria and urinary incontinence.

In adult male geldings, urethral obstruction may also be associated with cystitis. If
there is urethral blockage by smaller uroliths, stranguria, pollakiuria, incontinence,
restlessness, colic and stretched posture may be more prominent.
83. A pig farm reports a problem in weaning-age piglets.

The affected piglets are depressed and anorexic with slight fevers. A few of
the more severely-affected piglets look like the image below.

Which one of the following choices is the best action to take?

A - High-dose antibiotics for sick piglets

B - Cull affected animals
C - Vaccinate herd with modified live vaccine
D - Report to state vet
E - Topical Coumaphos/ disinfectant combination dip: A

Use high-dose antibiotics for sick piglets.

This is exudative dermatitis ("greasy pig disease"), caused by Staph hyicus.

Responds to most antibiotics (pen, amoxi, TMS, erythromycin, lincomycin, tylosin,
AGs, cephs) at high dose 7-10 days, plus topical antiseptic.

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In severe outbreaks, antibiotics for contact pigs recommended for a few days.
Disinfection, good environmental hygiene important.

In chronically affected herds, autogenous bacterins have been used with some
success to decrease incidence.
84. A 7-year old female spayed Standard Poodle presents with weakness and
lethargy. A chemistry panel shows a Na+ = 130 mEq/L (142-152 mEq/L), K+ =
6.5 mEq/L (3.9-5.1 mEq/L), BUN 55 mg/dl (8-28 mg/dl), creatinine 1.9 mg/dl (0.5-
1.7 mg/dl). The test to run for a definitive diagnosis would be which of the
following?

A - Bile acids test

B - Electrocardiogram
C - Thoracic radiographs
D - ACTH stimulation test: D

The correct answer is ACTH stimulation test. The chemistry profile above is highly
suggestive of hypoadrenocorticism. An ACTH stimulation test would give a definitive
diagnosis for Addison's disease if the plasma cortisol concentration is low after
ACTH administration.

A bile acids test is not indicated since liver function is not in question. Thoracic
radiographs may show microcardia, hypoperfused lungs, and rarely
megaesophagus. ECG abnormalities would be consistent with hyperkalemia, which
includes wide, flat, or absent P waves, widened QRS complexes, tall spiking T
waves, and bradycardia.
85. A 2-year old Quarter Horse presents for intermittent muscle fasciculation
followed by weakness. What condition should you suspect?

A - Grass tetany
B - Tetanus
C - Stringhalt
D - Myotonia
E - Hyperkalemic periodic paralysis: E

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The correct answer is hyperkalemic periodic paralysis (HYPP). HYPP is seen in

Quarter Horses due to a point mutation in a key part of a skeletal muscle sodium
channel subunit. This results in elevation of the resting membrane potential to
increase the likelihood of depolarizing. Excess concentrations of potassium can
result in failure of the sodium channels to inactivate. Therefore, treatment is directed
at decreasing dietary potassium.
86. In canine patients with primary hyperparathyroidism, a chemistry panel
would show:

A - Hypocalcemia, hyperphosphatemia
B - Hypercalcemia, hyperphosphatemia
C - Hypercalcemia, hypophosphatemia
D - Hypocalcemia, hypophosphatemia: C

The correct answer is hypercalcemia, hypophosphatemia. Patients with primary

hyperparathyroidism would have hypercalcemia and normo to hypophosphatemia
due to the law of mass action in which phosphorus decreases as calcium
increases and vice versa.
87. Which of these would be appropriate for a horse with hyperkalemic
periodic paralysis (HYPP)?

A - Alfalfa hay
B - Beet molasses
C - Timothy hay
D - Brome hay: C

The correct answer is timothy hay. Of these choices, the only feed with low
potassium is timothy hay. A low potassium diet is the most important nutritional
modification in the treatment of HYPP. Regular exercise and feeding smaller,
frequent meals can also reduce clinical signs. This disease is inherited in an
autosomal dominant fashion, and owners should be discouraged from breeding
affected animals.
88. Several younger sheep in a large herd have died suddenly with a diagnosis
of infectious necrotic hepatitis secondary to fluke infestation. Which one of
the following choices is the most practical and effective control measure?

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A - Vaccinate all animals with Clostridium novyi toxoid

B - High-dose penicillin for clinical cases
C - Clostridium hemolyticum bacterin for animals under 3 years
D - Clorsulon antihelmintic for whole herd
E - Treat ponds with copper sulfate molluscicide against lymnaeid snails: A

Active immunization with Clostridium novyi toxoid before the late summer is the
most effective way to control and prevent infectious necrotic hepatitis (Black
disease) in sheep.Because vaccinated sheep have long-term immunity after only
one shot, only new introductions to the flock (lambs and sheep brought in from other
areas) need to be vaccinated.

Reducing the number of snails (intermediate hosts for fluke cercaria) with
molluscicides or by fencing off wet areas may not be practical due to expense or
amount of pasture lost. Likewise, use of flukicides is complicated by the need for
careful timing and long withdrawal times for meat and milk.
89. Black walnut toxicity causes what condition in horses?

A - Hypersalivation
B - Pulmonary edema
C - LaminitisD - Colic: C

The correct answer is laminitis. Black walnuts contain Juglone (naphthoquinone)

which results in laminitis. Do not use black walnuts for horse bedding.
90. A 2-year old male castrated Border Collie presents for a 1-week history of
small bowel diarrhea. A fecal flotation shows numerous Giardia cysts. What
is the treatment of choice for this dog?

A - Ipronidazole
B - Albendazole
C - Metronidazole
D - Decoquinate: C

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

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metronidazole. If fenbendazole were offered as an answer choice, it would be the

best option.
91. You perform an abdominal ultrasound to evaluate a Yorkshire Terrier with
a suspected liver shunt. After finding the shunt vessel, you complete the
ultrasound and find several calculi in the bladder. What is the most likely type
of stone?

A - Calcium oxalate
B - Xanthine
C - Struvite
D - Urate
Cysteine: C

The correct answer is urate. Animals with portosystemic shunts are very
predisposed to developing urate uroliths due to their inability to metabolize purines
appropriately.
92. What nerve or nerves need to be blocked in order to dehorn cattle?

A - Auriculopalpebral
B - Infratrochlear
C - Cornual
D - Cornual and Infratrochlear
E - Auriculopalpebral and Infraorbital: C

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.
93. A 15 year old cat is presented with a 3 week progression of wandering in
circles to the left, standing in corners, and dull mentation. Conscious
proprioceptive deficits (knuckling) can be elicited in the right thoracic and
right pelvic limbs. There is a decreased menace response on the right, but

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pupillary light reflexes are normal in both eyes. The examination is

otherwise normal. A brain tumor is suspected. Where is the most likely
location of the lesion?

A - Right brainstem
B - Right cerebrum
C - Left brainstem
D - Left cerebrumE - Cerebellum: D

Left cerebrum.

Remember that conscious proprioception and visual perception are affected by

lesions in the contralateral cerebral hemisphere. Circling direction is generally
toward the side of the lesion.
94. Severe combined immunodeficiency is a lethal autosomal recessive trait
in Arabian foals. Heterozygotes are clinically normal. If the heterozygote
carrier rate for the genetic mutation is 8%, what is the expected frequency of
Arabian foals that are homozygous for the mutated allele?

A - 2%
B - 0.064%
C - 0.64%
D - 25%
E - 4%
F - 0.16%: F

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).

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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 0.64% x 0.25= 0.16%.
95. A mare is presented with a history of intermittent lameness in the right
fore involving a shortened stride and occasional stumbling. She relieves pain
by pointing the affected foot with the heel off the ground. A flexion test of the
distal right forelimb exacerbates the lameness temporarily. Which one of the
following choices is the most likely diagnosis?

A - Laminitis
B - Caudal heel pain
C - Villonodular synovitis
D - Pedal osteitis
E - Sidebone: B

Caudal heel pain (also called navicular disease) is an intermittent-onset lameness

with a poorly understood pathogenesis. Click here to see a see a radiograph of
the navicular area in an affected horse.

The horse may point the affected foot with the heel off the ground to relieve the
pressure of the deep digital flexor tendon on the painful navicular area. If both fores
are affected, a horse may alternate pointing.

Typically presents as an intermittent lameness early in the course of disease, with

a shortened stride. The horse may tend to stumble.

A flexion test of the distal affected forelimb can usually exacerbate the lameness
temporarily.
96. Which one of the following choices would be the best method for
controlling anaplasmosis in adult cattle in the United States?

A - Serotest and cull affected cows

B - Vaccination with a modified live vaccine
C - Long-acting oxytetracycline for entire herd
D - Spray pastures with carbaryl insecticide

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E - Imidocarb prophylaxis: C

Cattle who survive anaplasmosis become carriers. Treat carriers with long-term
oxytetracycline IM and repeat at least once more in a week.

In acute clinical cases, prompt treatment with tetracyclines in the early stages (ie:
PCV greater than 15%) usually ensures survival (ie: tetracycline, chlortetracycline,
oxytetracycline, rolitetracycline, doxycycline, minocycline).
A blood transfusion can greatly improve survival rates in more severely affected
cattle.

Anaplasmosis is transmitted through tick vectors primarily in tropical and subtropical

areas. The disease is sporadic in Canada.
Theoretically, tick control should eliminate the agent. Unfortunately, there is no
effective method for controlling ticks on a range pasture.

Imidocarb is a suspected carcinogen with long withholding times.

Imidocarb has been used effectively to treat clinical and carrier cows in some
countries, but is not approved for use in North America or Europe.

Modified-live vaccines exist, but have variable efficacy, availability and adverse
effects. Modified-live anaplasmosis vaccines are not approved for use in North
America.
The USDA has approved an experimental killed vaccine for use in 20+ states in the
U.S. and Puerto Rico.
97. You need to perform a CBC and take thoracic radiographs on a somewhat
fractious cat. You sedate the cat with an intramuscular injection of
medetomidine. While on the X-ray table, you become concerned that the cat
is not doing well and you decide you want to reverse the effects of
medetomidine. What should you give the cat?
A - Xylazine
B - Flumazenil
C - 2-pralidoxime
D - Atropine
E - Atipamezole: E

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Atipamezole (trade name: Antisedan), an alpha-2 antagonist, is the reversal agent

for medetomidine (trade name: Dormitor). Medetomidine is an alpha-2 agonist.

Xylazine would be another example of an alpha-2 agonist. Yohimbine is its

reversal agent. Other alpha-2 agonists are clonidine, detomidine,
dexmedetomidine and romifidine

2-pralidoxime is a reversal agent for cholinesterase inhibitors.

Flumazenil is a reversal agent for benzodiazepines

Atropine is a muscarinic antagonist of acetylcholine and may be dangerous to use

after administration of alpha-2 agonists. This is because alpha-2 agonists cause
marked vasoconstriction and high afterload on the heart. Giving atropine and
increasing the heart rate can place further stress on the heart. You do not want to
set in motion peripheral vasoconstriction and compensatory bradycardia brought on
by the alpha-2, then increase the heart rate against that high afterload. This could
make for an unhappy heart in the event underlying subclinical heart disease is
present.
98. What profile would you expect in a dog with hypervitaminosis D?

A - Low Ca, Low P

B - Low Ca, High P
C - High Ca, Low P
D - High Ca, High P: D

Excessive intake of vitamin D is associated with an increase in 25-hydroxyvitamin

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

99. 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
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normal limits. Urinalysis shows 3+ glucose. Which of the following is your

most likely differential diagnosis?

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

The correct answer is Fanconi syndrome. Fanconi syndrome is an inherited disease

in Basenjis. The disease involves renal tubular defects causing an abnormal loss of
electrolytes and solutes leading to hypophosphatemia, hypokalemia, and metabolic
acidosis. DM is less likely because serum glucose is normal. The lab abnormalities
present in this dog are not consistent with pyelonephritis. Pyometra is not a viable
choice as the signalment describes a male.
100. A 7-week old male Yorkshire terrier is presented with a 2 week history of
on and off vomiting and diarrhea that began around the time he was weaned.

The owners relate that he seems to "drink and pee a lot". They report
pacing, disorientation, weakness, and "stumbling around". Physical exam is
unremarkable, but only one testicle has descended. As the puppy explores
the room he appears ataxic, stumbles a few times, and bumps his head into
the wall. What is the clinical diagnosis?

A - Congenital hiatal hernia

B - Portosystemic shunt
C - Canine distemper
D - Diabetes insipidus
E - Lead poisoning: B

Signs of hepatic encephalopathy (ataxia, disorientation, vomiting, diarrhea)

beginning after weaning combined with polyuria/polydipsia ("drink and pee alot")
in a cryptorchid male Yorkshire terrier says congenital portosystemic shunt.

Seen most in pure-breeds. Think SMALL - Maltese, Yorkshire terriers, miniature

schnauzers. (can also see in Old English sheepdogs, Irish Wolfhounds). Usually
in YOUNG animals, especially after weaning. 50% of males are CRYPTORCHID.

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Lead poisoning can cause vomiting, diarrhea and CNS signs (blind, hyperactive,
seizures). Can see PU/PD in older animals but Hx here puts a shunt first on DDX.
101. The feline insulin molecule is identical to insulin from what other animal?

A - Bovine
B - Porcine
C - Ovine
D - Human
E - Canine: A

Although feline diabetics often utilize other sources of insulin, the feline insulin
molecule is identical to the beef insulin.

Most insulins are human products used in animals, except for Vetsulin (the
veterinary form of human PZI, which is derived from pigs).

The types of insulin available change almost every year, as products go on or off
the market. It's like musical chairs. For example, NPH (Humulin) was off the market;
then it became available again. Vetsulin went off the U.S. market in spring 2010 due
to product quality issues.
102. A 15 year old cat is presented with a 3 week progression of wandering
in circles to the left, standing in corners, and dull mentation. Conscious
proprioceptive deficits (knuckling) can be elicited in the right thoracic and
right pelvic limbs. There is a decreased menace response on the right, but
palpebral and pupillary light reflexes are normal in both eyes. The rest of the
examination is normal. A brain tumor is suspected. Where is the most likely
location of the lesion?

A - Right brainstem
B - Right cerebrum
C - Left brainstem
D - Left cerebrumE - Cerebellum: D

Remember that conscious proprioception and visual perception are affected by

lesions in the CONTRALATERAL cerebral hemisphere. Circling direction is
generally TOWARD the side of the lesion.

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Neurologic lesion localization can be challenging. Here are some summary points
that may help you in this case.

What signs make the lesion cerebral?

- Standing in corners (head pressing)
- Wandering in circles to the left (toward side of lesion)
- Contralateral visual loss with normal palpebral and pupillary light reflexes

Why is the lesion NOT in the brainstem?

- Visual pathways do not course through the brainstem, so the visual loss does not
fit.

Pearl of wisdom: You could lose the menace response with an ipsilateral facial
nerve lesion in the brainstem, but you would NOT have the wandering and head
pressing. 103. A canine coagulation profile indicates increased values for
APTT, PT, TT and FDPs.
Thrombocytes=62,513 per microliter (normally greater than 211,000 per
microliter). What is the typical prognosis for a dog with the condition
suggested by this pattern?

A - Good
B - Fair
C - Grave
D - Excellent
E - Need more information: C

A lab pattern of low platelets and across the board increases in bleeding time, APTT,
PT, TT and FDP tests suggests disseminated intravascular coagulation (DIC).
Remember that DIC also stands for "Death Is Coming". Prognosis is typically grave
and mortality is high even with treatment.

DIC is not a disease in its own right. It is a complex hemostatic defect characterized
by enhanced coagulation and fibrinolysis, secondary to other diseases. Fibrinolysis
and depletion of clotting factors leads to hemorrhage. Many diseases, all of them
bad, can precipitate DIC.

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Remember your "H diseases" associated with DIC:

Heartworm
Heart failure

Hemolytic anemia
Hemangiosarcoma
Hemorrhagic gastroenteritis
Hepatic disease, esp. hepatic lipidosis in cats.
Gastric dilatation-volvulus (GDV), mammary gland carcinoma and pancreatitis can
also lead to DIC.
104. A 4-year-old Standardbred mare is examined in the fall with a 5-day
history of depression, left head tilt, facial paralysis and worsening gait. The
horse is ataxic and knuckles on both forelegs, worse on the right. There is
muscle atrophy of the left shoulder and right hindquarters and strips of
localized spontaneous sweating over the left trunk. Which diagnostic test
would best support the presumptive diagnosis?

A - Western Blot test on CSF for Sarcocystis neurona

B - MRI to rule out nigropallidal encephalomalacia
C - Serum IgM capture ELISA for West Nile Virus
D - Serum antibody titer for Eastern Equine Encephalomyelitis
E - Plasma antibody test for St. Louis encephalitis: A

Think of equine protozoal myeloencephalitis (EPM) due to Sarcocystis neurona

when you see ataxia and atrophy in horses, especially when neurologic signs are
multifocal (ie:cranial (head tilt), spinal (foreleg ataxia). The muscular atrophy and
localized strips of sweating are clues that EPM should be high on your DDX.

Whenever you see a febrile neurologic horse, especially in the Fall, think also of the
equine encephalidities, EEE, WEE and VEE as well as West Nile virus encephalitis.
Nigropallidal encephalomalacia is the result of poisoning with yellow star thistle
(image).
105. A female veterinarian is pregnant and her physician tests her
serologically for toxoplasmosis.

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IgM is negative.
IgG is positive

What is the most appropriate interpretation?

A - Mother is safe, baby at risk

B - Mother at risk, baby is safe
C - Both mother and baby are safe
D - Need to re-check in 2 weeks for rising titers
E - Both mother and baby at risk: Both mother and baby are safe. The
toxoplasmosis organism causes birth defects in a developing fetus if a mother is
infected for the first time in her life while pregnant (ie: IgM positive while
pregnant).

Toxoplasmosis is not generally dangerous to immune-competent people and a

positive IgG result suggests an old infection.

There are challenges to toxoplasmosis testing in pregnant women (false positives).

If a pregnant woman is IgM positive, confirmatory tests must be done.
106. What acid-base abnormality would be most likely in a dairy cow with a
displaced abomasum?

A - Metabolic alkalosis
B - Metabolic acidosis
C - Depends on severity of displacement
D - Respiratory alkalosis
E - Respiratory acidosis: D

Think of hypochloremic metabolic alkalosis due to hydrochloric acid (HCl)

sequestration in a cow with a displaced abomasum. Abomasal hypomotility,
ongoing HCl secretion into the abomasum and partial abomasal outflow obstruction
all contribute. Metabolic alkalosis can also be due to HCl loss in monogastic animals
who vomit.

In a similar way, metabolic acidosis can be due to HCO3-loss from diarrhea or saliva
loss if animal cannot swallow.
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107. A 2 day old pup has a GGT level of 500 times the adult upper reference
range. Which one of the following choices is the most likely interpretation?

A - Associated with neonatal cholestasis

B - Associated with bone development
C - Caused by traumatic placental detachment
D - Due to colostrum absorption
E - Suggestive of a congenital liver shunt: D

Very high GGT levels are seen with colostrum absorption. In newborn pups, lambs,
and calves, an increase in GGT up to 1000 times is normal when they receive high
levels of colostrum from the dam. High levels of GGT are produced in the mammary
epithelium during lactation. When evaluating bloodwork, reference ranges specific
for the age of the patient should be utilized.
108. Which of the following is the correct location for placement of a proximal
paravertebral block used to perform a standing laparotomy in a cow?

A - Caudal to the transverse processes of T13, L1, and L2

B - Above and below the transverse processes of L1, L2 and L4
C - Midway between spine and the ends of the transverse processes of L1, L2,
L3
D - In the spaces between L1, L2, L3, and L4
E - At the ends of the transverse processes of L1, L2, and L4: A

A proximal paravertebral block is performed via placement of local anesthetic just

off the midline and caudal to the transverse processes of T13, L1, and L2 vertebrae.

With a distal paravertebral block, local is placed above and below the ends of the
transverse processes of L1, L2, and L4 vertebrae. The spinal nerves, T13, L1, and
L2are targeted by a paravertebral block to completely desensitize the flank of a cow.

Note the difference - proximal at T13, L1, and L2, distal at L1, L2, and L4, but the
same nerves are affected because they gradually course caudally after exiting their
spinal foramen.

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Proper placement 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
towards the opposite side.
109. Which organism determines the minimum temperature needed to
pasteurize milk in the United States?

A - Mycobacterium bovis
B - Listeria monocytogenes
C - Brucella abortus
D - Coxiella burnetii
E - Escherichia coli: D

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.

Milk pasteurization standards in the United States are detailed in the 2011 Grade
A Pasteurized Milk Ordinance. Basically, the higher the temp, the shorter the
pasteurization time needed. ie: 90 C (194 F) for 0.5 seconds, or 100 C (212 F) for
0.01 seconds.
110. 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. Mycoplasma mycoides
C. Corynebacterium pseudotuberculosis
D. E. coli
E. Arcanobacterium pyogenes: C

The correct answer is Corynebacterium pseudotuberculosis. This is a description of

caseous lymphadenitis. Infection of supramammary lymph nodes in sheep and
goats is of economic importance due the fact that caseous lymphadenitis can cause

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weight loss in the individual, can become a herd problem, and could also be a
potential public health concern.
111. For the last 10 years, your state has had a mandatory vaccination
program against "pedunculated giblet disease" in fur-bearing turtles and the
prevalence of this terrible disease has decreased markedly. How does this
decrease in prevalence affect the predictive value positive (PVP) of the best
serologic test for pedunculated giblet disease?

A - PVP depends on the number tested, not prevalence

B - PVP is affected by specificity, not prevalence
C - PVP increases as prevalence decreases
D - PVP decreases as prevalence decreases
E - PVP stays the same as prevalence decreases: D

Don't think too hard on this: As prevalence of a disease goes DOWN, PVP of your
serologic test also goes DOWN. That is, as your disease becomes more and more
rare, the predictive value of your same old test gets WORSE. That is all you need
to know. Read more only if you want to see the math, (but you don't need it.)

Lets say prevalence of pedunculated giblet disease is 30% in 1000 turtles (that's
300 infected, 700 disease-free, then). A test with 90% sensitivity would correctly Dx
270 (cell "a") with the disease (true pos) and Correctly say 30 were negative (cell
"c"); a test with 90% specificity would correctly Dx 630 (cell "d") as disease-free
(true negs) and Correctly say 70 were positive (cell "b"):
PVP=a/(a+b)=270/(270+70)= 79%.

Now, do the same math on 1000 turtles, but assume prevalence is now only 1%
(0.01) after your vaccination program. You will see PVP goes down to 47%. 112. In
September, a 5-year-old Quarterhorse mare is presented with a 5-day history
of left head tilt, facial paralysis, depression, and stumbling. The horse is
ataxic and knuckles on both forelegs, worse on the left. There is muscle
atrophy of the left pectorals and right hindquarters and strips of localized
spontaneous sweating over the left trunk. The horse is immunoblot test-

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positive for Sarcocystis neurona. What prognosis is given to the owner if she
elects to treat the horse?

A - Only 25% of treated horses return to normal function

B - 50% of treated horses recover completely
C - Prognosis is good if treated with doxycycline
D - At least 60% of treated horses improve
E - Prognosis is grave: D

The prognosis is guarded to fair for treatment of equine protozoal myeloencephalitis

(EPM). Less than 25% recover completely, but at least 60% of treated horses
improve. Horses that remain positive by immunoblot testing commonly relapse, but
horses who become negative by immunoblot testing rarely relapse.
113. 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 - 99%
C - 3%
D - 72%: B

The correct answer is approximately 99%. The negative predictive value is the
proportion of test-negative animals that are truly disease negative (unaffected) in
this population. In the 2X2 table, where a= Disease +, Test +; b= Disease -, Test
+; c= Disease +, Test -; d= Disease -, Test -. The NPV is d/(c+d), or disease -, test
- animals DIVIDED by all of the test - animals.

The answer to the question has to consider the prevalence of mastitis in the herd,
which here is 5%. As the prevalence declines, NPV will increase.

The negative predictive value gives a proportion of the negative tests that are truly
negative. The value is the number of true negatives divided by the sum of the true
negatives and false negatives.

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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.

114. A stray dog is presented after being hit by a car. The dog has hypotonic
forelimbs and spastic paresis in the hinds. All four limbs have proprioceptive
deficits and sensation loss-signs are worse in the forelimbs. Where is the
lesion?

A - Cranial cervical: C1-C5

B - Cannot say without cutaneous trunci reflex results
C - Lumbosacral L4-S3
D - Thoracolumbar T3-L3
E - Cervicothoracic: C6-T2: E

Cervicothoracic: C6-T2. Weak, hypotonic (Lower motor neuron-LMN) forelimbs and

spastic paresis (Upper motor neuron-UMN) hindlimbs are signs of a cervicothoracic
(C6-T2) lesion. May see worse signs in fores then hinds.

NOTE: This is the OPPOSITE presentation as Schiff-Sherrington syndrome ie:

SEVERE acute spinal cord trauma T3-L3, with thoracic limb extensor rigidity (UMN)
and hind limb flaccid paralysis (LMN). Lesion is caudal to T2, typically see animal
soon (hours) after a bad trauma, like hit by car. With a typical, less severe T3-L3
lesion (like a disc, perhaps), expect to see UMN hind limb signs and normal
forelimbs.

Can localize T3-L3 lesion 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).

With C1-C5 would expect UMN signs in all 4 limbs, usually worse in hinds. With
a T3-L3, would see UMN hind limb signs and normal forelimbs. 115. What
distinguishes lymphoma from leukemia?

A - Lymphoma is benign
B - Leukemia is derived only from myeloid cells

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C - Leukemia is the precursor to lymphoma

D - Lymphoma originates in solid tissues
E - Lymphoma occurs only in dogs: D

Lymphoma=solid organs and bone marrow. Leukemia=blood circulation and bone

marrow.

Lymphoma originates in solid tissues. In general, lymphoma and leukemia both

arise from malignant transformation of lymphoid cells and are named based on
tumor location. Lymphoma is a tumor of lymphocytes that originates mainly in solid
lymphoid tissues including the bone marrow, thymus, lymph nodes, and spleen. In
addition, common extranodal sites include the skin, eye, CNS, testis, and bone.
Lymphomas are further distinguished according to their location (multicentric,
cutaneous, CNS, GI).

Leukemias can also arise from myeloid cells (monocytes, basophils, eosinoiphils,
megakaryocytes, erythrocytic precursor cells). Leukemia is a malignant neoplastic
disease of the WBC or RBC precursors with neoplastic cells in the bone marrow
and peripheral blood. Leukemias are further distinguished according to their
behaviour (acute or chronic) and their precursor cell (lymphoid or myeloid), so you
will see names like Acute Lymphocytic Leukemia (ALL) or Chronic Myeloid
Leukemia (CML).

In cats, FeLV infection is an important risk factor for both leukemia and lymphoma.
FIV infected cats have a higher than expected incidence of FeLV-negative
lymphomas.
116. You have diagnosed nitrate poisoning in a group of yearling cattle
which were grazing Sudan grass. Which of the following is the most
effective treatment?

A - Digitalis
B - Sodium thiosulfate
C - Vitamin B12
D - Methylene blue
E - Calcium gluconate: D

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Nitate 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, absorbed into 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.
117. The Animal Welfare Act is enforced by which U.S. government agency?

A - Institutional Animal Care and Use Committee (IACUC)

B - Department of Agriculture (USDA)
C - Food and Drug Administration (FDA)
D - National Institute of Health (NIH)
E - Centers for Disease Control and Prevention (CDC): B

The United States Department of Agriculture (USDA) enforces the Animal Welfare
Act. Specifically, it is the Animal and Plant Health Inspection Service (APHIS) within
the USDA that is responsible.

The Animal Welfare act sets minimal standards for care of laboratory animals
including dogs, cats and non-human primates. It regulates the pet trade, animal
transportation and exhibition and licensure of animal dealers. Since 1976 it has
prohibited most forms of commercial animal fighting.
118. Fractures of the proximal sesamoid bones in horses are often associated
with damage to which structure?

A - Suspensory ligament
B - Superior check ligament
C - Deep digital flexor tendon

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D - Superficial digital flexor tendon

E - Impar ligament: A

The suspensory ligament is most likely to be damaged with fracture of the proximal
sesamoids due to its insertion onto these bones. Proximal sesamoid fractures are
relatively common, caused by overextension.

The prognosis for return to soundness is often predicated on the extent of the
damage to the suspensory apparatus.

Proximal sesamoid fractures and their attendant suspensory apparatus problems

are the number one cause of racetrack deaths.
119. Which one of the following diseases is characterized by schistocytes on
a complete blood count?

A - Systemic lupus erythematosus

B - Cyanocobalamin deficiency
C - Disseminated intravascular coagulation
D - Methemoglobinemia
E - Acetaminophen toxicity: C

Disseminated intravascular coagulation. Schistocytes are produced by the

mechanical fragmentation of erythrocytes on intravascular fibrin strands.

They are most commonly associated with conditions that affect blood flow or clotting
like disseminated intravascular coagulation(DIC), heartworm, hemangiosarcoma
and glomerulonephritis.

Cobalamin deficiency causes a macrocytic anemia (pernicious anemia).

Systemic lupus erythematosus may cause anemia, thrombocytopenia and

leukopenia or leukocytosis.

Think of methemoglobinemia, heinz bodies and hepatotoxicity with acetaminophen

toxicity in cats.
120. 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
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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 - Squeeze and express the material out of the feather cyst

B - Lance and drain the feather cyst, flush with saline
C - No treatment is necessary as feather cysts typically resolve spontaneous-
ly
D - Surgical removal of the feather cyst and follicle
E - Treat with systemic antibiotics for 4-6 weeks: D

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.
121. Two bucket-fed veal calves are depressed and stunted and have sticky
feces coating their hindquarters. Fluid-splashing sounds are audible during
auscultation over the left flank when a calf is drinking. Passage of a stomach
tube obtains a rancid-smelling liquid with a pH of 5.2 [N=5.9-6.2] Which one of
the following choices is the most appropriate treatment?

A - Remove fermented rumen contents, flush with saline

B - Wean affected calves; Shift to bottle-feeding for well calves
C - Vitamin E/Selenium injections, plus dietary supplements
D - Cull affected calves
E - Inoculate rumen fluid from a healthy cow into calf by stomach tube: A.
Remove fermented rumen contents, flush with saline.

This is the clinical picture of a ruminal drinker calf with chronic indigestion from milk
deposited directly into the rumen. Treat by removing the fermented material and
flushing the rumen with saline. Attempt to induce gastric/reticular groove closure
during feeding by inducing vigorous sucking activity with a finger before feeding
milk. If calves relapse, consider weaning. The problem occurs due to failure of the

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gastric groove reflex, which normally shunts milk directly into the abomasum,
(bypassing the rumen). Most often seen in bucket fed calves who gulp their milk.
122. 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 - Right lateral recumbency abdominal radiograph

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

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.
123. A group of dairy calves were fed a home-made grain mix that had a high
percentage of cottonseed. 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 - Gossypol
C - Cardiac glycosides
D - Cyanide
E - Tannins: B

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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.
124. A petting zoo is experiencing a high mortality outbreak among young
chickens, guinea fowl, pheasants and turkeys. Affected birds huddle near
heat sources. They are off feed and weak, with whitish feces pasted around
their vents (diarrhea). On necropsy, lesions include unabsorbed yolk sacs
and gray nodules in the liver, spleen, lungs, heart, gizzard, and intestine.
There are firm, cheesy cecal cores. This presentation is highly suggestive of
which diagnosis?

A - Campylobacter jejuni
B - Salmonella pullorum
C - Avian spirochetosis
D - Histomoniasis
E - Coronaviral enteritis: B

This is the clinical picture of Salmonella pullorum, which usually causes very high
mortality (potentially approaching 100%) in young birds.

Pullorum disease was once common in North America but has been eliminated from
most commercial chicken stock. The disease may occur in other avian species (eg,
guinea fowl, quail, pheasants, sparrows, parrots, canaries, and bullfinches). 125.
During a routine immunization visit for a 2 year-old neutered male
Newfoundland dog, a systolic ejection-type (crescendo-decrescendo)
murmur is detected, audible loudest on the left side of the chest between the
2nd and 5th intercostal (IC) space and at the thoracic inlet lateral to the
trachea. Which condition is highest on a differential diagnosis list?

A - Pulmonic stenosis
B - Mitral dysplasia
C - Tricuspid dysplasia
D - Aortic stenosis

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E - Patent ductus arteriosus (PDA): D

Aortic stenosis (also called sub-aortic stenosis [SAS]), is a systolic, ejection-type

(crescendo-decrescendo) heart murmur which may be heard most loudly on the left
chest between the 2nd and 5th intercostal (IC) space or at the thoracic inlet (lateral
to trachea). Inherited in Newfoundlands. Predilection in many BIG BREEDS-
German Shepherd, Golden Retriever, Boxer, Rottweiler.

Mitral dysplasia and other mitral valve problems are heard further back on left at
5th-6th IC. More common in CATS.

With pulmonic stenosis see RIGHT ventricular hypertrophy, because pulmonic

valves blocks outflow from R ventricle (mostly dogs).

Tricuspid dysplasia is heard further back on RIGHT at 5th-6th IC. Uncommon.

Expect a continuous murmur with patent ductus arteriosus (PDA). Vast majority
detected at first vaccination visit.
126. Which one of the following antibiotics is the treatment of choice in the
face of a vibriosis abortion storm?

A - Tetracycline
B - Aminoglycoside
C - Cephalosporin
D - Fluoroquinolone
E - Chloramphenicol: A

Long acting oxytetracyclines are effective against Campylobacter jejuni and C.

fetus subsp fetus, the organisms that cause vibriosis. Daily dihydrostreptomycin or
penicillin can also be used but is more labor intensive.

Chloramphenicol is prohibited in food animals.

127. A 4-year old female ferret presents with a history of an enlarged vulva
and truncal alopecia. What is the most likely diagnosis?

A - Insulinoma

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B - Sertoli cell tumor

C - Adrenal tumor
D - Hypothyroidism: C

The correct answer is adrenal tumor. These tumors are very common in middle-
aged ferrets and usually secrete estradiol. Common clinical signs are hair loss,
enlarged vulva, pruritus, and behavior changes. Diagnosis is made by clinical signs,
ultrasound, and measurement of serum estradiol levels. Treatment is
adrenalectomy. 128. What is the neuroanatomic cause of extensor rigidity in
the forelimbs of a cat with Schiff-Sherrington syndrome?

A - Subdural white matter compression at C6-T3

B - Brachial plexus trauma
C - Interruption of inhibitory neuron input from lumbar spinal cord
D - Polyradiculoneurtitis of peripheral nerve sheaths at cervical intumes-
cence
E - Damage to thoracic spinocerebellar tracts in superficial white matter: C
With severe trauma between T2-T13, inhibitory pathways (esp. around L2-L4) are
interrupted and cervical intumescence neurons (C6-T2) are "released", causing
extensor hypertonia in the forelimbs.

Think of Schiff-Sherrington syndrome when you see a combination of forelimb

extensor rigidity and hind limb flaccid paralysis, in an animal that has just had major
spinal trauma, like being hit by a car.
129. After a stressful period of cold winter weather in northern Colorado, a
petting zoo reports that one adult mule deer out of a herd of eight is sick. On
physical exam, the animal has a fever, increased respiratory rate and
pulmonary rates, suggesting aspiration pneumonia. Which one of the
following choices is the most appropriate next step to take?

A - Report case to state health department

B - Treat sick animal with high-dose penicillin
C - Cull sick animal, vaccinate herd against histophilosis
D - Treat herd with high-dose penicillin
E - Perform an intradermal tuberculin test: A

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Suspect chronic wasting disease (CWD) in any adult cervid with aspiration
pneumonia. Reportable in most states and provinces, but especially in important in
Colorado. CWD was first identified in northern Colorado in 1967 and remains more
highly endemic there than anywhere else in the U.S.

Although weight loss is progressive throughout disease, remember that CWD may
be present in deer and elk that are not thin or emaciated. Some animals may die
of CWD without gross lesions. Death or clinical illness in CWD-affected animals
can be precipitated by stressors like cold weather or restraint.

When present, the most common gross lesions due to CWD are poor body
condition, watery rumen contents, and dilute urine.
130. You examine a very ill 4-year old Holstein dairy cow on a large
commercial dairy. She freshened one week ago and was producing well, until
she was found down and unwilling to rise this morning when you were called.
T=103F or 39.4 C, HR=90, and RR=35. The scleral vessels are dark are
enlarged, her rumen is fairly empty and the motility is poor, and she appears
too weak to rise. Rectal exam reveals an involuting uterus which can be
retracted, discharging a brownish red mucoid non-odorous lochia through
the vagina. The left rear quarter of her udder is swollen, hot, painful, and
discolored, and contains a serum-like secretion with clumps of fibrin in it.
What is your diagnosis?

A - Grain overload
B - Metritis
C - Displaced abomasum
D - Hypocalcemia (milk fever)
E - Coliform mastitis: E

This is a case of severe acute coliform mastitis, and the absorbed endotoxin (LPS)
is causing many of the systemic signs observed. The cow needs to be aggressively
treated with IV fluids, NSAIDS, and supportive nursing. The gland should be
frequently milked out. The use of both intramammary and systemic antimicrobial
drugs to which most coliforms are susceptible is still controversial, but is often done
in cows in a severe state of illness as in this case. While this cow may have
secondary hypocalcemia, treatment with calcium needs to be approached
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cautiously, as endotoxic animals have very sensitive myocardium and arrest may
occur if calcium is given IV. If given, preferred routes of calcium administration
would be subcutaneous or oral.
131. An 8-year old dog is presented with a 2-week history of occasional cough
and moderate exercise intolerance. On physical exam there are increased
lung sounds. Thoracic radiographs show right ventricular enlargement. Lab
testing shows that the dog is heartworm antigen-positive, anemic and has
proteinuria on urinalysis. What class of heartworm disease is this?

A - Class III
B - Class I
C - Class II
D - Class IV
E - Cannot say without more information: C

This is the clinical picture of class II heartworm disease (ie: moderate disease). In a
nutshell, Class I is mild and class III is severe. Class IV is an acute shock-like
syndrome. Canine heartworm disease can be classified with 4 parameters--physical
exam, thoracic radiograph, packed cell volume (PCV) and urinalysis.

Class I heartworm disease is an asymptomatic-to-mild case with no radiographic

signs and no lab abnormalities.

Class II heartworm disease is moderate, with occasional coughing and mild-to-

moderate exercise intolerance. On physical exam there may be slight loss of body
condition and increased lung sounds. Mild-to-moderate radiographic changes, like
right ventricular enlargement are present. Lab results may show anemia and
proteinuria.

Class III heartworm disease is severe. Variably characterized by weight loss,

exercise intolerance and tachypnea at rest. Look for severe or persistent coughing,
dyspnea, hemoptysis, fainting and ascites. Severely abnormal radiographs may
show right ventricular hypertrophy, enlargement of the main pulmonary artery, and
diffuse pulmonary densities. Labwork will indicate marked anemia,
thrombocytopenia, and proteinuria.

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Class IV heartworm disease (also called post-caval or caval syndrome) is an acute,

shock-like presentation caused by retrograde worm migration from the pulmonary
artery through the right ventricle, right AV valve and into the vena cava.

Caval syndrome is characterized by acute collapse, hemoglobinuria, and respiratory

distress. Usually fatal if surgery is not immediately instituted to physically remove
worms.
132. A 1 year old German Shepherd is presented with a 2-week history of
lameness. Although the dog limps on the right foreleg as it enters the exam
room, the owner reports that the dog was lame on the left hindleg last week.
On physical exam, the dog reacts painfully on palpation of the long bones of
the right foreleg. Which one of the following choices is the most likely
diagnosis?

Value Normal
99.8 F (37.7 C) 99.5-102.5 F, 37.2-39.2 C
HR=100 bpm 0-120
RR=24 brpm 15-34

A - Panosteitis
B - Multiple cartilaginous exostoses
C - Hypertrophic osteodystrophy
D - Hypertrophic osteopathy
E - Retained ulnar cartilage cores: The hallmark of panosteitis is an acute-onset
shifting leg lameness with long bone pain in a young (5 mos-2 years), medium to
large breed dog.

German Shepherds are reported to be at highest risk of panosteitis. Basset hounds

may be over-represented.

Hypertrophic osteodystrophy (HOD) is characterized by bilateral metaphyseal pain,

swelling in distal radius and ulna, fever, anorexia and depression. Typically a
disease of young, growing large and giant breed dogs.

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Hypertrophic osteopathy (HO) is a diffuse periosteal proliferative disease of long

bones in dogs SECONDARY to neoplastic or infectious masses in the thoracic or
abdominal cavity.

Multiple cartilaginous exostoses is characterized by non-painful ossified swellings

on metaphyseal cortical surfaces of long bones, vertebrae, and ribs in young dogs
and cats. Animals may have no signs at all.

Diagnosis is confirmed by palpation and radiography. Click here to see a radiograph

of cartilaginous exostoses

Retained ulnar cartilage cores are characterized by lameness and eventually,

angular limb deformity in young, large breed dogs.
133. A 12-year old male neutered domestic short hair cat presents for ongoing
evaluation of diabetes mellitus. The cat was diagnosed 6 months ago and has
continued to be markedly polyuric, polydipsic, polyphagic, and has been
gaining weight. The cat is currently receiving 10 units of glargine insulin every
12 hours. On physical exam, the cat weighs 15 pounds (6.8 kg) and has an
enlarged head, abdomen, and paws. What imaging modality would be most
appropriate to try and prove what you suspect is causing the uncontrolled
diabetes and weight gain in this cat?

A - Magnetic resonance imaging (MRI) of the head

B - Computed tomography (CT scan) of the abdomen
C - Radiographs of the thorax
D - Ultrasound of the neck
E - Ultrasound of the abdomen: A

This cat has the signs and symptoms of acromegaly. Acromegaly is caused by
excessive growth hormone release from the pars distalis from a tumor in the
pituitary gland. Excessive growth hormone causes a defect in the insulin receptors
on target cells causing insulin resistant diabetes mellitus. The enlarged head, paws,
abdomen, and weight gain despite uncontrolled diabetes is due to the anabolic
effects of the growth hormone.

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Treatment for this condition includes radiation therapy to the pituitary tumor, high
doses of insulin to try and control the diabetes, and somatostatin analogs
(octreotide) to try and inhibit the release of growth hormone from the tumor.
Surgical excision has been used as a form of treatment in people with pituitary
tumors, but this has only been rarely reported in cats.
134. A valuable female show dog is approaching estrus and the owner wants
her bred by artificial insemination to one of the most successful and
expensive stud dogs in the country. What testing method is most accurate to
insure optimum timing for breeding the bitch?

A - Estrogen levels
B - Progesterone assays
C - Vaginal cytology
D - LH monitoring
E - Vaginoscopy: D

Daily testing for the LH surge is the most accurate method of ovulation timing. The
day of the LH surge becomes "day 0" and you plan breedings from there, typically
at days 2, 4 and 6. You might choose LH monitoring for frozen or chilled semen
breedings, infertility cases or breedings with valuable, or subfertile studs.

Progesterone assays, vaginal cytology and vaginoscopy are all useful adjuncts to
breeding management.

Progesterone starts to increase at about the same time as the LH surge- although
progestrone levels are not as accurate as measuring the actual LH surge, the
tests may be more convenient and available than LH tests.

Estrogen measurement is of little value for ovulation timing because peak levels
vary from dog to dog and do not necessarily correlate with the fertile period.
Increased estrogen speeds up the turnover of vaginal epithelial cells, which causes
progressive cornification seen on vaginal cytology.
135. What is the primary mode of transmission of West Nile Virus (WNV)
between birds?

A - Via Cnemidocoptes mites

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B - Via feces
C - Via saliva
D - Via mosquitoes
E - Via placenta: D

Mosquito vectors are the primary mode of transmission for WNV between birds and
other hosts (horses, humans). There are infrequent documented cases of the
disease being spread by feces or saliva. No mites have been documented to
transmit the disease. Birds do not have a placenta.
136. Which one of the following choices is a cardinal and early sign of
toxicoinfectious botulism in a foal?

A - When startled, affected foals fall and exhibit opisthotonos

B - Tongue hanging out, foal cannot retract it
C - Sawhorse stance
D - Risus sardonicus with protruding third eyelids
E - Hemorrhagic enterocolitis with headpressing: B

A nonretractable tongue is a cardinal and early sign of toxicoinfectious botulism,

(Shaker foal syndrome).

Affected foals demonstrate signs of progressive symmetric motor paralysis,

including stilted gait, muscular tremors, and recumbency.. Mortality is higher than
90%. 137. In which one of the following cattle breeds is syndactyly most
commonly inherited?

A - Holstein-Friesian
B - Angus
C - Hereford
D - Brown Swiss
E - Simmental: A

Holstein-Friesian cattle inherit syndactyly, or "mule foot", a simple autosomal

recessive trait, more often than other breeds. Syndactyly is the partial or complete
fusion of the digits of one or more feet. Forefeet are affected most often.

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Affected animals walk slowly, usually with a high-stepping gait. They may also be
more prone to hyperthermia than normal cows.
138. A 2-year old nonlactating dairy cow in California has a sudden onset of
head tilt and drooling. The owner also reports that she appears less active
and less interested in feed than normal, and today is circling in one direction
in the pen. You examine her and find T=105F (40.6 C), HR=96, and RR=32.
There is ptosis, drooped ear, and weakness of the lips on the affected side.
You take a lumbosacral spinal tap, and submit the CSF to your lab. The results
show elevated protein and WBCs, with the cell type being mainly monocytes.
The lab reports seeing some gram positive bacteria in the monocytes of the
CSF. Based on these findings what is the best treatment for this condition?

A - Enrofloxacin
B - Metoclopramide
C - Metronidazole
D - Chloramphenicol
E - Penicillin: E

The diagnosis is Listeriosis. Listeria monocytogenes can effectively be treated in

the early stages of the disease with penicillin, ampicillin, or tetracycline.
Intramuscular procaine penicillin for example has a withdrawal of 10 days for
slaughter (meat) and 48 hours for milk if the animal is lactating. Other choices of
approved antimicrobials would also likely be effective since L. monocytogenes is
susceptible to most antimicrobials. For a list of approved animal drugs see
www.farad.org/vetgram. FARAD is the United States Food Animal Residue
Avoidance Databank which gives withdrawal information as well as a list of
prohibited drugs. The other drugs listed as choices here are prohibited and cannot
be legally used in food animals in the USA. 139. Acquired equine motor neuron
disease is a disease characterized by weight loss, paresis with trembling,
preference to lying down, and decreased activity. Which one of the following
choices is associated with this disease?

A - Vitamin E deficiency
B - Thiamine deficiency

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C - Lead toxicosis
D - Organophosphate toxicosis
E - Rickettsial infection: A

Vitamin E deficiency. Acquired equine motor neuron disease uncommon today due
to horse owner awareness. When it occurs, it is usually seen in older adult horses.

Owners may say that the horse can "walk better than it can stand" when a horse
has acquired equine motor neuron disease. The horse will stand still trembling in a
tucked up stance, but it will walk well (but in short strides).

140. A 2-year old mare presents to you several weeks after recovering from a
mild upper respiratory infection. She now presents with edema and sloughing
of the legs, chest and abdomen as well as mucosal petechial hemorrhages.
She is sore and reluctant to move. Biopsy of the skin lesion is consistent with
aseptic necrotizing vasculitis. What is the most likely diagnosis?

A - Cantharidin toxicity
B - Idiopathic thrombocytopenia
C - Bastard strangles
D - Type I hypersensitivity
E - Purpura hemorrhagica: E

This is the clinical and histologic appearance of purpura hemorrhagica. It is a type-

III hypersensitivity which is when antigen-antibody complexes accumulate, leading
to disease.

Purpura hemorrhagica most commonly occurs 2-4 weeks after exposure to certain
infectious agents or vaccines. This condition is most commonly seen subsequent to
infection with Streptococcus equi subsp. equi or vaccination against it but it can also
be associated with other pathogens, particularly respiratory pathogens including
other streptococcal species and equine influenza.

Regardless of the cause, purpura hemorrhagica results from accumulation of

antigen-antibody complexes that deposit on blood vessel walls and activate a

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strong immune response (vasculitis). The leaky blood vessels lead to hemorrhage
and edema.

Bastard strangles refers to the condition when Streptococcus equi subsp. equi
creates abscesses in unusual sites (other than the lymph nodes draining the throat)
such as abdominal or lung lymph nodes.

Cantharidin toxicity (also known as blister beetle toxicity) leads to mucosal irritation
and results in colic and cystitis. It can also lead to hypocalcemia.

Primary immune-mediated thrombocytopenia (sometimes called idiopathic

thrombocytopenia) can be seen in horses but is not consistent with the necrotizing
vasculitis described in the case.

Type I hypersensitivity reactions are immediate reactions (such as urticaria) invoked

by an antigen or allergen.
141. A 4-year-old Rat Terrier is presented with a 3 day history of progressive
stumbling and falling. Physical exam reveals a right head tilt, left sided
hypermetria, generalized ataxia and vertical nystagmus. Which one of the
following choices is at the top of the differential list?

A - Granulomatous meningoencephalitis
B - Fibrocartilagenous embolism
C - Ascending and descending myelomalacia
D - Central pontine myelinolysis
E - Amyotrophic lateralizing sclerosis: A

Granulomatous meningoencephalitis.
The lesion in this case localizes to the left cerebellum causing the left hypermetria
and a right paradoxical head tilt. Granulomatous meningoencephalitis often affects
this area. Another top differential would be a cerebellar neoplasm.
142. A 2-year old male neutered cat presents to you depressed,
hypersalivating, and ataxic with muscle tremors. The owner reports that a
pyrethrin-based spot-on formulation for flea control belonging to their Golden
Retriever was accidentally applied on the cat earlier today. Which of the
following drugs will you use to treat the cat's clinical signs?
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A - Atropine
B - Amoxicillin
C - Methocarbamol
D - 2-PAM
E - Acepromazine: C

Pyrethrins alter the activity of the sodium ion channels of nerves, which prolongs
the period of sodium conductance. This increases the length of depolarization
resulting in repetitive nerve firing. Cats are particularly sensitive to pyrethrin-
containing products and can develop clinical signs within hours after
administration. Affected animals should be bathed to remove remaining product.
Minor clinical signs such as hypersalivation and ear twitching are usually self-
limiting and do not require treatment. Control of marked tremors or seizures can
be achieved with methocarbamol (Robaxin).
143. A 2-month old calf is presented that was found dead. The night before
this calf was weak, feverish and had a mucoid brown diarrhea with a small
amount of blood and a nasty odor. Necropsy reveals a pseudo-diptheritic
membrane lining parts of the distal small bowel and large bowel. What is the
diagnosis?

A - Cryptosporidiosis
B - Salmonellosis
C - Bovine Viral Diarrhea, mucosal form
D - Coccidiosis
E - Ostertagiasis: B

If you see "pseudo-diphtheritic membranes" in the intestines, think Neonatal

salmonella. Look also for fever, diarrhea, especially with a "Septic tank odor" and
systemic signs like septicemia, pneumonia, meningitis. Can die suddenly without
diarrhea.

Other rule outs for OLDER calf diarrheas include:

Coccidiosis ( Older than 21 days and in ALL ages, bloody diarrhea, tenesmus)
Ostertagiasis (anorexia, poor growth, diarrhea in less than 2 year olds on pasture-
a chronic disease)
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BVD (Young cattle 6-24 mos, with mucosal lesions, diarrhea)

Winter dysentery (explosive outbreak watery diarrhea with clotted dark blood,
stabled animals, all ages in winter) and
Johne's disease (Intractable diarrhea, cachexia).
Crypto is typically a disease of the young, 1-4 weeks old.
144. A pregnant mare was brought out to your barn for observation in
anticipation of parturition. After several hours of restless behavior, several
gallons of allantoic fluid rush out from the vulva. Which of the following
would you expect to happen next for a normal parturition?

A - The thin, white, glistening amniotic membrane emerges from the vulva
B - The hind legs of the foal emerge from the vulva
C - The red, velvety, chorioallantoic membrane emerges from the vulvaD - The
placenta is expelled from the vulva: A

This case description is consistent with stage I of labor in the horse. The first stage
of foaling typically lasts 30 minutes to 4 hours. During this stage, mares act restless
and may exhibit signs similar to colic such as flank watching, pawing, and constantly
getting up and down. When the placenta ruptures ("water breaks"), there may be
several gallons of allantoic fluid that come out. Usually, within about 5 minutes, the
second stage of labor begins and the foals feet and nose appear at the vulva,
covered in the white, thin, glistening amnion. If a red, velvety, membrane is seen,
this is the chorioallantois which indicates premature placental separation which can
impair oxygen delivery to the fetus and can result in death of the foal. Usually, the
muzzle will emerge from the amnion by the time the foal's hips pass through the
pelvis but if not, the amnion can be gently broken and removed. Usually, the
umbilical cord breaks naturally when the mare stands or foal begins to rise. Then,
within 30 minutes to 3 hours after foaling, the placenta should be expelled.
145. Which three diseases are on the differential diagnosis list when
encountering sudden death in a young, fast-growing calf?

A - Lasalocid toxicity, Salmonellosis, Lymphosarcoma-juvenile form

B - Salmonellosis, Colibacillosis, Enzootic Calf Pneumonia
C - White muscle disease, Enterotoxemia, Colibacillosis
D - Bovine Viral Diarrhea, Lasalocid toxicity, White muscle diseaseE - Winter
dysentery, Enterotoxemia, IBR-encephalitic form: C

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White muscle disease, Enterotoxemia, Colibacillosis.

When you hear "Sudden Death" in calves, think of white muscle disease caused by
Selenium/vitamin E deficiency. Also think of enterotoxemia caused by Clostridium
perfringens type B or C. And think of severe colibacillosis.

Can also see sudden death with encephalitic form of IBR and severe salmonellosis.
146. A bovine diet that is low in thiamine or high in sulfur can cause
____________.

A - Polioencephalomalacia

B - Pregnancy toxemia

C - Parturient paresis

D - Downer cows

E - Pseudorabies: A

The two most common causes of polioencephalomalacia (PEM) are low thiamine
(due to thiaminase activity from plants like bracken fern or low thiamine diets) and
high sulfur in the diet (which can come from a high molasses-urea diet, corn or sugar
cane byproducts, water, or other plants, including alfalfa, Canada thistle (Cirsium
arvense), kochia, (Kocchia scoparia), and lambsquarter (Chenopodium spp).
147. A cow is presented on emergency with urea/non-protein nitrogen
toxicity. What is the treatment of choice?

A - Rumenal infusion 2-8 liters vinegar,3-10 gallons cold water

B - Relieve bloat, drench with 2-8 liters sodium bicarbonate

C - Rumenotomy

D - IV Fluids with MgSO4, Na thiosulfate PO

E - Atropine, Protopam chloride IV q 4-6 hours: A

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Treat Urea/non-protein nitrogen (NPN) toxicity with a rumenal infusion 2-8 liters 5%
acetic acid (vinegar) and 3-10 gallons of cold water. The vinegar decreases rumenal
pH which slows absorption of un-ionized ammonia. Repeat Q 6 hours up to 48
hours. Best results if animal is still ambulatory. It is often impossible to treat these
cases before they die because of rapid progression to death. If possible, Rx with IV
fluids. If necessary, relieve bloat. Urea/NPN toxicity is related to ammoniated feed
toxicity which causes so-called "Bovine bonkers". Manage ammoniated feed toxicity
by removing the ammoniated feed and treating severe cases with anticonvulsants
like diazepam, pentobarbital.
148. What is the potential udder fate of goats infected with caprine arthritis
encephalomyelitis virus?

A - The udder is not affected

B - Bluebag
C - Gangrene
D - Hardbag: D

CAEV is a retrovirus and when it affects the udder it will cause fibrosis and result
in a firm udder with agalactia. Treatment is ineffective and the goat should be
culled. The disease is usually subclinical but can cause arthritis in adults and
encephalitis in kids.
149. Your client is pregnant and is worried about acquiring toxoplasmosis
from her cat. What do you advise?
A - Submit toxoplasmosis titers from the cat. A IgG titer of 1:64 or greater
suggests recent or active infection that could pose a danger.

B - Submit toxoplasmosis titers from the cat. A positive cat infected with
toxoplasmosis can shed multiple times in its lifetime and pose a zoonotic risk.

C - Toxoplasmosis titer should be performed on the owner by a human

physi-cian. A positive titer indicates antibodies to the organism that will
prevent infection in the first trimester. A negative titer indicates she should
remove her cats from her environment.

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D - Empty the litter box daily as a simple precaution to prevent infection as

it takes 1-3 days for passed oocyts in the stool to sporulate into an infective
form: D

Toxoplasmosis gondii is a protozoal organism. The cat is the definitive host; the
entire life cycle of the organism can be completed within this host. Most cats become
infected when they consume an exposed rodent with bradyzoites encysted in their
tissues. Only recently infected cats generally shed oocysts in their stool, and cats
typically only shed these oocysts for 1-2 weeks. Most cats will only have one
shedding episode in their lifetime.

A IgM (not IgG) titer of 1:64 or greater suggests recent or active infection and that
cat is at risk of shedding oocysts in their stools. Oocyts are not infective until they
sporulate. This process takes > 24 hours, so emptying the litter box daily is advised,
preferably by someone who is not pregnant.

If an owner has owned cats for a long while, it is possible that they may have
previously been exposed and therefore have mounted an immune response to the
organism. If so, it may be advisable to test for Toxoplasma antibody titers in the
owner. A sufficient antibody titer will mean the client is protected from infection
during the first trimester.
150. A 4-year old male Manx cat presents to you because the owners found
an empty, opened pill vial in the bathroom and the cat vomited. On physical
exam, you note ptyalism and facial edema. The cat's mucous membranes
are pale and slightly icteric. You perform a blood smear and detect Heinz
bodies in erythrocytes. The cat's packed cell volume (PCV) is 26% (30-45%).
The owners provide you a list of the medications in the medicine cabinet
which are acetaminophen (Tylenol), finasteride (Propecia), enalapril
(Vasotec), and omeprazole (Prilosec). What treatments should you institute
for this cat?

A - Acetylcysteine and S-adenosylmethionine

B - Emesis and methylene blue
C - Activated charcoal and whole blood transfusion
D - Prednisone and amoxicillin: A

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Acetaminophen toxicity in cats usually occurs when owners administer the drug,
unaware of its significant potential toxicity in cats. In this case, the cat's clinical signs
are most consistent with acetaminophen toxicity based on the Heinz body anemia
that is present. Cats can die from oxidative damage and methemoglobinemia within
1-2 days of ingestion. It may also be associated with hepatotoxicity in cats, although
this is seen more frequently in dogs.

Recall that cats are particularly sensitive to acetaminophen because they have
decreased glucuronyl transferase activity which conjugates acetaminophen to
glucuronic acid for excretion. As a result, 50-60 mg (a single tablet) may be fatal
for a 4-5 kg cat.

Treatment should consist of toxin removal if possible by inducing emesis in some

cases. As the cat in this case is already vomiting, this may not be necessary.
Activated charcoal is controversial and should only be given if ingestion occurred
within hours and should be administered very carefully in cats due to the risk of
aspiration.

The specific antidote is acetylcysteine which binds to some of the reactive

metabolites of acetaminophen and increases the availability and synthesis of
glutathione. Other treatments may include S-Adenosylmethionine (SAMe) which
has hepatoprotective and antioxidant properties. Cimetidine can be given to inhibit
the p450 oxidase in the liver and limit formation of toxic metabolites. Ascorbic acid
can also be used as an adjunct treatment to bind toxic metabolites. In cats with
signs of hypoxemia from severe hemolytic anemia (PCV <20%), a transfusion and
further supportive care may be warranted.
151. 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 - Gentamicin
C - Streptomycin
D - Metronidazole
E - Chloramphenicol: A

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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.
152. An 18 month old steer is presented that is just down from summer
pasture in the mountains of Colorado with brisket edema, slight dyspnea
and distended jugular veins. What condition is at the top of the differential
diagnosis list?

A - Hardware disease
B - Cardiac lymphosarcoma
C - White muscle disease
D - High Mountain disease
E - Cor pulmonale: D

Bilateral dilated jugulars says "Heart problem". Hx of high altitude exposure and
brisket / submandibular edema point towards High Mountain disease. Remember
Locoweed (Astragalus and Oxytropis) ingestion worsens disease, due to
swainsonine.
153. Porcine reproductive and respiratory syndrome (PRRS) is characterized
by postweaning respiratory disease in piglets and by reproductive failure in
sows (ie: increased stillborn and weak-born piglets, mummified fetuses,
premature farrowings). Which choice is the most effective control measure
in infected herds after an outbreak of a new strain of PRRS virus?

A - Cull all sows after first farrowing

B - Maintain therapeutic levels of streptomycin in feed
C - Segregated early weaning 12-18 mos after initial event
D - Buy PRRS-negative gilts, test on arrival, segregate 45 days, retest before
join herd
E - Vaccinate boars in contact with sows, maximize pen ventilation: C

12-18 months after the initial outbreak, sows are usually no longer transmitting the
porcine reproductive and respiratory syndrome (PRRS) virus. So, segregated early
weaning and removal of nursery pigs (with concurrent disinfection of nursery before
repopulation) may help control the virus. Strains of PRRS virus vary markedly in
virulence, and there is genetic and antigenic variability between isolates. Recovered

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sows are resistant to re-infection when exposed to a homologous (same/similar)

strain of the virus but are likely to show clinical signs if a heterologous (new/different)
strain is encountered. Because it appears that sows generally only abort once due
to a particular PRRSV strain, culling after the first farrowing not advisable. Antibiotic
administration can help control secondary bacterial infections, but not the arterivirus
responsible for PRRS. Adding negative gilts to a herd already infected with the virus
is unlikely to result in control. There is no single successful strategy for control of
PRRS. You can try to eliminate PRRS (difficult) or try to live with PRRS, which is
called breeding herd stabilization. The goal of many farms is to live with PRRSV
infection in the sow herd by acclimatizing them to a particular strain of the virus.
Herd immunity to that specific strain of PRRSV (eventually) prevents reproductive
failure and can decrease transmission of virus from sows to fetuses and offspring.
This is stabilization. Acclimatization to a herd PRRSV strain minimizes clinical
PRRS, especially when combined with segregated rearing of piglets. Ohter
breeding herd stabilization interventions include by vaccination, intentional whole-
herd infection, aggressive acclimatization of replacement breeding stock to the herd
PRRSV strain, or combinations of these
154. 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 - Pheochromocytoma
B - Cushing's disease (Pituitary Pars Intermedia Dysfunction)
C - Diabetes insipidusD - Hypothyroidism: B

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.
155. What percentage of dairy cows have a retained placenta after calving?

A - 1-4%
B - 5-15%
C - 25%
D - 20-30%

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E - 30-40%: B

Retained placenta occurs in 5-15% of dairy cattle. Very common, about 1 in 10

calvings. NORMALLY, the placenta is expelled in 3-8 hours. If it's still there 12-24
hours after calving, it's retained. Typically, retained placentas are dispelled
spontaneously after 4-10 days as the caruncles necrose.

An owner may insist you pull it out. Manual removal is usually not helpful-should
only be done if placenta comes out with GENTLE traction. Manual removal is
contraindicated if cow has signs of septicemia- removal may cause a septic metritis,
peritonitis.
156. A 5-year old lactating Holstein dairy cow is being evaluated for a 2-month
history of watery diarrhea, weight loss, and decline in milk production. On
examination, the cow is bright, alert and responsive, but unthrifty and very
thin, with a soft intermandibular swelling. What is the most appropriate
management of this herd?

A - Cull positives, ensure 4 L. colostrum uptake for calves

B - Quarantine herd, treat until herd tests negative
C - Test herd, treat positive animals, add coccidiostat to ration
D - Test herd, cull positives, remove calves from dam at birth
E - Test herd, treat positive animals, test and treat replacements: D

This is likely to be Mycobacterium avium subspecies paratuberculosis (Johne's

disease).

NO Rx: Test-and-cull programs offer best chance of attaining a Mycobacterium

avium subspecies paratuberculosis-free herd. Calves, kids, or lambs should be
birthed in manure-free areas.

For dairy cattle, calves should be removed from dam immediately after birth, bottle-
fed pasteurized colostrum or colostrum from test-negative dams. They should be
segregated as much as possible from adult cows and their manure until more than
1 yr old. Must also remove calves at birth from the dam to prevent.

REPORTABLE in many states.

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157. Under what conditions is a very sensitive test used?

A - Rare disease, Early diagnosis improves prognosis

B - Lethal disease, Highly prevalent disease
C - Treatment does not affect prognosis, Non-infectious diseases
D - Common disease, infectious diseases
E - Highly prevalent disease, Treatment does not affect prognosis: A

You need a very sensitive test if: 1. Disease is rare (ie: BSE), or 2. Early Dx improves
prognosis (ie: HIV in people), or 3. The disease is highly lethal or consequences of
missing a case are severe. (ie: Rabies, Brucellosis, BSE, Screw-worm, FMD, EIA)

Remember that a HIGHLY SENSITIVE test will have very FEW false negatives.
That means if a test is highly sensitive, you can TRUST a NEGATIVE TEST. This
sounds contradictory, but it makes more sense if you review this sensitivity diagram.

Sensitivity=a/(a+c). "a" are true positives. "c" are false negatives. If sensitivity is
HIGH then "c" (FALSE negs) must be small. Therefore, high sensitivity means you
can really trust a NEGATIVE result to be correct.
158. 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 leukemia virus

B - Feline calicivirus
C - Feline immunodeficiency virus
D - Feline infectious peritonitis: D

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

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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.

159. Several piglets in a group weaned 10 days ago in the nursery facility of
a large commercial swine operation were found dead. On evaluation, some
weaners have swelling around the eyes and forehead. Some are in lateral
recumbency and dyspneic. Necropsy of the dead piglets reveals
subcutaneous and submucosal edema. The most likely causative organism
is...

A - Brachyspira hyodysenteriae
B - Escherichia coli
C - Lawsonia intracellularis
D - Clostridium septicum
E - Streptococcus suis: B

E. coli causes the characteristic lesions of Edema disease in recently weaned

piglets. Marked swelling of the periocular region, forehead and submandibular
area follow infection. Piglets may die peracutely. Usually only a few piglets in a
group are affected, but affected piglets perish rapidly (within 12 hours). Hemolytic
E. coli that produce F18 pili and Shiga toxin 2e are implicated in edema disease.
To make a definitive diagnosis, E. coli must be first isolated and then
characterized as an edema disease strain (that is, producing F18 pili and Shiga
toxin 2e). The course is so rapid that treatment is ineffective. Antibiotics may be
administered to unaffected pigs in the group.

Brachyspira hyodysenteriae causes Swine dysentery also called bloody scours.

Lawsonia intracellularis causes Porcine proliferative enteritis (diarrhea, often with

fibronecrotic casts).

Clostridium septicum is the agent of Malignant edema in many animals. Infection

occurs through contaminated wounds and turns affected muscle dark brown or
black.

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Streptococcus suis causes septicemia and meningitis in weaners and growing pigs.
160. 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 - ALT, AST, GGT, and total bilirubin levels

B - BUN and creatinine levels
C - Abdominal radiographs to diagnose intestinal obstruction
D - Induce emesis and administer activated charcoal: B

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.
161. Which of these is the most common cause of seizures in the adult ferret?

A - Hepatic encephalopathy
B - Hypocalcemia
C - Hypoglycemia
D - Intracranial neoplasia
E - Idiopathic epilepsy: C

The correct answer is hypoglycemia. Hypoglycemia secondary to insulinoma is the

most common cause of seizures in the adult ferret. Keep in mind, a prolonged
seizure can actually cause hypoglycemia, so the finding of low blood glucose in a
seizuring ferret does not necessarily confirm a diagnosis of insulinoma. Idiopathic
epilepsy has not been reported in ferrets. Hypocalcemia and hepatic
encephalopathy can cause seizures, but are not as commonly reported as
hypoglycemia.

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162. A middle-aged, depressed, coughing, exercise-intolerant Doberman

pinscher is presented. The dog has a rapid and irregular heart rate. What
disease is at the top of the differential diagnosis list?

A - Dilated cardiomyopathy
B - Mitral regurgitation
C - Left-sided congestive heart failure
D - Wolf Parkinson White syndrome
E - Tricuspid insufficiency: A

This is a classic presentation for dilated cardiomyopathy. Prognosis is GUARDED-

with Rx may live 6 mos-2 years. Px especially poor for Dobies.

Rx varies, but foundation includes the "3 D's" -- Diet (Low salt), vasoDilators
(Enalapril), Diuretics (Furosemide), +/- Digoxin (+ inotrope to strengthen
contraction). NOTE that Dobies can be sensitive to digitalis, so may need lower
doses.

So, remember your "DCM D's" : "Depressed Dilated Dobies need Diet, Dilators,
Diuretics (and maybe Digoxin, but overDose is Doom)."
163. A 4-year old female spayed mixed Chihuahua presented to the
emergency service at approximately 5am this morning after presumptively
being attacked by a coyote. The patient has a flail chest and it is questionable
if there is direct communication between the thoracic cavity and the
environment (it was difficult to examine the dog due to her fractious nature).
Exploration of the wound was performed, and once anesthetized, it was
apparent she had a pneumothorax. The patient must be ventilated, as there is
no vacuum present in the chest for lung expansion to occur. What pressure
should the anesthetist not exceed if manually bagging the patient during
anesthesia?

A- 8cm H2O
B - 20cm H2O
C - 12cm H2O

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D - 24cm H2O: B

Pressures above 20cm H20 may result in barotrauma. In an otherwise healthy

patient it is not recommended to exceed this pressure. In patients with chronic
atelectasis, anesthetists will be much more apprehensive about over ventilating or
ventilating the lungs too quickly, as acute expansion can trigger re-expansion
pulmonary edema, which may then lead to acute respiratory distress syndrome and
death.
164. A 3-year old, indoor-only, male castrated Maine Coon cat is presented to
you for acute-onset of hindlimb pain and paresis. Physical examination
reveals a grade III left parasternal heart murmur and minimal movement in the
hind legs. Femoral pulses are bilaterally absent, and the hindlimb toes are
cold to the touch. The cat is tachypenic, but lung sounds are normal. What is
the most likely diagnosis?

A - Thrombus at the aortic bifurcation (saddle thrombus)

B - T3-L3 intervertebral disc disease
C - Chlorpyrifos toxicity
D - Tetanus
E - Lymphoma of the spinal cord: A

Maine Coon cats are predisposed to development of hypertrophic cardiomyopathy

at a young age. Consequently, left atrial enlargement predisposes to atrial thrombus
formation, and these clots frequently lodge in the arterial supply to the hindlimbs.
The trifurcation is where the aorta divides into the two external iliac arteries and the
common origin of the internal iliac arteries. Classic findings due to a clot at the aortic
trifurcation include posterior paresis/paralysis, hindlimb pain, cyanotic nailbeds,
absent femoral pulses, and a firm leg musculature. Other signs of cardiac
disease/failure (murmur or pulmonary edema) are often but not always evident at
presentation.

Neither cord lesions, tetanus, nor toxicities should cause the vascular compromise
evident on this cat's physical exam. 165. A clinic's waiting room has:

A Rottweiler dog with foreleg osteosarcoma

A white mouse with a mammary gland tumor on her belly

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A Norway rat with a mammary gland tumor near her neck

A snot-nosed ferret with a chin rash and crusts around the eyes A
thin boa constrictor that can't right itself from dorsal recumbency

Which one of these animals has the BEST prognosis?

A - Ferret
B - White mouse
C - Norway rat
D - Rottweiler
E - Boa constrictor: C

The rat has the best prognosis.

MAMMARY GLAND TUMORS are typically BENIGN in rats (but MALIGNANT in

mice).

As many as 50% of boid snakes (boas, pythons) harbor the retrovirus which can
cause Inclusion Body Disease (IBD). IBD can cause regurgitation, weight loss and
in later stages neurologic signs, like failure to right itself.

Febrile catarrhal (mucopurulent oculonasal discharge) in a ferret is suggestive of

Canine Distemper (poor Px).
166. A horse is suspected of having the muscle disease rhabdomyolysis,
and you are seeking a laboratory test to help confirm the diagnosis. Of the
following, which test would likely be the most helpful?

A - Ionized phosphate
B - Gamma glutamyl transferase (GGT)
C - Creatine kinase (CK)
D - Anion gap
E - Sorbitol dehydrogenase (SDH): C

CK, also called, CPK, is found in muscle cells and is elevated in the serum when
muscle damage occurs.

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167. A 2-year old heifer is presented who died the night before. She was
stunted compared to her herdmates, and had a 3-week history of poor
appetite, unthriftiness, diarrhea. Necropsy reveals that the abomasum is
edematous and covered in small umbilicated nodules 1-2 mm in diameter
(cobblestone or "Moroccan leather" appearance).

Several other younger cows in this Spring-calving herd look unthrifty and
have diarrhea too. What is the plan of action?

A - Cull the sick cows, Keep horses off same pasture 3 months
B - Deworm cows post-calving, calves by midsummer, all stock in fall
C - Treat affected heifers with Albendazole
D - Treat affected heifers with Ivermectin, repeat in 6 months
E - Treat herd with Amprolium, repeat q 5 weeks: B

Treatment includes deworming cows post-calving, calves by midsummer, all stock

in fall.

An abomasum with a cobblestone or "Moroccan leather" appearance is

pathognomonic for Ostertagia , one of the three stomach worms of cattle. These
worms remain dormant in the gastric glands of the abomasum, emerging in the
spring. Rx is based on regular deworming of whole herd (2-4 times/year).
Ivermectin or high dose Albendazole/Fenbendazole, given repeatedly can help
treat the dormant ("hypobiotic") Ostertagia in the gastric glands.

Amprolium is your treatment of choices for calves and cows with Coccidiosis. 168.
A practice is using an FeLV test with a sensitivity of 90% and a specificity of
95%. Assuming the prevalence of feline leukemia in the area is 5%, what is
the predictive value positive (PVP) of the test?

A - 45%
B - 48%
C - 55%
D - 88%

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E - 90%: It is 48%. The trick with this kind of question is to pick an imaginary number
of animals that you test, like 1000, and fill out your 2x2 table from there. Follow
the links to see diagrams step by step.

If prev is 5% then there must be 50/1000 cats with FeLV and 950 cats that are
disease-free.

A 90% sensitive test will correctly call 45/50 positive (box "a"), and IN-correctly call
5/50 negative, (box "c": these are the false negs).

If 50/1000 animals are infected, then 950/1000 are disease-free. Your 95%
specific test will correctly call 902/950 disease-free (box "d": 0.95 X 950=902) and
IN-correctly call 48/950 positive, (box "b": these are the false pos).

Now your a,b,c,d boxes are all filled, it is easy to calculate PVP
=a/(a+b)=45/(45+48)=48%
169. A 4 year old mare has bilateral swelling and drainage of the mandibular
lymph nodes. Rectal temperature is 101.8F (38.8 C). Which of the following
is the most appropriate plan for this horse?

A - Administer corticosteroids
B - Culture the discharge for bacteria
C - Inform the state veterinarian
D - Administer penicillin: B

The correct answer is to culture the discharge for bacteria. The most likely diagnosis
for this horse is equine strangles. Strangles most commonly affects younger horses
(<5 years of age), but can cause disease in any age horse. The etiologic agent of
this disease is Streptococcus equi subsp. equi. The diagnostic test of choice to
confirm this is bacterial culture. While awaiting culture results, the horse should be
separated from any other horses, as strangles is highly contagious to other horses.
Antibiotic therapy is controversial and thought to lengthen the course of disease
rather than shorten it when given at this stage; also, it may possibly interfere with
the natural immunity acquired from natural infection. This is not a reportable
disease. 170. When performing a subtotal colectomy on a feline patient, what
blood vessel limits the amount of colon that you are able to remove?

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A - Pudendal artery
B - Caudal mesenteric artery
C - Left colic artery
D - Ileocolic artery: D

The correct answer is ileocolic artery. The site for colonic resection is limited by
tension on the ileocolic artery when trying to suture your new end of colon to the
rectum. Sometimes the tension is too great and instead of a colocolic anastomosis,
an ileocolic anastomosis must be performed. Essentially you are trying to connect
a section of ascending colon to the rectum. Now that can be pretty far! Performing
an ileocolic anastomosis is not ideal because you eliminate the ileocecal valve, and
that may predispose the animal to bacterial overgrowth. The caudal mesenteric
artery gives branches to the rectum and descending colon. The left colic artery also
feeds the descending colon. The pudendal artery supplies the external genitalia.
The ileocolic artery provides blood supply to the ascending and transverse colon.
171. Foal heat diarrhea is typically associated with which choice?

A - Hemorrhagic enteritis
B - Neutropenia and fever
C - Decreased suckling
D - Alterations in diet
E - Warm and humid weather: D

Mild, self-limiting diarrhea in a foal 7-14 days of age is called foal heat diarrhea,
because it coincides with the first estrus cycle post-foaling in the dam.

Causes of foal heat diarrhea are poorly understood, but are thought to be related to
a foal's tendency to start sampling hay and grain and practice coprophagy by 5 to 7
days of age, with consequent alterations in bacterial flora.

Foals are active and alert, with a normal appetite and vital signs. Clinical signs such
as fever and lethargy, hematochezia or melena, and laboratory findings such as
neutropenia are not routinely observed.
172. An outbreak of diarrheal disease of piglets has occurred which affected
the healthiest animals in the herd, 1-2 weeks after weaning.

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Some affected piglets had no signs except peracute death. Other affected
piglets exhibit diarrhea, ataxia, paralysis, and recumbency. What condition
is at the top of the differential diagnosis list?

A - Clostridium perfringens type C enteritis

B - Hemagglutinating encephalomyelitis virus (HEV)
C - Porcine proliferative enteritis
D - Epidemic transmissible gastroenteritis (TGE)E - Edema disease: E

Edema disease is caused by Shiga toxin-producing E. coli (STEC). Look for

severe acute illness ranging from peracute death with no signs to CNS
involvement with ataxia, paralysis, and recumbency in healthiest pigs 1-2 weeks
after weaning.

Hemagglutinating encephalomyelitis virus (HEV), is almost exclusive to piglets less

than 4 weeks old. Two clinical presentations: Vomiting and wasting disease (VWD)
and encephalitic.

Clostridium perfringens type C enteritis ,also called enterotoxemia in other animals,

is characterized by a HEMORRHAGIC diarrhea in 1-3 day old piglets.

Porcine proliferative enteritis is principally a diarrheal disease of growing finishing

(40- to 80-lb) pigs and young breeding pigs.

Epidemic transmissible gastroenteritis (TGE) in non-immune pig herds

characterized by HIGH MORBIDITY and HIGH MORTALITY in piglets less than 1
week old. 173. Many turkeys on a poultry farm develop whitish "wart-like"
nodules and scabs on the comb, wattles, feet, and vent. Which management
intervention would help prevent spread of the disease?

A - Add antibiotics to the drinking water

B - Mosquito control
C - Raise the room temperature 5 degrees
D - Immediate removal of fecal waste
E - Thoroughly disinfect pens and equipmentF - Tick control: B

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The condition described here is is the dry form of avian (fowl) pox. This is a relatively
slow spreading disease that can be spread by contact or by mosquitoes that may
harbor infective virus for greater than a month.

In the dry form of the disease, the main sign is raised, whitish wart-like lesions on
unfeathered areas (head, legs, vent, etc.). The lesions heal in about 2 weeks.
Unthriftiness, decreased egg production and retarded growth may be seen.
Mortality is low with this form of the disease. The wet form mainly involves the oral
cavity and upper respiratory tract. Lesions are diphtheritic and can ulcerate or erode
mucous membranes. Marked respiratory involvement can lead to mortality

A diagnosis is usually based on flock history and presence of these lesions. This
is a pox virus and there is no specific effective treatment but there is a vaccine.
Disease control is best accomplished by preventive vaccine as sanitation alone
will not prevent spread of disease. Several vaccines are available and a single
application results in permanent immunity.

There are not many tick borne poultry diseases but they may include spirochaetosis
and Pasteurella infection.

Raising the temperature 5 degrees may be part of the treatment for infectious
bronchitis in chickens. Disinfecting pens +/- quarantine is done for quail bronchitis,
aspergillosis, and ulcerative enteritis. Antibiotics in the drinking water are most
effective for preventing secondary bacterial infections and for mycoplasma but not
preventing spread of the virus.
174. What species is the principle carrier and vector of Malignant Catarrhal
Fever (MCF) virus in North America?

A - Sheep
B - Horse
C - Donkey
D - Bison
E - Cattle: A

MCF virus is ovine herpes virus-2 (OvHV-2) and is carried by 95-99% of sheep in
North America which show no symptoms. It is also carried by 75% of domestic
goats, 40% of muskox, 37% of bighorn sheep, 25% of pronghorn antelope, 62%

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of mouflon sheep, and by a small percentage of elk, mule deer, and white tailed
deer. Susceptible hosts include cattle, water buffalo, deer, pigs, and bison; bison
are the most susceptible.
175. A rabbit is presented with inflamed and chapped membranes of the anus
and genital region. The genital area is scalded and raw, with brownish crusts
and purulent exudate. What two conditions top the differential diagnosis list?

A - Treponematosis, Hutch burn

B - Tularemia, Cystitis
C - Myxomatosis, Moist dermatitis
D - Glomerulonephritis, Coccidiosis
E - Pasteurellosis, Ulcerative pododermatitis: A

Treponematosis (rabbit syphillis, vent disease) and hutch burn (urine burn)
resemble each other and are often confused.

Treponematosis (rabbit syphillis, vent disease) is a venereal disease of rabbits

caused by Treponema paraluis cuniculi. Affects the genitalia, may affect eyes and
nose. Click here to see a rabbit with cutaneous treponematosis.

Hutch burn is caused by wet and dirty floors, affecting the anus and genitalia. Click
here to see a rabbit with hutch burn and here to see severe dermatitis secondary to
hutch burn.

Remember that cauda equina neuritis (polyneuritis equi) in horses may present with
urine scald on the thighs. Other signs include a weak tail, hypotonic anus, urine
dribbling and fecal retention. There may be a history of rubbing or chewing the tail
head.
176. A client calls in the middle of winter to say her furnace went out the night
before and the whole house became very cold. This morning one pet hamster
appears to be dead and several others are lethargic. What message should
be communicated to the owner?

A - The other animals are likely to die

B - The hamster is not dead
C - Put tetracycline in the water and maintain the ambient temperature

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D - Need to examine the lethargic animals and increase calorie intake

E - Males are more likely to die from cold stress: B
The hamster is not dead. At temperatures under 41°F (5°C), hamsters will enter
pseudohibernation. Though not a true hibernation, they are called "permissive
hibernators".

They may look "dead" to the owner, but they are alive. Cold temperatures may also
stimulate hamsters to gather up food.
177. Which of these drugs is a neuromuscular blocker when given to a dog?

A - Atracurium
B - Naloxone
C - Neostigmine
D - Edrophonium
E - Fentanyl: A

The correct answer is atracurium. Atracurium is a non-depolarizing neuromuscular

blocker. Other neuromuscular blockers include pancuronium, d-tubocurarine and
succinylcholine. Succinylcholine is a depolarizing neuromuscular blocker.
Fentanyl is an opioid. Naloxone is an opioid antagonist. Edrophonium and
neostigmine are cholinesterase inhibitors used to reverse neuromuscular
blockers.
178. A dozen young chickens at a broiler-raising facility are found dead on
their backs and sides with no premonitory signs.

Necropsy of a dead bird shows good body condition and no particular

pathology. What is the most likely clinical diagnosis?

A - Ascites syndrome
B - Newcastle
C - Flip over disease
D - Highly pathogenic avian influenza
E - Dissecting aneurysm: C

This is the clinical picture of flip-over disease, a production-related disease

associated with intensive husbandry.
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The cause is not known but thought to be related to high carbohydrate intake.

Ventricular fibrillation may be the cause of sudden death, and a lack of gross
pathology is common.

Because broilers affected with flip over disease frequently die on their backs,
differential diagnosis includes ascites syndrome (waterbelly).

Sick birds with ascites syndrome typically show clinical signs like cyanosis, panting
and abdomens distended by fluid.

Essentially a form of right ventricular heart failure secondary to pulmonary

hypertension or more rarely, hepatic failure.

Dissecting aneurysm is another cause of sudden death, but animals display severe
hemorrhage on necropsy.
179. When a foal is being treated with erythromycin (for Rhodococcus equi
for example), the mare is at risk of developing enterocolitis due to which one
of the following organisms?

A - Escherechia coli
B - Clostridium novyi
C - Lawsonia intracellularis
D - Rhodococcus equi
E - Clostridium difficile: E

A history of recent antimicrobial therapy is common in cases of Clostridium difficile

associated diarrhea.

Adult horses exposed to erythromycin are particularly at risk for C. difficile

enterocolitis.

Clostridium novyi is the cause of infectious necrotic hepatitis, which is primarily seen
in sheep but can also be seen in cattle, hogs, and horses.

Lawsonia intracellularis is the cause of proliferative enteropathy, resulting in

diarrhea and hypoproteinemia in foals and swine.
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Rhodococcus equi is a notable cause of pneumonia in older foals characterized by

pulmonary abscessation as well as some extrapulmonary manifestations.

Escherechia coli can be a cause of septicemia and diarrhea in foals and calves.
180. Atresia coli in the calf is associated with which one of the following
choices?

A - Freemartins
B - Rectal palpation in 1st 42 days of pregnancy
C - History of ketosis/hepatic lipidosis in dam
D - Oral doxycycline
E - Dry matter intake over 20% during dam's peak lactation: B

Vascular damage secondary to amniotic vesicle palpation in the first 6 weeks of

embryonic development can lead to intestinal ischemia and atresia in calves.

Inherited atresias of the intestine are relatively common in large animals. Only 30%
of calves with atresia coli survive to adulthood.

Surgical correction is not recommended in Holstein calves because atresia coli is

probably heritable in this breed.

Click here to see a barium series radiograph of atresia coli in a calf and a necropsy
image from same calf.

Congenital atresia ani, (imperforate anus, seen most in cattle, sheep, pigs) occurs
when the dorsal membrane separating the rectum and anus fails to rupture.

Clinical signs at birth include tenesmus, abdominal pain and distention, retention of
feces, absence of an anal opening.
181. A 1-year old female spayed Doberman Pinscher has presented after being
hit by a car. Initial chest radiographs show mild contusions, and the patient
appears to be otherwise stable. A right mid-shaft long oblique femoral
fracture has been identified. Routine pre-operative blood work is
unremarkable. A buccal mucosal bleeding test (BMBT) is elevated at 6
minutes. What will you administer prior to surgery?

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A - 1,25 dihydrocholecalciferol
B - Desmopressin acetate
C - Vitamin K
D - Whole blood transfusion: B

The correct answer is desmopressin acetate (DDAVP). Administration of

desmopressin results in release of von Willebrand factor, which will help this
patient with clotting. Given this dog's breed and elevated BMBT there is a very
strong likelihood she is afflicted with von Willebrand's disease. In Dobermans this
results in an inability to form a clot. This can be life threatening if the dog is taken
to surgery.

A whole blood transfusion does not provide an adequate source of von Willebrand
factor but may be necessary if the patient's bleeding cannot be controlled despite
appropriate pre-operative measures. 1,25 dihydrocholecalciferol is the active form
of vitamin D which aids intestinal resorption of calcium. The BMBT does not assess
factors 2, 7, 9, or 10 and therefore vitamin K is not indicated.
182. You are presented with a bitch that whelped her first litter 2 weeks ago.
Two of the pups have died and the remaining 2 have neurological signs,
suckle poorly, and cry constantly. Which one of the following choices is the
primary differential diagnosis?

A - Canine herpes virus

B - Canine parvovirus
C - Neonatal septicemia
D - Transplacental roundworm infection
E - Congenital disease: A

Canine herpes virus (CHV) rarely causes disease other than mild respiratory signs
in adult dogs. However, naïve newborn pups have high morbidity and mortality if
infected at less than 3 weeks of age. Naïve bitches should be exposed to CHV prior
to breeding or the bitch and pups quarantined for 3 weeks before and after whelping.
Canine parvovirus in neonates can cause vomiting, diarrhea, or acute death due to
cardiovascular failure in pups 3-8 weeks old.
183. Which one of the following antibiotics is the treatment of choice in the
face of a vibriosis abortion storm?

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A - Tetracycline
B - Aminoglycoside
C - Cephalosporin
D - Fluoroquinolone
E - Chloramphenicol: A

Long acting oxytetracyclines are effective against Campylobacter jejuni and C. fetus
subsp fetus, the organisms that cause vibriosis.

Daily dihydrostreptomycin or penicillin can also be used but is more labor intensive.

Chloramphenicol is prohibited in food animals.

184. Which infectious agent causes the clinical presentation of pigs most
similar to Haemophilus parasuis (Glasser's disease)?

A - Fusobacterium necrophorum
B - Mycoplasma hyosynoviae
C - Streptococcus suis
D - Erysipelothrix rhusiopathiae: C

The correct answer is Streptococcus suis. Streptococcus suis and H. parasuis both
cause polyarthritis, polyserositis, fever, and pneumonia in young piglets up to
several weeks of age. Both can cause fibrinopurulent inflammation as well as
meningitis and convulsions.

Erysipelas and M. hyosynoviae typically occur in grower and finisher pigs and do
not result in pneumonia. Diamond-shaped skin lesions (thus the name "diamond
skin disease") are pathognomonic for Erysipelas. Fusobacterium necrophorum
causes lameness via footrot or laminitis.
185. 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.

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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): C

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.

186. Once infected, for what period of time is canine parvovirus usually shed?

A - 7-10 days
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B - 5-6 months
C - 2-3 months
D - 3-4 weeks: A

The correct answer is 7-10 days. Canine parvovirus mainly affects puppies and
young dogs less than a year of age. Transmission of the virus is through contact
with infected feces and fomites such as hands, toys, the dog's hair coat. The virus
is very resilient in the environment and is resistant to many types of disinfectants.
It replicates in the crypt epithelium of the gut and causes epithelial necrosis and
hemorrhagic diarrhea. The virus can also affect the heart of young puppies,
causing myocarditis. This occurs less commonly now since most bitches are
immunized against the virus, which allows for maternal antibodies to protect
young puppies from this form of the disease.
187. If a mass appears in the lungs on a right lateral radiograph but not on a
left lateral radiograph, where is the mass located?
A - Body wall
B - Left lung
C - Mediastinum
D - Right lung: B

The correct answer is left lung. On a right lateral radiograph, the right side is down.
In this situation, the right lung lobes are compressed and the left lung lobes inflated,
accentuating a mass in the left lung. On a left lateral radiograph, the left lobes are
compressed and a mass in the left lung can be concealed due to compression of
the lung surrounding the mass.
188. Which of the following correctly describes placement of the electrodes
when performing an electrocardiogram on a dog or cat? (note arms = forelegs,
legs = rear legs)

A - White on left arm, black on right arm, red on right leg

B - White on right arm, black on left arm, red on left leg
C - Red on right arm, green on left leg, black on left arm
D - Black on right arm, white on left leg, red on right legE - Red on left leg,
green on right arm, black on left arm: B

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White on right arm, black on left arm, red on left leg.

The electrodes used to record an ECG are always attached the same way. The
white colored wire is attached to right arm, black to the left arm, and red to the left
leg. When 4 are used, the green wire is attached to the right leg.

To record each lead (I, II, III), the ECG monitor automatically compares the electrical
difference between the appropriate locations.

The different leads allow measurement of activity from different angles around the
heart. This is useful for monitoring, as different leads are tried till a good waveform
is found.

The waveforms vary with each lead, abnormal waveforms are seen with cardiac
enlargement.

Click here for excellent summaries on performing and interpreting ECGs, and ECG
lead placement, courtesy of the UPenn CAL site.

189. A 10 year male castrated German Shepherd dog presents for an acute
onset of ptosis, drooping of the lip, and drooping of the cheek all on the left
side. What nerve has been damaged?

A - CN VI
B - CN V
C - CN III
D - CN VII: D

The correct answer is CN VII. This is the facial nerve which is responsible for motor
of the facial muscles as well as sensation in the ear and lacrimation. CN V is mostly
responsible for sensation. CN III is the oculomotor nerve and serves in movement
of the eye. CN VI is also involved in movement of the eye.
190. Failure to control mild endemic respiratory disease in swine caused by
Mycoplasma hyopneumoniae predisposes pigs to complications.

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Exudative bronchopneumonia and polyarthritis are most commonly seen in

herds infected with both Mycoplasma hyopneumoniae and which other
organism?

A - Bordetella bronchiseptica
B - Fusobacterium necrophorum
C - Hemophilus parasuis
D - Pasteurella multocida
E - Swine influenza virus: D

Pasteurella multocida infection in conjunction with Mycoplasma hyopneumoniae

causes exudative bronchopneumonia, polyarthritis, and chronic lung lesions.

Mycoplasma hyopneumoniae, (also called "Enzootic pneumonia") is a common,

smoldering low-level illness.

Stressors (parasites, other infections, even weather) can result in severe

pneumonia.

Best managed by decreasing stressors with improved ventilation and decreased

overcrowding.

In endemic herds, ABX for sick individuals (ie: lincomycin, tylosin, tiamulin, or a
tetracycline) helps control illness, most likely by preventing secondary bacterial
infection (like Pasteurella).

Bacterin vaccines give good protection, decrease signs (coughing).

Pre-farrowing vaccination of sows decreases colonization in suckling piglets. 191.

You have a 6-kg cat that you wish to raise his PCV from 15 to 25%. You plan
to administer packed red blood cells. How many milliliters of packed red
blood cells will this cat need?

A - 15 ml
B - 120 ml
C - 60 ml

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D - 30 ml: C

The correct answer is 60 ml. In order to raise the PCV 1% you will need to give
1ml/kg of packed red blood cells. So it takes 6mls to raise this cat's PCV by 1%. If
we are going to increase it by 10% we will need 60ml of packed red blood cells.
192. Which choice is the pastern joint?

A - Carpometacarpal joint
B - Proximal interphalangeal joint (PI-PII)
C - Distal interphalangeal joint (PII-PIII)
D - Metacarpophalangeal jointE - Intermetacarpal joint: B

The proximal interphalangeal joint (PI-PII) is the pastern.

Clinically important because one of the 3 most important nerve blocks, the foot
block (also called pastern or abaxial sesamoid nerve block (ASNB)) is done just
above the pastern.

Can use a pastern block to make a horse with acute laminitis comfortable.
193. A newborn foal is examined two hours after birth. The foal has a heart
rate of 100 bpm [N=100-120], and a continuous murmur loudest on the left
side. Which one of the following choices is the most likely explanation for
these findings?

A - Incipient septicemia
B - Hypoxic ischemic encephalopathy
C - Foal dysmaturity
D - Normal in a neonatal foal
E - Ventricular septal defect: D

These findings are NORMAL in a neonatal foal.

The heart rate and a finding of a continuous murmur on the left side (due to slight
opening of the ductus arteriosus, which usually closes within 4-5 days) are normal
in newborn foals. Persistent patent ductus arteriosus is rare in horses.

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194. A one-month old foal develops fever, icterus, and diarrhea acutely.
Bloodwork shows hyperfibrinogenemia, hypoglycemia, and elevated liver
enzymes. Which of these conditions is most likely?

A - Clostridium novyi type B

B - Theiler's disease
C - Tyzzer's disease
D - Herpesviral hepatitis: C

The correct answer is Tyzzer's disease. This is the most likely cause because of the
age of the foal and the acute nature of the disease. Tyzzer's disease is caused by
Clostridium piliformis, which causes an acute necrotizing hepatitis. It affects only
foals from about 1-6 weeks of age. Theiler's disease is a condition of adult horses.
Clostridium novyi is rare in horses and seen much more in sheep and cattle.
Herpesvirus can cause hepatitis but is usually seen at or very soon after birth.
195. A large male guinea pig from a group of four is presented with swollen
and scabby hind feet from which Staphylococcus aureus is cultured. Which
one of the following recommendations is the most appropriate choice?

A - Isolate affected animal, treat with oral amoxicillin

B - Improve sanitation, install smooth-floored enclosure
C - Cull affected animal, increase ventilation of environment for remaining
animals
D - Tetracycline-medicated water for all animals
E - Debridement and topical 1% butenafine cream: B

The preferred answer is to improve sanitation and install a smooth-floored

enclosure. Bumblefoot (pododermatitis) in guinea pigs usually occurs secondary
to poor sanitation, obesity and wire cage floors or rough bedding.

If detected early, switch to smooth-bottom flooring, keep the enclosure clean, and
change to a softer bedding. Chlorhexidine soaks and debridement can help the feet.
Prognosis is guarded.

Avoid penicillins in guinea pigs.

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196. A 6-month old cat presents for having ptyalism and for being
underweight. On physical examination, you note a bright copper color to the
cat's iris bilaterally. What is this suggestive of?

A - Toxoplasmosis
B - Portal systemic shunt
C - Hemolytic anemia
D - Polycystic kidney disease: B

The correct answer is a portal-systemic shunt. Ptyalism is a sign commonly seen

with PSS in cats but not dogs, and the copper-colored iris is a striking and almost
pathognomonic finding in conjunction with other clinical findings. Hemolytic
anemia could cause icterus but not the change in iris color. Animals with
polycystic kidney disease would not have a copper-colored iris. Toxoplasma can
cause ocular signs such as uveitis but would not have a copper iris.
197. Which one of the following choices is the most appropriate next step
after a 3-year old stray cat tests positive for Feline Immunodeficiency Virus
(FIV) on a routine FIV ELISA screening test?

A - Recheck serum by FIV complement fixation test

B - Do a Rivalta test to rule out feline coronavirus-related interference
C - Pull a blood sample for FeLV Antigen test
D - Pull a blood sample for a Western blot FIV testE - Euthanize: D

Pull a blood sample for a Western Blot FIV test. The feline immunodeficiency virus
(FIV) ELISA is the standard first-step screening test to detect if the cat has been
exposed to the FIV virus and has circulating antibody.

A confirmatory Western blot antibody test for FIV is the standard confirmatory test.
A Western blot test is especially important in areas with low FIV prevalence, where
the risk of false positive FIV ELISA is higher. Remember that cats vaccinated for
FIV will test positive for FIV antibodies by FIV ELISA and Western blot.

Kittens up to 6 months of age born to seropositive queens can also be seropositive,

even though they are not infected, due to persistence of maternal antibodies.
Seropositive kittens should be retested at greater than 6 months of age.

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This is DIFFERENT from feline leukemia virus (FeLV) testing because the FeLV
ELISA and IFA tests measure ANTIGEN, not antibody, so FeLV vaccination does
NOT interfere with testing.
198. Which of these are used in the minor cross match for blood products
when looking for a compatible blood donor for a dog?

A - Recipient red blood cells, recipient plasma

B - Recipient red blood cells, donor plasma
C - Donor red blood cells, donor plasma
D - Donor red blood cells, recipient plasma: B

The correct answer is recipient red blood cells, donor plasma. In a minor
crossmatch, you are looking to see if the factors in the plasma of the donor are
going to react to the recipient's red blood cells.
199. A dog is presented with the following findings.

Blood Gas
PCO2 venous=28.3 mm Hg....[N=35-44], pH=7.27..[N=7.31-7.53]
PO2 arterial=85.2 mm Hg....[N=85-95] HCO3-=13.9 mEq/l..[N=25-35]

Blood chemistry
Na=136.2 mEq/L.................[N=146-156], Cl=91.3 mEq/L..[N=109-122]
Ca=9.1 mEq/L.....................[N=9.6-11.6], K=3.5 mEq/L..[N=3.8-5.6]
P=9.3 mEq/L.......................[N=2.5-6.2], TCO2=14.2 mEq/L..[N=17-27]
ALT=331 U/L...................[N=8.2-57], LDH=354 U/L..[N=24-219]
AST=14 U/L....................[N=13-15], SDH=6 U/L..[N=3.1-7.6]
GGT=20 U/L....................[N=1.0-9.7], Bilirubin (total)=0.3 mg/dl....[N=0.0-0.4]
Alk Phos=1018 U/L..........[N=1-114 U/L]
BUN=28 mg/dL (10 mmol/L)..........[Normal: 7.0-26 mg/dl (2.5- 9.29 mmol/L)]
Glucose=150 mg/dl or 8.3 mmol/L.........[N 63-132 g/dl or 3.5-7.3 mmol/L]

What is the anion gap?

A - 28.1
B - 34.5

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C - 28.3
D - 31.2
E - 42.2: D

34.5
Anion gap= (Positives)-(Negatives) = (Na+ and K+) -(Cl- and HCO3-).
If you did not do a blood gas analysis, then substitute TCO2 for HCO3-, and the AG
value is about the same, (34.2 in this case).

Anion Gap (AG) = [136.2 (Na+) + (3.5(K+)] - [91.3 (Cl-) + 13.9(HCO3-)] AG=
[139.7 cations] - [105.2 anions]=34.5 anion gap

Typically see increased anion gap with:

Diabetic ketoacidosis
Renal insufficiency
Ethylene glycol toxicity
Lactic acidosis from grain overload or strenuous exercise

Decreased anion gap is UNcommon. Think hemodilution, hypoalbuminemia,

hypercalcemia.
200. It is your first day on the job and your boss says there is a dog in room
two with Horner's syndrome. Which four signs correctly constitute Horner's
syndrome?

A - Sweating ipsilaterally, Exopthalmia, Sunken nictitans, Mydriasis

B - Dry eye ipsilateral, Miosis, Sunken nictitans, Exopthalmos
C - Proptosed nictitans, Lip deviated ipsilaterally, Miosis, Anhidrosis
D - Protruding nictitans, Bupthalmia, Ptosis, Mydriasis
E - Miosis, Protruding nictitans, Enopthalmos, Ptosis: E

Remember "My 3rd Sunken Toe"

(Miosis, 3rd lid protrudes, Sunken eye, Ptosis) and "sweaty horses".

A syndrome, not a disease per se. Can see 4 things with Horner's, ALL associated
with the eye:
1. MIOSIS (constricted pupil-lose sympathetic innervation)

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2. PROTRUSION 3rd eyelid (nictitans)

3. ENOPHTHALMOS (sunken eye)

4. PTOSIS (drooped eyelid), +/- anisocoria

Anhidrosis (dry, decreased sweating ipsilaterally) occurs in all animals EXCEPT

horse, but difficult to observe. PARADOXICALLY, Horses can show profuse
sweating ipsilaterally due to loss of peripheral vasoconstriction.
201. Which of these nerve blocks is used to examine the eyes of a horse?

A - Trigeminal nerve block

B - Corneal nerve block
C - Auriculopalpebral nerve block
D - Oculomotor nerve block: C

The correct answer is auriculopalpebral nerve block. Blocking this branch of

cranial nerve VII (facial nerve) disrupts the motor innervation to the orbicularis
oculi, which is the muscle that closes the eye. In the horse, this muscle is very
strong and can prevent a thorough ocular exam. To perform this block, lidocaine is
injected subcutaneously at the caudal aspect of the zygomatic arch where the
nerve is palpable. Because this is a motor nerve, the eye will not be able to close
as well, but there is no anesthesia of the tissue.
202. A 9 year old female spayed Brittany is presented with a 1 week history of
apparent disorientation and bumping into things around the house. The
owners report recent weight gain, increased appetite, increased water-
drinking and frequent urinary accidents.

The dog is obese but otherwise appears healthy and afebrile. The pupils are
dilated and poorly responsive to light. The ocular fundus appears normal
OU (both eyes).

In addition to routine labwork (CBC, biochemistry panel, urinalysis) what

other diagnostic test should be considered?

A - Genetic testing for rod-cone photoreceptor dysplasia

B - ACTH stimulation

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C - Serum, urine ornithine concentration

D - Gradual water deprivation test
E - Tonometry: B

ACTH stimulation. Sudden-onset blindness in an older dog with normal fundi

suggests Sudden Acquired Retinal Degeneration (SARD).

Typically, SARD is associated with metabolic abnormalities-PU/PD, polyphagia,

obesity and hyperadrenocorticism. An ACTH stimulation test (or an LDDS) can help
you determine if the dog has hyperadrenocorticism and SARD.

SARD and progressive retinal atrophy (PRA) are often categorized together as
forms of retinal degeneration.
203. Histopathology findings show intestinal crypt necrosis and lymphoid
depletion of Peyer's patches. The sample came from a 4 month old male
Rottweiler puppy that died following a severe illness with vomiting, fever and
neutropenia. Which one of the following choices is the most likely diagnosis?

A - Enterotoxigenic E. coli
B - Thymic hypoplasia
C - Distemper
D - Parvovirus
E - Canine adenovirus-1: D

Parvovirus. Expect to see intestinal crypt necrosis, lymphoid depletion of Peyer's

patches, shortened, blunt villi and collapse of the lamina propria with canine
parvovirus. Puppies with parvo are severely neutropenic and lymphopenic which
may help you remember that feline panleukopenia is ALSO caused by a
parvovirus.

Think of canine distemper with intracytoplasmic eosinophilic inclusion bodies,

catarrhal enteritis and mucopurulent oculonasal discharge.

Canine adenovirus-1 is the causative organism of infectious canine hepatitis.

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NOTE: If you hear of necrotic Peyer's patches from necropsy of a cow with severe
diarrhea, stomatitis and fever think of the foreign disease, rinderpest. In 2011, the
United Nations Food and Agriculture Organization (FAO) and the World
Organisation for Animal Health (OIE) officially declared that rinderpest was
eradicated globally. But because it is a classic, severe, reportable, stomatitis-type
disease, it's unlikely that vets will be allowed to forget rinderpest on DDXs for years.
204. A 10-year old male castrated cat that you have previously diagnosed with
hyperthyroidism presents to you for acute onset of blindness. You perform
an ophthalmic exam and note retinal hemorrhage. What diagnostic test
should you perform first?
A - Coagulation times
B - Free T4 levels by equilibrium dialysis
C - Serum BUN and creatinine
D - Blood pressure
E - Total T4 levels: D

The correct answer is blood pressure. Cats with hyperthyroidism are likely to
develop hypertension. If this is severe enough (>180-200 mmHg systolic), they can
be at risk for acute retinal detachment or hemorrhage resulting in blindness. Prompt
resolution of the hypertension is critical to prevent further damage to the eye and
other organs.
205. Which parasite can cause cutaneous larva migrans in people?

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

Hookworms (Ancylostoma spp.) may cause cutaneous larva migrans in people.

Note that Roundworms (Toxocara spp., Toxasacaris spp.) are also zoonotic,
causing visceral and ocular larva migrans in people.

In dogs, Whipworms, Trichuris spp. are associated with a hypoadrenocorticism-

like syndrome (hyponatremia, hyperkalemia, azotemia, metabolic acidosis).

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Whipworm infection has been suggested as one cause of cecocolic

intussusception.

Habronema spp. in horses can cause tumorlike stomach nodules and sometimes
cutaneous lesions.

Trichostrongylus spp. cause parasitic gastritis and enteritis in sheep, goats, and
cattle.
206. Which choice is associated with osteosarcoma and hypertrophic
osteopathy?

A - Spirocerca lupi
B - CoccidioidomycosisC - Habronema spp.
D - Blastomycosis
E - Ollulanus tricuspis: A

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.
207. Which description correctly matches gonitis?

A - Inflammation of the mesorchium, parietal tunic and testicle

B - Avulsion of the extensor process of the third phalanx
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C - Inflammation of the stifle leading to degenerative joint disease

D - Infection of the crop and sinuses with Trichomonas gallinae
E - Progressive unilateral or bilateral wide-angle glaucoma: C

Gonitis is an inflammation of the stifle leading to degenerative joint disease. In

cases of glaucoma you might use gonioscopy to classify the glaucoma, detect
iridocorneal outflow changes as the disease progresses and help determine the
most appropriate medical and surgical treatments.

Infection of the crop and sinuses with Trichomonas gallinae is trichomonosis, a

protozoal disease of birds.
208. A 6-year old female spayed English Pointer presents for lethargy and
weight gain. The owner notes that the dog is eating and drinking a normal
amount, but the dog is still gaining weight. A physical exam reveals weak
pelvic limbs, facial nerve paralysis, a symmetrically patchy haircoat, and
seborrhea. Lab work reveals a normocytic, normochromic anemia with a
PCV of 29% (35-57%), lipemic serum, and cholesterol of 1090 mg/dl (135-278
mg/dl). What is the most likely diagnosis?

A - Hyperthyroidism
B - Adrenal dependent hyperadrenocorticism
C - Hypothyroidism
D - Pituitary dependent hyperadrenocorticism: C

The correct answer is hypothyroidism. The clinical signs, physical exam findings,
and lab work abnormalities are classical for hypothyroidism. Other common
abnormalities seen with hypothyroidism include pyoderma, neuromuscular signs
(ataxia, knuckling, vestibular signs, etc), markedly elevated triglycerides, and a mild
normocytic, normochromic anemia.

Hyperthyroidism rarely occurs in dogs.

You would expect to see polyuria, polydipsia, and polyphagia with

hyperadrenocorticism.
209. Hyperadrenocorticism is suspected in a 9-year old female spayed dog
with a two-month history of increased appetite, thirst and urinary accidents.

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Which of the following diagnostic test is most reliable when results are
positive?

Urine Cortisol Creatinine Ratio (UCCR). Sensitivity=90% , Specificity =25%

ACTH Stimulation. Sensitivity=80% , Specificity =85%
Low Dose Dexamethasone Suppression. Sensitivity=95% , Specificity =50%

A - Low Dose Dexamethasone Suppression (LDDS)

B - ACTH Stimulation
C - Urine Cortisol Creatinine Ratio
D - Cannot say without knowing the positive predictive value
E - Cannot say without knowing the negative predictive value: B

ACTH Stimulation. The two diagnostic screening tests used most commonly for
diagnosis of hyperadrenocorticism are the ACTH stimulation test and the LDDS.
Remember your Ps and Ns.

ACTH Stim is the most sPecific (fewer false Pos, so trust a POS test more). LDDS
is more seNsitive (fewer false Negs, so trust NEG test more).

Either way, these 2 tests are useful to screen for Cushing's, but a confirmatory test
is usually required if you get a positive, to differentiate between a pituitary HAC or
an adrenal HAC case [high-dose dexamethasone suppression test (HDDST) or
ACTH concentration].

The Urine Cortisol Creatinine Ratio (UCCR) has a low specificity (~25%), which
means high false positives. 75% of dogs with non-adrenal illness will have a
UCCR result consistent with HAC.

So, a positive UCCR is not useful to identify HAC, however, a negative is very useful
to rule-out HAC as dogs with a normal UCCR cannot have HAC.
210. You are visiting a small "back-yard" flock of chickens and examining
the animals. You find several small gray-red mites (approx 0.7 mm) on
several of the chickens which you recognize as Dermanyssus gallinae and
Ornithonyssus sylviarum. How are these mites best controlled?

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A - Ornithonyssus sylviarum is controlled primarily by thorough

insecticidal treatment of the environment and Dermanyssus gallinae must
be controlled by application of approved pesticides to affected birds
B - Dermanyssus gallinae is controlled primarily by thorough insecticidal
treatment of the environment and Ornithonyssus sylviarum must be
controlled by application of approved pesticides to affected birds
C - Control of both Ornithonyssus sylviarum and Dermanyssus gallinae
relies on application of approved pesticides to affected birds
D - Control of both Dermanyssus gallinae and Ornithonyssus sylviarum
relies on thorough insecticidal treatment of the environment: B

Dermanyssus gallinae (the common red mite) maintains the majority of the
population in the environment so it is important to monitor and treat the environment
including the cracks and crevices where mites tend to reside. Ornithonyssus
sylviarum mites (northern fowl mites) spend their entire life cycle on the bird. This
allows them to multiply more rapidly and makes it essential to treat the birds
themselves to control the problem.
211. Which one of the following choices is the mechanism of action of
omeprazole?

A - Cyclooxygenase blocker
B - Beta-adrenergic receptor agonist
C - Synthetic prostaglandin E1 analog
D - H2-receptor antagonist
E - Proton pump inhibitor: E

Omeprazole is a proton pump inhibitor that decreases gastric acid secretion.

Omeprazole inhibits the sodium/potassium proton pump at the luminal surface of
parietal cells. Parietal cells normally secrete hydrogen ions into the stomach, a
key component of acidic HCL.

Other drugs that decrease gastric acid secretion include the H2-receptor
antagonists cimetidine, ranitidine, and famotidine and a synthetic prostaglandin E1
analog called Misoprostol.

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Carprofen, Etodolac, Deracoxib, Meloxicam and Firocoxib are all nonsteroidal anti-
inflammatory drugs (NSAIDS) that may CAUSE gastric acid secretion.
212. Which of these is an adrenergic vasopressor in dogs?

A - Dopamine
B - Hydralazine
C - Atropine
D - Glycopyrrolate: A

The correct answer is dopamine. Adrenergic vasopressors are frequently used to

treat hypotension during anesthesia. Drugs in this category are dopamine,
dobutamine, ephedrine, phenylephrine, and norepinephrine. Atropine and
glycopyrrolate are anticholinergic drugs. Hydralazine is a vasodilator used to treat
hypertension. 213. Several litters of 2 to 3 day old pigs have recently died
rapidly with hemorrhagic enteritis. Post mortem lesions include mucosal
hemorrhage, necrosis and emphysema in the small intestines. What pathogen
is most likely to cause these signs?

A - Haemophilus parasuis
B - Clostridium perfringens type C
C - Salmonella choleraesuis
D - Erysipelothrix rhusiopathiae
E - Enterotoxigenic E. coli: B

The age of these affected pigs along with the rapid course of hemorrhagic and
necrotic enteritis help you come to this conclusion. As with many Clostridial
diseases, vaccination is the most effective means of control. Other important
clostridial diseases of swine include C. perfringens type A, C. difficile, C. tetani, C.
botulinum, C. novyi, C. septicum, and C. chauvoei.
214. What condition is associated with rectal stricture in pigs?

A - Rotavirus
B - Intestinal spirochetosis
C - Salmonella typhimurium
D - Intussusception
E - Coccidiosis: C
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Salmonella typhimurium is associated with rectal strictures in growing pigs. Caused

by an ulcerative proctitis that damages rectal tissue. Can see large numbers of
cases. Can see sporadic rectal strictures as a sequelae to rectal prolapse.

Intestinal spirochetosis is a post-weaning diarrhea seen in the ABSENCE of

Brachyspira (Serpulina) hyodysenteriae (swine dysentery), but similar in
presentation to it. This syndrome is being recognized more frequently worldwide.
215. A 5-year old Arabian mare expels the placenta 2 hours after foaling. On
examination, it appears that the placenta has passed "inside out", with the
allantoic side of the allantochorion exposed. What is the correct
interpretation?

A - Normal finding
B - Sign of placental insufficiency
C - Suggests premature placental separation
D - Do not rebreed this mare
E - Foal at risk for peripartum asphyxia: A

It is normal for a horse to expel the placenta "inside out", with the allantoic side of
the allantochorion exposed. Following parturition, the placenta should be expelled
within 3 hours, or it is considered retained in the horse.
216. Which choice is permitted for use in food animals?

A - Diethylstilbesterol
B - Chloramphenicol
C - Dexamethasone
D - Estradiol cypionate
E - Furazolidone: C
Dexamethasone is allowed in food animals, but may cause abortion in pregnant
animals. Typically, use dexamethasone in cattle to induce parturition (20-30 mg, IM,
given within 2 wk of normal term).

Diethylstilbesterol (DES) is banned for use in food producing animals and should
never be used.

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Chloramphenicol has been associated with bone marrow suppression/aplastic

anemia in exposed humans, and is contraindicated in food-animals.

According to a 2006 report from the Food and Drug Administration (FDA) the use of
Estradiol cypionate (ECP) in animals is illegal. ECP has been used as an estrogenic
hormone for reproductive therapy in food animals, but even extra-label, this is not
allowed.

Furazolidone a nitrofuran, is not allowed in food animals.

217. Which two diseases would be on a differential diagnosis list for equine
urinary incontinence?

A - Cauda equina neuritis, herpesvirus myeloencephalopathy

B - Equine degenerative myelopathy, botulism
C - Nigropallidal encephalomalacia, locoweed poisoning
D - Bracken fern toxicity, equine encephalomyelitis
E - Tetanus, West Nile virus encephalopathy: A

Horses with cauda equina neuritis (also called polyneuritis equi) have a progressive
symmetric LMN paresis of the tail, bladder, rectum, anal sphincter. Look for urinary
incontinence, fecal retention, and a weak or paralyzed tail. May see hind limb
paresis if lumbosacral spinal cord is affected.

Cranial nerves can also be affected, but typically cranial involvement is asymmetric.
May see temporal or masseter atrophy (cranial nerve 5), facial paralysis, and
exposure keratitis (cranial nerve 7), head tilt, or other CNS signs. Cause is
unknown, may be an autoimmune process. Grave prognosis. Eventually
euthanized.

Herpesvirus myeloencephalopathy (EHV-1) may also present with urinary

incontinence, but this is a relatively uncommon manifestation of equine
rhinopneumonitis. You would expect to hear a history of the more common EHV
signs in other horses from the same farm, like respiratory disease ("snots") in
foals and abortions in mares.

Bracken fern toxicity (Pteridium aquilinum) causes thiamine deficiency in

monogastrics (like horses) and bone marrow depletion, aplastic anemia, and
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bladder tumors in ruminants. In horses, look for signs of anorexia, weight loss,
incoordination, and a crouching stance with feet placed wide apart. Horses may
have trembling muscles when forced to move.
218. What is the most common neoplasia seen in the equine stomach?

A - Mesothelioma
B - Lymphosarcoma
C - Gastric adenocarcinoma
D - Squamous cell carcinoma: D

The correct answer is squamous cell carcinoma.

219. What is the average length of estrus in the cat?

A - 2-3 days
B - 4-5 days
C - 9-10 days
D - 6-7 days
E - 21 days: D

Cats are seasonally polyestrous and induced ovulators. The length of feline estrus
is affected by whether a male is present. If a male is present, estrus typically lasts
1-4 days. Without a male, estrus lasts 7-10 days and recurs in 2-3 weeks.

Unlike dogs, the feline estrus cycle is controlled by day length. In North America,
cats go through an anestrus period in December and January when day length is
less than 12 hours.
220. A 4-year-old Thoroughbred mare is presented with a sudden onset of
profuse, watery diarrhea and marked depression.

The mare has been treated intermittently with phenylbutazone over the last 2
months for minor lameness and was recently transported to the racetrack by
trailer for 9 hours.

On physical exam the horse is dehydrated, with a slow capillary refill time,
purplish mucous membranes, and cold extremities.

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No gastric reflux is present. No distention or displacement of bowel is found

with rectal exam, but the rectal wall feels thickened.

T=97.0 F (37.8 C)..[N 99-101.3 F, N=37.2-38.5 C]

HR=92 bpm.............[N 28-40 bpm]
RR=50 brpm............[N 10-14 brpm]
PCV=70%................[N 32-53%]
Total protein 4.0 g/dl .......[N 5.8 - 7.5 g/dl]

The horse dies 3 hours later. On necropsy the walls of the cecum, large colon,
and rectum are edematous and hemorrhagic; intestinal contents are primarily
serosanguinous fluid.

Which one of the following choices is the most likely cause of death in this
mare?

A - Non-steroidal anti-inflammatory toxicity

B - Parascaris equorum infestation
C - Sand enteropathy
D - Granulomatous enteritis
E - Colitis X: E

This is the clinical picture of colitis X, a lethal diarrheal disease of horses with an
acute to peracute-onset.

The specific cause is unknown, but infectious and toxic etiologies are most likely.
Anaphylaxis also produces similar intestinal lesions. Look for signs of shock,
peracute severe diarrhea and a packed red cell volume (PCV) above 65%, and
sudden death. Some cases may die before diarrhea is seen. The cause is unknown
but stress (like transport) or surgery often precedes disease. This is a diagnosis of
exclusion.

If other potential causes of peracute diarrhea such as Salmonellosis, Potomac

horse fever (PHF), Clostridial enterocolitis, cantharidin toxicity, etc., are ruled out,
you are left with Colitis X.

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This is not likely to be NSAID-associated right dorsal colitis due to the distribution
of lesions seen at necropsy and the minimal amount of NSAIDs the horse had
received (and not recently).
221. Which one of the following ectoparasites normally spends its entire life
cycle on the chicken, causing feather damage, anemia and irritation?

A - Neocnemidocoptes gallinae
B - Dermanyssus gallinae
C - Northern fowl mite
D - Trombicula alfreddugesi
E - Red chicken mite: C

The Northern fowl mite (Ornithonyssus sylviarum) is the only poultry mite that
normally spends its entire life cycle on the host. O. sylviarum is the most
important parasite of caged layers and breeding chickens in the U.S.. Click here
to see northern fowl mites on a hen.

MOST chicken mites are nocturnal feeders that are only on the birds at night.
They hide during the day away from the chicken, under manure and in crevices of
the chicken house, where they lay eggs.
222. Which of these drugs has the greatest potential for causing acute renal
failure in the horse?

A - Oxytetracycline
B - Xylazine
C - Dexamethasone
D - Neomycin
E - Diphenhydramine: D

The correct answer is neomycin. Aminoglycosides are one of the most common
causes of renal tubular nephrosis and acute renal failure. Of the aminoglycosides,
neomycin is probably the most nephrotoxic, followed by gentamicin, amikacin, and
streptomycin. The other big class of nephrotoxic drugs is non-steroidal anti-
inflammatory drugs.
223. A 4 month old calf from a small beef herd presents with a fracture of the
right metatarsus. He was normal last night. The owner found the calf this

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morning after rounding up the herd for deworming. This is the 5th calf this
season with fractured bones. One had a vertebral fracture, two calves had
humeral fractures, and one other had a cannon bone fracture. Which one of
the following choices is the most likely problem in this herd?

A - Low dietary copper

B - High dietary phosphorus
C - Hypovitaminosis D
D - Low dietary protein
E - High dietary calcium: A

Low dietary copper levels (Cu) causes bones of growing animals to be brittle
because they do not develop the normal trabecular structure. Higher fracture rates
are seen in Cu deficient than in Cu replete animals. Pathologic fractures are more
common during periods of exertion, such as the morning round up. Rough
handling exacerbates the number of fractures. Treatment of Cu deficiency
includes copper glycinate injections, and feeding of mineral mixes with Cu.
Copper boluses can also be given.

In areas with high levels of molybdenum (Mb) in the soil, Cu levels are often low.
Mb interferes with absorption of Cu, hence Mb excess results in Cu deficiency.
Pathologic fractures can be seen with hypovitaminosis D growing cattle, but this is
unlikely in animals on pasture.

Calcium deficient calves may also develop a similar syndrome of pathologic

fractures.
224. Which one of the following choices is a major clinical complication of
equine pituitary pars intermedia dysfunction?

A - Dyshormonogenetic goiter
B - Circling, Head-pressing
C - Diabetes insipidus
D - Colic
E - Laminitis: E

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The major clinical complication of pituitary pars intermedia dysfunction (PPID,

hyperadrenocorticism) is laminitis

Laminitis affects more than 50% of the horses with PPID.

225. Which one of the following hormones can induce neoplastic
transformation of hypertrophied mammary tissue in cats?

A - Progesterone
B - Estrogen
C - Oxytocin
D - Testosterone
E - Prolactin: A

Exogenous progesterone administration can lead to neoplastic transformation of

mammary hyperplasia in intact or neutered male or female cats.

Patients undergoing progesterone therapy that develop mammary hyperplasia

should have the enlarged mammary gland(s) removed and submitted for histology
in addition to the cessation of progesterone therapy.
226. A 1.5-year old Quarter Horse gelding is presented to you for symmetric
ataxia, weakness, and spasticity of all limbs, but worse in the hind limbs.
When walking, the horse frequently drags his toes and the hind limbs
frequently interfere with one another. Based on the signalment, history and
physical examination findings, which of the following is the most likely cause
of these clinical signs?

A - Equine Protozoal Myeloencephalitis (EPM)

B - Equine Motor Neuron Disease (EMND)
C - Botulism
D - Equine Degenerative Myeloencephalopathy (EDM)
E - Cauda Equina Syndrome: D

The horse in this question has clinical signs most consistent with EDM; cervical
vertebral malformation (wobblers) is also a possibility, but was not provided as an
answer. The cause of EDM is unknown, but this disease typically affects young

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horses (< 2-3 years of age; but older horses can develop disease). Clinical signs
are a result of diffuse neuronal fiber degeneration of various portions of the central
nervous system. This disease has been associated with low serum vitamin E
concentrations, suggesting that oxidative damage may play a role in the
development of disease.

EMND is typically associated with muscle tremors, shifting of weight while standing,
muscle atrophy and recumbency. Botulism is associated with generalized muscle
weakness. Cauda equina syndrome causes analgesia of the perineum. EPM can
cause a range of clinical signs, but is typically with asymmetric neurologic deficits.
227. A litter of one day old kittens presents with anemia, icterus, and tail tip
necrosis. Which one of the following choices is the most likely differential
diagnosis?

A - Liver disease
B - Neonatal isoerythrolysis
C - Neonatal septicemia
D - Pyruvate kinase deficiency
E - Hemobartonella felis infection: B

Neonatal isoerythrolysis (NI) is a disease of newborns born with a blood type

different from that of the dam. NI is more common in kittens with blood type A or AB
born to type B queens, as anti-A antibodies occur naturally without prior exposure
in type B cats.

Nursing kittens ingest anti-A antibodies in the colostrum produced by the queen.

Hemolysis leads to hemoglobinuria, icterus, and anemia; weakness, gasping, tail

tip necrosis, and eventually death is seen within 48 hours.

Certain purebred breeds have a higher incidence of type B blood type than the
general population.
228. Suzie-Q, a 6-month old female spayed domestic short hair was recently
adopted from the humane society. She has had watery diarrhea since
adoption. Her fecal float and Giardia ELISA tests were negative. She was
treated with metronidazole with no clinical improvement. You soak a cotton

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tip swab with saline and swab the rectum. You see elongated motile oval
shaped protozoan organisms that do not look like Giardia lamblia. What
organism might this be and what is the appropriate therapy?

A - Paragonimus kellicotti, Praziquantel

B - Tritrichomonas foetus, Ronidazole
C - Taenia taeniaformis, Praziquantel
D - Cryptosporidium, Clindamycin
E - Enterobius vermicularis, Fenbendazole
F - Giardia intestinalis, Fenbendazole: B

Tritrichomonas foetus is a flagellated parasite most commonly found in kittens that

have had an unresponsive diarrhea. The parasite can be very difficult to diagnose.
It is most often responsive to Ronidazole.

Paragonimus is a lung fluke. The eggs are typically passed in the feces.
Fenbendazole and Praziquantel have been effective against this parasite.

Giardia is unlikely if the ELISA is negative as it is a very sensitive test.

Taenia is a tapeworm and is not a flagellated parasite. It is treated with Praziquantel.

Cryptosporidium is a coccidian that invades the small intestinal villi after ingestion
of infected oocysts. It can be diagnosed with PCR. It is treated with clindamycin,
azithromycin, or tylosin most commonly. It is usually an opportunist, so evaluation
for underlying disease is appropriate.

Enterobius vermicularis, or pinworm, is a parasite of people and primates but not

cats and dogs.
229. You are examining a 13-year old Standardbred brood mare 5 hours after
parturition. You note that the placenta is still present in the reproductive
tract of the mare (see image). What is the most appropriate therapy?

A - Do nothing; the placenta is not considered retained until 12 hours post-

par-turition and it will likely be expelled by this time
B - Administer oxytocin (IM or IV) and lavage the uterus to facilitate removal

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C - Administer penicillin (IM) until the placenta is expelled on its own

D - Place physical traction on the placenta and remove it manually: B

Most texts state that the placenta in a mare is retained after greater than 3 hours
post-parturition; therefore, this would be considered a retained placenta. Oxytocin,
along with uterine lavage, will cause the uterus to contract and facilitate expulsion
of the placenta. Strong physical traction on the retained placenta is generally
considered contraindicated, as you may tear the placenta and leave remnants of it
within the uterus, resulting in possible complications. Broad-spectrum antimicrobials
are often administered to decrease the incidence of metritis but alone would not be
appropriate.
230. Which one of the following management recommendations is most
helpful to reduce the incidence of mare reproductive loss syndrome?

A - Cut down all the black walnut trees on premises

B - Vaccinate mares and stallions against equine coital exanthema
C - Remove the horses from affected pastures
D - Progesterone supplementation between 4-6 months of pregnancy
E - Spray paddocks to kill Habronema muscae larvae: C

Removal of mares from affected pastures is necessary for control of mare

reproductive loss syndrome (MRLS).

The exact pathogenesis of MRLS is still unknown, however, it is associated with

exposure to/ingestion of "hirsute" or hairy catepillars.

The eastern tent caterpillar was associated with the first outbreak in Kentucky in
2001-2 where over 3000 pregnant mares aborted.

Other episodes have been seen in Florida (2005) and Australia (2007) with
exposure to other animals of hirsute catepillars.

The most current theory - damage to the oral mucosa or intestinal lining by the
setae (spines) of the catepillars introduces bacteria that causes bacteremia and
subsequent infection of the fetus and/or placenta.
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Early embryonic loss, abortion, stillbirths, weak foals, and infected foals are seen.
Swollen umbilical cords are also often seen in aborted fetuses.

Feeding hay and removal of wild cherry trees, a major food source for the
caterpillars, is also beneficial in reducing the incidence of MRLS abortion.
231. You are called out to examine a 4-year old dromedary who was
castrated 10-days ago and is now not eating. The groin and prepucial area is
extremely swollen. The camel is unable to stand and is drooling. His neck is
extended and he appears to be unable to swallow. Which of the following is
most likely responsible for these symptoms?

A - Trypanosoma evansi
B - Clostridium tetani
C - Methicillin-resistant Staphylococcus aureusD - Rabies virus: B

This camel is showing signs of tetanus. The organism was likely introduced into the
body through the castration wound. It is recommended that camels are vaccinated
against tetanus prior to castration.

While rabies may cause paralysis of the tongue and difficulty swallowing, the recent
history of castration in this camel makes tetanus most likely.

Trypanosoma evansi is transmitted via biting flies and causes a slow wasting
disease in camels.
232. A herd of 12 multiparous broodmares housed on a 25 acre pasture in
the southeastern United States are having reproductive problems. Of the
three mares that have foaled so far this year, none have produced milk.
Another mare is now 12 months in foal and has no udder development.
Which one of the following choices is the most likely diagnosis?

A - Mastitis
B - Malnutrition
C - Placentitis
D - Fescue toxicity
E - Retained placentas: D

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Ingestion of fescue grass contaminated with the endophyte fungus Acremonium

coenophialum causes agalactia, thickened placentas, and prolonged pregnancy in
mares by suppressing prolactin release. Toxicity is most significant in the last 90
days of gestation. Mares should be removed from fescue pastures (and not fed
fescue hay) for the last 90 days of gestation to reduce the incidence of fescue-
associated problems. Treatment with domperidone can help affected mares
produce milk.

Mares with malnutrition are more likely to abort than carry a pregnancy over term.
233. What kind of organism causes equine granulocytic ehrlichiosis?

A - Spirochete
B - Anaplasma
C - Ehrlichia
D - Protozoa
E - Chlamydia: B

This is a tricky question to help you remember that two diseases FORMERLY
classified as ehrlichia have now been re-classified.

The causative organism of Equine granulocytic ehrlichiosis (EGE) was originally

classified as Ehrlichia equi, but is now called ANAPLASMA phagocytophilum due
to DNA sequencing studies. Do not confuse EGE, a necrotizing vasculitis in HORSE
with BOVINE anaplasmosis, primarily an anemia, with icterus, fever.

Another name change occurred with the causative organism of Potomac Horse
Fever (PHF), from Ehrlichia risticii to NEOrickettsia risticii. PHF presents as a febrile
colitis/diarrhea, with laminitis 3-5 d after diarrhea in horses of all ages: A big rule out
is salmonella (think septicemia/fever+ diarrhea).
234. A dog presents with acute onset vomiting, hemorrhagic diarrhea and
fever. On fecal examination, you find many large fluke eggs. You question
the owner and discover that the dog was recently in Oregon on a boating
trip. What agent is most likely causing the clinical signs in this dog?

A - Neorickettsia helminthoeca
B - Nanophyetus salmincola

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C - Oxytrema silicula
D - Rickettsia rickettsii: A

The correct answer is Neorickettsia helminthoeca. This rickettsial organism is the

causative agent of salmon poisoning. It is carried in the fluke, Nanophyetus
salmincola, which requires the snail, Oxytrema silicula in its life cycle. The snail is
what confines occurrence of salmon poisoning to the northwest coast. 235. 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 yearsE - 5-6 years: D

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. 236.
Closure of the eyes is mediated by cranial nerve ____ and opening the eyes
is mediated by CN ____.

A - VII, V
B - V, VII
C - III, VII
D - VII, III
E - V, III: D

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The answer is VII, III. Closure of the eyes is performed by the orbicularis oculi
muscle innervated by the facial nerve. Opening of the eye is by the levator
palpebrae superioris innervated by the oculomotor nerve. The trigeminal nerve
supplies sensory innervation to the eye.
237. An obese 6 year-old neutered male Pomeranian presents with a 2-year
history of intermittent dry, honking cough. This morning he started retching.
The dog never boards in a kennel and has not traveled recently.

On physical exam, a cough can be elicited by pressing on the trachea. A heart

murmur is noted, loudest on the left at the 5th-6th intercostal space. The rest
of the exam was unremarkable.

What diagnosis is at the top of the differential list?

Value Normal
T=102.2 F (39 C) N=99.5-102.5 F, N=37.2-39.2 C
HR=120 bpm N=60-120
RR=80 brpm N=15-34
CRT=2 sec N= less than 2 sec MM=pink

A - Congestive heart disease

B - Tracheal collapse
C - Chronic bronchitis
D - Tracheobronchitis
E - Tracheal obstruction: B
When you hear a "HONKING COUGH" and heart murmur in a fat little dog that
coughs after touching his tracheal area, think tracheal collapse. Toy/Min. breeds
(Pomeranians, Toy poodle, Min. poodle, Yorkies) are predisposed.

Mitral valve insufficiency / dysplasia murmurs are often detected concurrently.

Intermittent hx and lack of fever suggest a chronic, non-infectious cause.

For definitive diagnosis do thoracic radiographs, bronchoscopy.

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