Clinical Medicine and Surgery Finals, Exams of General Surgery

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Clinical Medicine and Surgery Finals What are the 5 types of wormer in ruminants? - Group 1 (white) - Benzimidazoles Group 2 (yellow) - levamizoles Group 3 (grey) - macrocyclic lactones Group 4 (orange) - amino derivatives Group 5 (purple) - spiroidoles Which group of wormers has the most resistance? - Benzimidazoles (group 1 white wormers) Which parasites can you use forecasting for? - Nematodirus batted and Fasciola hepatica Draw/Describe the nematodirus life cycle - Draw/Describe the fasciola hepatica life cycle - Draw/Describe the haemonchus life cycle - Draw/Describe the trichostrongylus life cycle - Draw/Describe the cyathostomin life cycle - What is the difference between a direct and indirect insurance claim - Direct = practice paid directly, owner pays only excess (more common, increases practice debt) Indirect = owner pays the practice and then claims the money back, excess deducted from claim amount What is the difference between maximum benefit, time limited, lifetime, and accident only insurance? - maximum benefit covers each new medical condition up to a pre-agreed monetary value, cheap time limited - claim can be made for each medical condition for a period of time from the start of the claim, cheap Lifetime covers pet for entire life if renewed every year, always covered but expensive accident only covers fees for injuries or accidents up to agreed amount, cheap, doesn't cover medical conditions Under new 'Under Care' guidance, when is a physical exam needed - possible notifiable disease prescribing controlled drugs prescribing antimicrobials Describe the 5 stages of the drug cascade - 1. authorised for target sp/condition 2. authorised for different sp/condition 3. human meds authorised in UK or VM authorised outside UK 4. med prepared by vet/pharmacist/manufacturer if no drug available 5. human medicine outside UK Describe the pathophysiology for OA - shift in cartilage anabolism and catabolism causing degeneration of articular cartilage remodelling of subchondral bone, synovitis, decreased viscosity and nutritional value, fibrosis of capsule, nociceptive and inflammatory pain pathway Describe diagnostic techniques for OA - radiography cytopathology (arthrocentesis) arthroscopy (gold standard) histo 4 principles of herd health - food security animal health and welfare environmental management antimicrobial resistance 6 key areas of herd health management - lameness and welfare nutrition mastitis and milk quality infectious diseases youngstock repro and genetics BOAS anaesthesia problem list - airway - sedation, induction, recovery, intubation regurgitation/aspiration corneal sensitivity hypoventilation/hypoxaemia Difference between BOAS pre-med for painful and non-painful surgery - painful: pethidine or methadone non-painful: butorphanol or buprenorphine Justify sedative choice for BOAS anaesthesia - want a short acting and antagonisable drug Justify tx of glucose derangements - hypoglycaemia - 5% dextrose of hypertonic glucose hyperglycaemia - over 16mmol/l, glucose free solutions and insulin IV Justify anaesthetic drugs in patient with diabetes mellitus - not alpha 2 agonists or glucocorticoids available drugs - ACP, opioids, propofol, alfaxalone, inhalation agents, nitrous oxide Anaesthetic considerations in cat with hyperthyroidism - euthyroid or hyperthyroid increased oxygen demand and carbon dioxide production tachycardia, arrhythmias, hypertrophy - demand hypoxia organ failure and weight loss common - esp. renal post-op hypocalcaemia Hyperthyroid pre-op evaluation - hx cardiac failure - beta blockers, diltiazepam, diuretics, oxygen CBC and biochem - renal/hepatic arterial blood gas/pulse oximetry tx - euthyroid 2w before surgery Justify anaesthetic drug choice in hyperthyroid cat - If euthyroid can follow normal anaesthetic drug selecion if hyperthyroid avoid increased sympathetic stimulation e.g. ket or arrhythmogenic drugs or those which increase cardiac workload e.g. atropine ACP - anti-arrhythmic, but decreases after load (prob. HCM) isoflurane + midazolam +/- low dose alpha 2 agonist protocol: ACP/Midazolam + vagomimetic opioid (methadone) +/- low dose alpha 2 Justify induction agent choice for hyperthyroid cat - propofol and alfaxalone ok not ketamine (sympathetic) or inhaled agent (slow and stressful) Risks of lidocaine in cats, are there alternatives - convulsions and methaemoglobinaemia alternatively propranolol or esmolol Clinical signs, diagnosis and treatment of iatrogenic hypoparathyroidism - muscle tremors, tetany, restlessness, seizures monitor blood Ca for 48hr emergency Ca therapy - 10mg/kg IV calcium gluconate, for recurring signs infuse 1mg/kg/hr Anaesthetic considerations canine hypothyroidism - reduced cardiac performance - bradycardia, low contractility, low vol distribution thermoregulation anaemia - oxygen delivery obesity drug metabolism muscle wastage associated conditions - DM, Addisons, megaoesophagus Pre-anaesthetic medication in hypothyroid dog - positive chronotropic opioid - Pethidine IM not ACP - long sedation, vasodilation, hypothermia anticholinergics e.g. atropine IV useful for intra-op bradycardia What extra precautions should be taken with induction agents in canine hypothyroid dogs - prolonged circulation time and reduced volume of distribution - care with doses and wait for effect Clinical signs and differentials for hyperkalaemia - renal failure addisons iatrogenic blocked cat urinary trauma/bladder rupture v+/d+, weakness, PUPD, bradycardia Tx of hyperkalaemia - IVFT - electrolytes, dehydration, low BP calcium gluconate protect against cardiotoxicity insulin and glucose shifts K from extracellular to intracellular compartment sodium bicarb - metabolic acidosis, shifts K from extracellular to intracellular compartment albuterol - inhalation, K from extracellular to intracellular compartment KPI pre-weaning mortality piglets - 10% Piglet management - heat lamps/mats colostrum (sow vaccination, 250ml/piglet) umbilicus supplement glucose drying hygiene Sow vaccination pre-service - erysipelas, parvo, lepto to protect pregnancy Sow vaccination pre-farrowing - E.coli, clostridia to protect piglets Piglet vaccination at weaning - mycoplasma hypopneumoniae, PCV2, PRRS Piglet vaccination post weaning - lawsonia Infectious dz affecting piglets - First 24hr - necrotic enteritis From 24hr - enteric coliobacillosis 4 to 21 days - cocci at weaning - strep suis, glasserella parasuis, c.dificile, c.perfringens type A Piglet presenting with jejunal haemorrhage, profuse dark red d+ and mortality in the first 12-24hr - Necrotic Enteritis Clostridium perfringens type C (dx intestine contents toxin ELISA, gross and history path, beta toxin) Necrotic Enteritis vaccination piglets - sow 3w pre farrowing gilt 6 + 3w pre farrowing Piglet presenting with watery/creamy yellow d+, wasting, dehydration and mortality - Enteric Coliobacillosis E.coli dx E.coli culture, virulence factor Enteric Coliobacillosis vaccination piglets - Sow 3w pre farrowing gilt 6 + 3w post farrowing Piglet presenting with swollen joints, temperature, tremors, sudden death and bacteraemia - Joint ill Strep suis type 1 dx bacterial culture (brain, joints, heart blood) serotyping Tx for acute outbreak of Strep suis type 1 in piglets 7 days pre-weaning - whole litter penicillin Iron deficiency anaemia prophylaxis in piglets - pale piglets up to 28d old <90g/L = anaemic tx iron injection 10d old piglet presenting with yellow pasty d+ - Cocci Isospora suis 7-11d dx clinical signs, oocysts in faeces tx toltrazuril Pig presenting with gait abnormalities, recumbency, extended neck, convulsions and blindness - TPR HR (nb. buscopan causes tachycardia) pulse peripheral skin temp mm (inc. CRT) skin turgor PCV hyper/hypomotility caecal flush tympany sand Do large horse require a lower or higher frequency ultrasound for adequate penetration - lower FLASH technique for colic horses - paralumner fossa/flank region ICS (5th-17th) ventrum FLASH fast localised abdominal sonography of the horse 7 topographical locations 1. ventral abdomen (small intestine, bladder, colon + caecum 3-4mm) 2. gastric window (ventral to lung, splenic vein, SI loops, 10-15 ICS LHS, gastric distension) 3. splenorenal window (LHS, L kidney deep to spleen 15-17 ICS, hyper echoic relative to liver and kidney, nephrosplenic entrapment) 4. left middle third of abdomen 5. duodenal window (R kidney 14-17 ICS, descending duodenum ventral to R kidney, deep to R liver lobe 11-17 ICS) 6. right middle third of abdomen 7. thoracic window Rectal exam LD - spleen - cd edge nephrosplenic lig nephrosplenic space L kidney - cd pole aorta roof of mesentery Rectal exam RD and RV - distended duodenum maybe ventral and medial Tania of caecum inguinal ring - herniation stallion Rectal exam LV - pelvic flexure L dorsal colon small colon - faecal balls inguinal ring bladder repro tract Gold standard dx for abdomen horses - ex lap A colic horse has increased TP, RBC and degenerate neutrophils in peritoneal fluid sample, how can this affect tx choice - surgery indicated Neoplasia associated with colic in horses - lymphoma ovarian tumour Post-op surgical colic care - Within 48hr - pain, ischaemic bowel, ischaemic/reperfusion injury, leakage at enterotomy/anastomosis, ileum, recurrent displacement Within 2-7d - obstruction at anastomosis, delayed adaptation at anastomosis, leakage, peritonitis, ileum, large colon impaction, gastric ulcers Over 7d - adhesions, recurrence Post op surgical complications colic - incisional infection - c+s, drain + lavage, broad spec abx, abdominal bandage/hernia belt, pain, oedema incisional herniation - hernia belt, abdominal bandage, box rest, herniorrhaphy thrombophlebitis - catheter removal, c+s, abx, US monitoring, can become septic Differentials for GI dz in small animals - cardiac dz - v+, abdominal distension hepatic and pancreatic dz - v+, d+, abdominal pain/distension urogenital dz - v+, abdominal pain splenic dz - abdominal pain/distension endocrine - v+, d+ musculoskeletal - abdominal pain GI dz dx tests SA - radiography (plain, contrast) A-FAST peritoneal fluid tap haematology + biochem Haematology and biochemistry in dog with GI dz - rule out other causes dehydration - inc HCT and TP, azotaemia upper GI obstruction - metabolic alkalosis due to loss of H, K and Cl infectious dz - WBCC Compare and contrast antiemetics available in dogs and cats with GI dz - contraindicated where obstruction present maropitant - neurokinin 1 receptor antagonist, centrally mediated, effective against emetogens, v+ ondansetron - serotonin receptor antagonist, central and peripheral, v+ and nausea, off licence metoclopramide - dopamine receptor antagonist, serotonin receptor antagonist at higher dose, dogs, pro kinetic, contraindicated if obstructed Compare and contrast gastroprotectants available in dogs and cats with GI dz - H2 receptor antagonist - twice daily, decreased gastric acid, increase GI motility Proton pump inhibitor (omeprazole) - decrease gastric acid production, more effective than H2 Sucralfate - binds to ulcer site, barrier protecting from further erosion, stem bicarb and PGE, binding of epidermal growth factor, best Abx in severe v+/d+ - amox/clav: peri-op entering GI tract, first choice for hemorrhagic d+, risk of sepsis, Parvo metronidazole: hemorrhagic d+, GI anti-inflammatory, Giardia, Clostridia spp. Dog presenting with choking, increased salivation and regurgitation, what is your top ddx and dx tests - Oesophageal obstruction radiographs oesophagoscopy Radiograph shows an oesophageal obstruction in a dog, what are the tx options - endoscopic gastronomy (lower risk) thoracotomy (higher risk) end to end anastomosis sucralfate NSAID/opioid (dec stricture risk) +/- abx (amax/clav) soft diet feeding tube - severe damage Aim of GDV surgery - 1. identify + remove damage/necrotic areas of stomach/spleen > partial/complete resection 2. correct stomach position > clockwise common 3. adhere stomach to body wall > incisional and belt loop gastropexy Summarise dx anad tx of intestinal and gastric FB - dx - radiographs, ultrasound, endoscopy Initial investigation of small animals with PUO - haematology and biochemistry FeLV and FIV SNAP urinalysis radiographs abdominal ultrasound faecal analysis Tx for cat bite abscess - release pus and flush with sterile saline O to bathe wound in saline/chlorhexidine meloxicam opioid if dehydrated fluids (sc bolus or IVFT) abx Cat presents with peritoneal effusion with non-regenerative anaemia and lymphopenia, and hyperglobulinaemia and hyperbilirubinaemia, what is your top differential - wet feline infectious peritonitis You suspect a cat has feline infectious peritonitis, what are your dx and tx options - High titres FCoV serology and PCR (not diagnostic) gold = immunostaining FCoV antigen within macrophages in effusions or tissues and histo changes consistent with FIP tx = steroids How can you reach a definitive diagnosis in cats suspected of having toxo gondii infection - tachyzoites in tissue biopsies or cytology immunohistochemistry or immunofluorescence on histo samples First line tx for toxoplasma gondii - clindamycin BID for 4 weeks supportive therapy: fluids, appetite stimulants, topical glucocorticoid if ocular inflammation) A dog has been found in a car and you suspect heat stroke, what are common clinical signs - continuous panting +/- cyanotic mm hypersalivation stiffness collapse A young dog presents with neck pain but no other neurological deficits, you do haematology and biochemistry, showing leucocytosis with left shift and C reactive protein, what dx test should you do next, what is your top differential, how would you tx this? - Steroid responsive meningitis arteritis CSF cytology is most important dx test, acute phase pleocytosis, non-degenerated neutrophilic granulocytes, increased proteins, negative microbiological culture, chronic phase lymphohistiocytic cells (lymphocytes and macrophages) Could do MRI to rule out other dz tx: prednisolone first line, prednisolone in combination with azathioprine second line, NSAID in mild cases (wash out before swapping drug) A dog presents with altered gait, lameness and swollen and painful joints. It is also pyrexic and has had intermittent bouts of v+ and d+, what is your top differential? How would you tx this? - Immune mediated polyarthritis (ddx based on arthroscopy of at least three joints + baseline tests) tx = prednisolone first line, prednisolone and azathioprine second line, opioid analgesia whilst waiting for test results (must culture before starting steroids as septic arthritis is main differential which steroids would make worse) Describe the pathogenesis of a pyometra - 1. oestrogen stimulation of uterus, followed by periods of progesterone influence 2. endometrial proliferation, uterine glandular secretions, cervical closure and decreased myometrial contractions 3. cystic endometrial hyperplasia/endometrial hyperplasia 4. secondary invasion with bacteria (E.coli) 5. neutrophilic inflammation, accumulation of pus within uterus +/- septic shock, polyuria Risk of using Alazin in entire bitches - Risk factor for pyo Explain the difference between open and closed pyometra - open = pus drains out of cervix, may consider medical management if mild/unsuitable candidate for GA closed = pus trapped in uterus, higher risk of rupture and sepsis, always surgical, emergency An entire bitch presents with signs of pyometra, what would you expect on haematology, biochemistry and cytology? - increased PCV, TP, pre-renal azotaemia leukocytosis/leukopenia non-regenerative anaemia cytology - neutrophils and bacteria Diagnostic tests confirm a bitch has an open pyometra, she is older and GA may be a significant risk, what are your options for medical management of a pyometra? - fluids abx (amox/clav) prostaglandin (aglepristone or cloprostenol or cabergoline) aglepristone (PG receptor antagonist, relaxes cervix, expels pus, licensed for inducing abortion, 3 doses at day 1, 2 and 7) or cloprostenol (PGF2a, combination with aglepristone, off license in dogs, luterolysis and uterine contraction) or cabergoline (dopamine agonist, open cervix in closed pyo) Which breed is predisposed to uterine inertia (failure to contract with normal strength/duration) - Golden Retriever Justify the use of medical management or surgery to tx dystocia - medical: bitch in good condition, max 4 puppies, no prolonged labour, no obstruction, Ca (increase contraction strength, IV bolus or SC, risk of granuloma if SC, repeat in 6-8 hours) and oxytocin (increased frequency) surgical: more than 4 puppies, obstructive, medical already tried and failed, pre-op IVFT, ovariohysterectomy at same time? O wants to know when is best to spay their guinea pig as they previously had a male guinea pig who they spayed at 5m as soon as testicles had dropped but are unsure about females - before 6-8m, closure of pelvic symphysis Possible infectious causes of orchitis or epididymitis in a rabbit - P. multocida, T. cuniculi, myxomatosis Compare medical management and surgical management of orchitis/epididymitis in a well rabbit - surgical: castration medical: abx (TMPS first line, baytril second line), NSAID (meloxicam) What is the most likely cause of a uterine prolapse in a ewe immediately after lambing compared to 12 to 48 hours after lambing? - immediately: prolonged second stage labour, delivery of large singleton lamb 12-48hr: straining caused by pain from infection and swelling of vagina and vulva A ewe has a uterine prolapse, what will you use as pain relief? - epidural - 1ml/50kg procaine meloxicam licensed under cattle but not sheep 1ml/20kg SC ketoprofen, carprofen, flunixin licensed in cattle used under cascade You administer a ewe with a uterine prolapse procaine epidural, meloxicam analgesic and amoxicillin antibiotic, what is the consequence of using these drugs? - Withdrawal periods in food producing animals: procaine: 0 days meat/milk meloxicam: 7d milk/28d meat amoxicillin: not for use in sheep producing milk for human consumption, 10d meat What analgesic classes are available for food producing species? - local - procaine +/- adrenaline NSAIDs - meloxicam, carprofen, ketoprofen, flunixin opioids - ket, butorphanol steroids NB. withdrawal times Compare appropriate analgesia for a calf with a fractured leg, a cow with low grade mastitis, and a cow that has fallen and is due to go to slaughter in 4 days - calf - xylazine as long lasting mastitis - ketoprofen or carprofen have no milk withhold injury and slaughter - ketoprofen 1 day meat withdrawal IV or 4 day meat withdrawal IM A down cow presents with a raised temperature, firm and painful right hind quadrant of udder, watery thin milk, tachycardia and d+. What is your tx? - lactate electrolytes (critical to address potassium) A blocked cat is dehydrated and presents with shock, what is your first line management? - 10ml/kg bolus of crystalloid over 15-20m What does hyperkalaemia look like on ECG? - increased T waves decreased P waves bradycardia A blocked cat presents with hyperkalaemia, how can you correct this before proceeding with other tx? - fluid therapy - improve GFR and potassium excretion 5-20% glucose - insulin mediated potassium translocation insulin - translocates potassium into cells 10% calcium glutinate - reduced risk of arrhythmia sodium bicarbonate - alkalinising leading to intracellular movement of potassium terbutaline - translocates potassium into cells Following decompressive cystocentesis what urinalysis should be performed - dipstick sediment preparation - crystalluria and casts culture and sensitivity Which radiographic views should be taken of a blocked cat; which areas should be assessed? - RL and VD kidneys, ureters, bladder, urethra Name 2 types of urinary catheter used in cats - slipper sam tom cat catheter mila catheter Risks of post-obstructive diuresis in cats - hypokalaemia - must monitor during hospitalisation decrease fluid rate by 25% every 8-12hr to reduce fluid overload Why is diazepam unsuitable as an analgesic in blocked cats? - Hepatotoxic Detrusor Atony - prolonged bladder over distension damage to myocyte tight junctions resulting in absent ability to contract bladder not attempting to urinate after catheter removed despite full bladder leaking due to overflow bethanecol PO (promote urination and emptying bladder) Main cause of ureteroliths - calcium oxalate When is surgical management indicated in the case of ureteral obstruction? What is first choice for surgery? - marked azotaemia oliguria/anuria hyperkalaemia progressive renal pelvic dilation subcutaneous ureteral bypass device A dog presents with tachypnoea, decreased exercise tolerance, decreased appetite, lethargy, weight loss and abdominal distension. You suspect congestive heart failure. What are your dx tests and tx? - TFAST/POCUS (LA:Ao >1.5 = enlarged, b lines = consolidation in pulmonary alveoli) thoracocentesis furosemide ocygen butorphanol blood pressure biochemistry radiographs tx = furosemide (loop diuretic, risk AKI with too high dose) or pimobendan You perform a TFAST and pericardiocentesis and diagnose a dog with pericardial effusion. What are your tx options? - NOT furosemide - do not want to decrease circulating volume, makes effusion worse Management of aortic thromboembolism - tx for 72hr methadone (bup inadequate) not NSAID concurrent heart dz - furosemide clopidogrel, aspirin, or rivaroxaban tissue plasminogen activator low molecular weight heparin (anti-clotting) Define ventricular tachycardia - 4 or more ventricular premature complexes >160-180bpm beat originates abnormally in ventricle, cell to cell conduction, slower depolarisation, wide and bizarre beats Treatment for ventricular tachycardia - lidocaine bolus IV (care re cats neurotoxicity) electrolytes - potassium stall amiodarone electrical cardio version Difference between tx options for second and third degree AV block - chronotropic drugs - terbutaline, theophylline, propanthelline work for second degree AV block but third degree won't respond third degree AV block needs pacemaker Why is a cough most likely indicative of upper respiratory tract disease? - Cough receptors are in the trachea, pharynx and carina of trachea, they are absent beyond the bronchioles Westie's are susceptible to which lower respiratory disease - pulmonary fibrosis Does position influence respiratory pattern? - sometimes: orthopnoea - dyspnoea in any positing other than standing or erect sitting, usually due to bilateral pulmonary oedema trepopnoea - dyspnoea in one lateral recumbency but not the other, unilateral lung or pleural disease or unilateral airway obstruction Differentials for moist crackles, dry crackles and wheezes - most crackles - CHF, inspiratory, respiratory distress dry crackles - acute/chronic, acute respiratory distress syndrome wheezes - narrowing of airways, mostly expiration Describe the steps or a lower respiratory tract disease investigation - hx - coughing, distress? clinical exam haematology + biochemistry - inc eosinophils, inflammatory markers, pro-BNP, blood gas imaging - thoracic radiograph, fluoroscopy, CT, ultrasound, scintigraphy, MRI tracheal wash/bronchoscopy lung FNA/biopsies When may a horizontal radiograph be justified? - Patient is too dyspneic to be recumbent, aids with fluid and free gas identification, but radiation safety issues Which dx tests can be performed with BAL fluid? - direct and cytospin smear EDTA (cytology and PCR) plain (culture) When is bronchoscopy contraindicated? - hyper-responsive airways - allergies, wheezing suggests airway spasm unstable cardiac failure/arrhythmias tracheal obstruction haemorrhage - risk with pulmonary hypertension, uraemia, coagulopathies, neoplasia/gross lesions List tx options for lower airway dz in small animals - inhaled medications: corticosteroids, bronchodilators, nebulisers A 7 year old West Highland Terrier presents chronic progressive breathlessness, exercise intolerance, cyanosis and syncope. Upon clinical exam there are crackles throughout the lung field. What dx tests will you carry out next? - thoracic radiographs bronchoscopy (BAL) lung biopsy (only method of definitive dx) A 7 year old West Highland Terrier presents chronic progressive breathlessness, exercise intolerance, cyanosis and syncope. Upon clinical exam there are crackles throughout the lung field. What dx tests will you carry out next? You were able to do thoracic radiographs and a bronchoscopy. The radiographs showed a generalised interstitial lung pattern and R sided cardiomegaly. The BAL sample had low cellularity and no indications of an inflammatory process. What is your top differential? - interstitial pulmonary fibrosis You have diagnosed a 7 year old West Highland Terrier with interstitial pulmonary fibrosis. What tx options are available? - avoid collars, harness only bronchodilators corticosteroids anti-fibrotics pimobendan abx if needed? Dx test options for angiostrongylus vasorum in small animals - SNAP (high sensitivity and specificity) PCR - BAL/pharngeal swabs modified baermann flotation - pooled faecal sample over 3 days Management options for angiostrongylus vasorum in small animals - licensed: advocate, prinovox spot on (imidacloprid and moxidectin) milquantel, milbemax, milbactor (milbemycin oxime anad praziquantel) PO, 4 times at weekly intervals unlicensed: fenbendazole (low dose re risk of acute massive worm death), levamisole and ivermectin A cat presents with chronic feline asthma (cough, dyspnoea, expiratory wheeze). What are your ongoing tx options? - immediate: minimise stress oxygen IV steroids bronchodilators if in severe distress - adrenaline IV/ETT long term: salbutamol (1 puff bid, effective within 5m, lasts 4hr) fluticasone (2 puffs bid, long term inflammation, no systemic effects, 10-14d for peak effect) keep away from env allergens bronchodilators - terbutaline PO prednisolone 5mg/cat sid, taper dose When is CSF analysis indicated? - suspected inflammatory CNS disease: meningitis, meaning-myelitis, meaning-encephalitis Name 2 sites for CSF collection - cisterna magna lumbar When is CSF collection contraindicated? - raised intracranial pressure chiari-like malformation occipital dysplasia coagulopathy A dog is presenting with near signs, when is imaging indicated? - fracture/subluxation infectious neoplasm congenital anomaly pros and cons of myelography - pros: cost, visualisation from C1-L7, dynamic studies cons: risks, technically difficult (contrast agent injected into cistern magna or L5-7), limited information Compare the use of MRI or CT - CT - soft tissue and bone, nonionic iodinated contrast (renal, allergic reaction), quick, X-ray exposure, GA needed, trauma patients, tympanic bull, IVDD, spinal malformations, surgical planning, MRI can't be used (metal in body) MRI - better for soft tissue detail, long duration, anaesthesia, expensive, IV paramagnetic agent (gadolinium), brain, spinal cord, peripheral n. Pregnancy toxaemia is common in rabbits and guinea pigs, what are predisposing factors and the risk period? - obesity large litters last 2 weeks of gestation and first 2 weeks postpartum dx and tx of pregnancy toxaemia in NTCAs - history, cs, urinalysis (glucosuria, ketonuria, proteinuria) IV or IO isotonic fluids and dextrose (correct hypoglycaemia) oral glucose syringe feeding - high card diet e.g. emeraid emergency c section (risky) Compare serous and follicular cysts in guinea pigs - serous: incidental finding, not responsive to hormonal therapy, tx by percutaneous drainage/ovariohysterectomy (risk re recurrence) follicular: disrupt hormone cycle > non-pruritic alopecia, hormone responsive (GnRH agonist gonadorelin SC 2 dose 14d apart), hCG (anaphylaxis risk), ovariohysterectomy = curative (GnRH to shrink first) In which NTCAs are uterine tumours most common? - rabbits - uterine adenocarcinoma hedgehogs 4 methods of hyperoestrogenism tx in jills who are not brought out of oestrus and supportive care - surgical neutering (hyperadrenocorticism risk) deslorelin implant progesterone injection mating (vasectomised hob) supportive care: blood transfusion PCV <15%, steroids and iron dextrin for RBC production, abx if secondary infection Most common mammary tumours in small mammals - rats - fibroadenoma (hormonal influence - prolactin and oestrogen) mice - mammary adenocarcinoma trauma, ulceration, necrosis, infection surgical excision recurrence common, tx with cabergoline (reduce prolactin) Why are rabbits and rodents commonly affected by testicular trauma? - wide inguinal canal 2 common causes of dystocia in exotic pet birds - hypocalcaemia narrow pelvic canal Management of exotic pet birds with dystocia - warmth oral fluids +/- glucose injectable calcium gluconate PGE2 (prostaglandin) gel into cloaca GA and manual removal (warm water and KY gel to aid passage, break down adhesions with fingers, ovocentesis and collapsing the egg, post-op analgesia meloxicam + butorphanol) resp compromise > IPPV +/- abx (TMPS, amox/clav, doxycycline) Which species is most commonly affected by chronic egg laying? - cockatiels What pathological changes are associated with chronic egg laying? - calcium and protein depletion bone resorption and pathological fractures Avian Bornavirus (radiographs, RT-PCR, histopath crop biopsy with myenteric ganglioneuritis lesions) Emergency management of seizing NTCAs - warmth oxygen fluids +/- glucose Ca (IV, avoid aspiration) benzodiazepines (diazepam or midazolam IV or IM) A ferret presents with hypoglycaemia, what are your dx and tx options? - likely insulinoma (pancreatic b cell) tx with glucose whilst establishing cause dx: US, histopath, clinical signs and blood plasma glucose that respond to glucose administration tx: surgery, diazoxide (reduces insulin secretion, unlicensed), corticosteroid (increase hepatic gluconeogenesis, decrease glycogenolysis, side effects common) A nine week old turkey presents with Marek's disease on PM, what will the lesions look like? - pale white nodules in lungs, spleen, gall bladder, heart and liver A duck presents with ascending flaccid paralysis, it has been brought in by a concerned member of public who picked it up near a stagnant pond this afternoon, it is very warm outside. What is your top ddx and tx? - botulism remove source of toxin, supportive care, euthanasia (respiratory/cardiac symptoms) When is emesis indicated and contra-indicated for decontamination of toxins? - indicated: solid toxins stay in the stomach longer than liquids and powders contraindicated: non-toxic/low toxicity substance/dose, already vomited, caustic/corrosive agents, volatile agent (high risk of aspiration), respiratory distress, acid-base/electrolyte derangements A dog consumed a significant volume of dark chocolate about 45 minutes ago, you decide to induce emesis as first line tx. What drugs can you use? - apomorphine (licensed in dogs) xylazine (preferred option in cats, not licensed) How can charcoal be used in toxicity cases? - binds to toxins to prevent absorption What does ethylene glycol toxicity look like on urinalysis? - calcium oxalate crystals The allium family consists of onions, how do they cause toxicity? - organosulphoxides cause oxidative damage to erythrocytes, causing Heinz body anaemia Which anti-parasiticides are toxic to which species? - pyrethroids - cats, snakes (near) fipronil - rabbits (neuro) ivermectin - Chelonia (flaccid paralysis) Mechanism of toxicity in lilies - necrosis of renal tubular epithelial cells Mechanism of toxicity in chocolate - theobromine CNS stimulation calcium reuptake > cardiac and skeletal muscle contractility Mechanism of toxicity in ethylene glycol - Alcohol dehydrogenase > toxic metabolites > renal damage and hypocalcaemia Mechanism of toxicity in herbicides and fertilisers - renal and hepatic toxicity irritation to touch Paracetamol toxicity in cats and tx - 3 pathways of liver metabolism - 3rd pathway is toxic toxic metabolites induce cellular necrosis, methaemoglobin, and Heinz body formation tx: N-acetylcysteine Mechanism of toxicity in rodenticides - depletion of clotting factors - anticoagulant hypercalcaemia > mineralisation and renal failure tx: vitamin K, check PT after 48-72hr, severe anaemia needs blood transfusion, fluid therapy and diuresis, bisphosphonates or calcitonin to promote calcium excretion Mechanism of toxicity in xylitol and tx - stimulates insulin release > severe hypoglycaemia, hepatotoxicity A dog presents with a mass near his perineum which the owner unsure if it has increased in size as they only noticed it 2 days ago. You explain the diagnostic steps to the O: - First line dx - FNA (solid tumours/lymph nodes, simple, quick, non-invasive, low cost, no GA, but small sample, may not exfoliate well, may not be able to grade, not if bleeding disorder) Second line dx - FNA inconclusive/want more info, biopsy for histopath, larger sample, architecture assessed, can grade, prognostic info, but GA needed, invasive, time, more expensive, not if bleeding disorder or co-morbdities increasing GA risk, wedge biopsy including normal tissue (formalin) What imaging technique could be performed on lump before sampling for cytology/histopath if available in practice? - heat diffusing imaging (cancer cells have different thermal properties, graded AI 1-4 risk of malignancy > further investigation, 5-10 98% sure it is benign) Acronym for staging tumour - T - primary tumour N - spread to local lymph nodes (FNA/biopsy) M - has it metastasised (imaging) Best method for identifying pulmonary mets? - Radiograph - 3 inflated views (RL, LL, VD/DV), mets <3-5mm not visible CT - can detect mets as small as 1-2mm, has limitations re micromets in osteosarcoma US - cannot distinguish benign/malignant except target nodules (multiple in one organ), benign regenerative liver nodules common in old dogs (do not euthanise off ultrasound alone), liver and spleen can have mets and look normal on scan Most commonly used chemotherapy drug where surgery is contraindicated e.g. patient with CHF is not an appropriate candidate for GA - doxorubicin, epirubicin, vincristine, vinblastine List some key points to consider when performing oncological surgery - benign tumours need narrow margins up to 1cm malignant tumours need wide margins >2cm tumours most active at edge higher risk of infection get it right first time as less tissue available for closure at second surgery risk re tumour seeding - atraumatic forceps can you get enough margin with difficult locations chemotherapy to shrink tumour before surgery? remove any adhesions ligate vessels supplying tumour asap removal local lymph nodes if appear grossly abnormal during surgery change gloves and surgical kit following excision for wound closure avoid chemo 7 days before and 7 days after surgery - affect wound healing Common side effects of chemotherapy drugs - target fast dividing cells, in normal tissue this includes bone marrow and GIT > d+ and myelosuppression dose to be effective but minimise side effects renal toxicity - carboplatin and cisplatin cardio toxicity - doxorubicin/epirubicin hepatotoxicity - lomustine sterile haemorrhagic cystitis - cyclophosphamide GIT - pre-treat with maropitant and metoclopramide myelosuppression - monitor neutrophil nadir, prophylactic amoxicillin When is chemotherapy indicated in cancer tx in small animals? - lymphoma/leukaemia/metastatic neoplasia after surgery with high risk of mets (MCT, osteosarcoma, haemoangiosarcoma), smaller operable side, non-operable chemo sensitive tumours How can you reduce the risk of spillage when administering chemotherapy drugs - syringe with spiros cannot spill out unless attached to clave port on IV extension set A dog presents with an in-operable malignant tumour, O would like to try chemotherapy to maximise MST. It is a high grade tumour and you want to make the chemotherapy as successful as possible, how can you increase the success of chemotherapy drugs? - electrochemotherapy - makes tumour cells more permeable, greater uptake and sensitivity of drug excision biopsy - remove entire mass and send for histo large/multiple masses >3cm need full staging O bought a bitch puppy 2 months ago and wants advice on when to spay. When is it advised to spay bitches and why? - neutering before first season decreases risk of mammary neoplasia but increases behavioural impact, joint disease and bone neoplasia especially in larger breeds neutering advised 3m after first deacon A 10 year old lab presents with a large mass around his submandibular lymph node, what are your differentials? What are your dx steps? - lymphoma pyoderma leishmania ehrlichia babesia brucellosis aspergillus mineral associated lymphadenopathy leukaemia secondary mets to other neoplasia dx: history, clinical signs and exam, FNA from multiple nodes confirm B (most common)/T cell (worse) lymphoma, staging What is the most effective tx for B cell lymophoma? - CHOP protocol: vincristine IV, cyclophosphamide PO, epirubicin/doxorubicin IV, prednisolone PO weekly then every 2 weeks for 25 weeks A 14yo cat presents with chronic gastrointestinal signs and weight loss, what are your differentials? - GI: IBD, diet, adenocarcinoma, alimentary lymphoma, FeLV, FIV, FIP, giardia Non GI: hyperthyroid, pancreatitis, hepatic, CKD, neoplasia, diabetes, toxins A 14yo cat presents with chronic gastrointestinal signs and weight loss. You have a long list of GI and non-GI differentials, what dx tests will you do to narrow this list down? - biochem - liver enzymes, renal enzymes, TT4 haematology - CBC imaging diet trials faecal testing intestinal biopsy (endoscopic less invasive, lower risk, smaller sample/surgical invasive, risky, larger sample) cobalamin (B12) bloods - hypocobalaminemia in alimentary lymphoma AFAST - IBD and alimentary lymphoma will look similar FNA - enlarged mesenteric LN and PARR clonality Tx of feline alimentary lymphoma - chemo palliative prednisolone B12 supplement stabilise and surgery if vomiting/GI obstruction - anastomosis What is the typical appearance of canine osteosarcoma on radiograph? - single aggressive lesion proximal humours and distal radius distal femur and proximal and distal tibia (away from elbow near to knee) areas of lysis sunburst You have done radiographs on a dog with progressive lameness as you are concerned about a fracture or osteosarcoma. Which other tests will be needed to confirm osteosarcoma? - FNA - malignant mesenchymal neoplasia (Jamshidi needle) thoracic radiograph - stage if mets FNA local LN CT preferred for met checks How is a bladder tumour diagnosed? How is it treated? - never FNA US guided catheter suction biopsy for cytology cystoscopy and biopsy free catch urine cytology CADET BRAF urine test (PCR for BRAF mutation of transitional cell carcinoma, 80% sensitivity) surgery not possible chemotherapy with NSAIDs List 6 main causes of foot pathology in adult sheep in the UK - interdigital dermatitis (scald) footrot CODD toe granuloma toe abscess shelly hood (white line dz) What is your top differential for this sheep? What is the pathogenesis and tx for this cause? - foot rot (scald) dichelobacter nodosus gram -ve rod wet environment (spring and autumn) inflammation and necrosis facilitates infection with D. nodosus F. necrophorum = secondary pathogen tx = tx within 3d of onset, abx (oxytet) and spray interdigital space and foot, don't trim, analgesia (metacam) prevention = footvax (prevention or in face of an outbreak) What is your top differential for this sheep? What is the pathogenesis and tx for this cause? - CODD lesion at coronary band extends under horn down to toe > avulsion of horn > exposes laminae and affects pedal bone treponema, D. nodosus, F. necrophorum tx = injectable amoxicillin, oxytet, analgesia What is your top differential for this sheep? What is the pathogenesis and tx for this cause? - shelly hoof detached hoof horn wall from epidermis cavity for first to pack FB penetration > abscess > lameness stop foot bathing, stop foot trimming What is your top differential for this sheep? What is the pathogenesis and tx for this cause? - toe granuloma granulation tissue in response to injury/untreated footrot caused by excessive trimming bleed, regrow nursing, analgesia, cull predisposed if foot bathed in formalin What is your top differential for this sheep? What is the pathogenesis and tx for this cause? - toe abscess infection in white line, abscess under wall or sole horn pus from coronary band if bursts smelly hot to touch, painful before pus visible acutely lame A farmer calls with an onset of lameness in a multiple sheep within his flock. As you are gathering history he explains he had dipped some sheep a couple of days ago and used the same dip for another group yesterday. What is a likely cause of the lameness? - Erysipelothrix rhusiopathiae dull, lame and pyrexic a few days after foot bath tx with penicillin, avoid keeping dip too long 5 point plan used to manage sheep lameness - vaccinate (footvax) cull (build resilience) avoid treat quarantine A group of lambs approximately 2 weeks old present with lameness and recumbency. When you feel their joints they are hot and swollen. What is your top differential and tx? - joint ill procaine penicillin and NSAIDs CKD cats fed severely phosphate restricted diets How does neoplasia cause hypercalcaemia? - tumour PTHrP (parathyroid hormone related protein) production total and ionised Ca increased P normal/low PTH low, PTHrP high most commonly lymphoma, multiple myeloma, anal sac adenocarcinoma How do granulomatous diseases (infectious diseases) cause hypercalcaemia? - increased macrophages macrophages synthesise calcitriol without negative feedback macrophages may also synthesise PTHrP which active PTH receptors e.g. A. vasorum, mycobacteria, FIP Describe dx tests that can be undertaken to dx cause of hypercalcaemia - palpate LN - FNA, lymphoma? rectal exam - FNA anal gland carcinoma? orthopaedic exam - boney swellings, pain? bloods - ionised calcium, lymphocytes, renal, Addisons (hyperK, hypoNa), phosphate, basal cortisol vit D analogues basal cortisol +/- ACTH stim (Addisons) FIV/FeLV angiodetect (A. vasorum) imaging (TFAST, AFAST, US parathyroid) bone biopsy Describe 4 steps to approach hypercalcaemia dx - 1. hx, exam, CBC, biochem, urinalysis, imaging, FNA/biopsy, ionised hyperCa 2. ACTH stim (no increase in cortisol = hypoadrenocorticism) 3. Measure PTH (increased = primary hyperparathyroidism) 4. Measure PTHrp (increased = malignancy, normal = vitamin D/infection) 4 points for emergency management of hypercalcaemia - 1. IVFT - fluid deficit and diuresis 2. furosemide when hydrated - diuresis 3. calcitonin - opposes PTH, decreases blood Ca 4. oral bisphosphonates and oral glucocorticoids - slower onset, not helpful in acute settings but better long term 4 muscles related to urinary incontinence - detrusor internal smooth muscle sphincter external smooth muscle sphincter trigone 2 causes of urinary incontinence - structural (urethral length, urethral diameter) imbalance between storage capacity (innervation, detrusor atony) and urethral tone (bladder neck position, neutering, innervation) Dx approach to urianary incontinence in small animals - haematology, biochemistry, urinalysis radiographs retrograde urethrocystogram (contrast via urinary catheter) IV urethrography (contrast filtered by kidneys) cystoscopy (endoscopy of urethra + bladder) US CT medical vs surgical tx for urinary incontinence - phenylpropanolamine: adrenergic agonist increases contractility, first line in dogs estriol: oestrogen replacement, increased receptors responding to phenylpropanolamine, second line tx with phenylpropanolamine, female only surgical placement of urethral cuff - narrow proximal urethra surgery to move bladder neck and urethra cranially - urethra subject to intra-abdominal pressure Compare clinical signs of blue tongue in sheep with those in cattle - Sheep: more severe, oral swelling, oral erosions, drooling, conjunctivitis, nasal discharge, swollen cyanotic tongue, lameness (coronets), depression, pneumonic lung sounds, mouth breathing, mortality Cattle: mucopurulent nasal discharge, conjunctivitis, lacrimation, oral ulceration, swelling around muzzle, coronary band swelling, teat lesions and pain, pyrexia, decreased milk yield, abortion, infertility Supportive tx for blue tongue - abx and NSAIDs What is your top differential for this sheep? What is the vector? - blue tongue cullicoides midge Thi chicken presents with depression, a gaping beak, cough, sneezing, tremors, torticolis and watery green d+. What is your top differential and it's cause? - Newcastle disease avian paramyxovirus type 1 A chicken presents with respiratory signs, excessive lacrimation, oedema of the head and face, subcutaneous haemorrhage and d+. What is your top differential? - avian influenza A group of piglets present with profuse watery d+, the farmer has already lost some piglets from this group. What is your top different? - Porcine epidemic diarrhoea (coronavirus) notifiable high morbidity in piglets, older pigs will recover reduced appetite, lethargy, temperature, d+, dehydrated highly contagious part of Significant Disease Charter - early outbreak notification Camelpox is a notifiable disease. What are the clinical signs and pathogenesis? - contagious skin disease zoonotic pyrexia abortion local/generalised pox lesions on skin and oral/respiratory tract enlarged lymph nodes, swelling of head dx: transmission electron microscopy, cell cultures, PCR, serology, ELISA, orthopoxvirus biannual vaccination for young 6-9m isolation and tx A cow presents with chronic weight loss, d+, jaundice, peripheral oedema and depressed demeanour. You ask to look at the field they've been grazing on, why? - Symptoms for ragwort pyrrolizidine alkaloids Aetiology, presentation, symptoms and management of photosensitising agents as toxins in cattle - photodynamic substance reacts with UV > inflammation primary - ingestion of plants, metabolite reaches skin through circulation secondary - hepatogenous, increased phycoerythrin levels in blood when metabolised in liver, pyrrolizidine alkaloids cause hepatic damage presentation: oedema, erythema, vesicles, dermal effusions, skin necrosis, crusting, ulceration, sloughing, white/lighter areas, ears, muzzle, painful/sensitive, hepatic signs dx: clinical signs, biochemistry, liver biopsy management: remove causative agent, deride necrotic skin, control flies, manage hepatobiliary disease Why are acorns poisonous? Management? - tannins in acorns = nephrotoxic supportive therapy, large volumes of IV fluids A herd of cattle are grazing on sparse pasture and present with anorexia, pyrexia, petechial haemorrhage, weakness, tachycardia and tachypnoea. List some differentials. - bladder tumour: cystitis, pyelonephritis red water fever bracken poisoning Aetiology of bracken poisoning - bone marrow suppression carcinogenic Aetiology and dx of copper toxicity in sheep - ingestion of high Cu in ration > high liver Cu > sudden release > acute intravascular haemolytic crisis