What is the best interpretation of 5-10 nRBCs in peripheral circulation?

a.  reliable indicator of a robust regenerative erythroid response

b.  so variable that they cannot be used as an aid in hemogram interpretation

c.  always indicate lead poisoning

d.  suggest bone marrow damage

e suggests the bone marrow resonse involves more than solely the erythroid line

D

hypoxia can cause damage to architecture of bone marrow or its lining.  nRBC's fall out b/c there is nothing holding them in anymore.  could be primary or secondary in nature.

Which of the following best describes reasons for increased serum bilirubin in dogs?

a.  sepsis; GI hemorrhage

b.  ruptured gallbladder; increased RBC turnover

c.  hepatic lipidosis; cholestasis

d.  decreased renal excretion of bilirubin; hemoabdomen

e.  common bile duct obstruction; descreased RBC osmotic fragility

B

CWhich of the following is the strongest single piece of evidence supporting a diagnosis of IMHA?

a.  anemia with icterus

b.  severe regenerative anemia

c.  agglutination

d. spherocytosis

e.  anemia with thrombocytopenia

C

If Rosie peracutely developed dyspnea on day 3, which of the following would you suspect most strongly to be the cause?

a.  worsening anemia

b.  pulmonary thromboembolism

c.  pneumonia

d.  hemothorax

e.  lung lobe torsion

Which of the following is true with respect to steroid therapy?

a.  Prednisolone and prednisone differ in absorption after oral dosing in cats

b.  prednisolone is converted to prednisone in the liver

c.  3 mg of prednisone or prenisolone is considered the "pred" equivalent of 1 mg of dexamethasone

d.  corticosteroids cause increases in ALP and GGT in cats and dogs

e.  dexamethasone, prednisone and prednisolone are all suitable for alternate day administration as they have approximately the same biological half life

If presented with a clinically stable adult dog showing marked ascites and no other obvious abnoralities, you would suspect all of the following except:

a.  portal hypertension due to chronic hepatitis

b.  systemic hypertension

c.  PLE

d.  pericardial effusion

e.  right heart failure

Which is least likely to be a site of fluid accumulation due to hypoalbuminemia?

a.  ascites

b.  pleural effusion

c.  ascites & pleural effusion

d.  pulmonary edema

e.  edema of extremities of the limbs

Which of the following are not reasons for low serum albumin in dogs?

a.  sepsis; chronic GI hemorrhage

b.  lymphangiectasia; glomerulonephritis

c.  cholestasis; peritonitis

d.  PSS; renal amyloidosis

e.  PLE; protracted anorexia

Which of the following changes in the leukogram is most likely to be present in an untreated dog diagnosed with lyphocytic plasmacytic IBD?

a.  normal luekogram

b. stress leukogram

c.  inflammatory leukogram

d.  lymphocytosis

e.  eosinophilia

Symptomatic hypocalcemia can occur in dogs with PLE.  What is the main underlying pathophysiologic mechanism?

a.  low serum albumin results in low total calcium

b.  decreased calcium absorption due to underlyng enteric disease

c.  decreased calcium absorption due to hypovitaminosis D

d.  low dietary intake due to poor appetite

e.  calcium loss into cavitary effusions

Based on the reason for hyper-coagulable status of dogs with PLE, which of the following anticoagulants would be the least appropriate choice?

a.  low-dose aspirin

b.  clopidogrel

c.  warfarin

d.  heparin

e.  all of the above would be appropriate

D

animals with PLE lack ATIII. heparin binds to ATIII so wouldnt work

Which of the following is false regarding doxycycline?

a.  is used to treat canine erhliciosis, anaplasmosis and RMSF

b.  is minimally effective against Babesia canis

c.  Doxy and an aminoglycoside are used to treat brucellosis in dogs

d.  is used to treat toxoplasmosis in cats

e.  kills Wolbachia bacteria in the reproductive tract of canine heartworms

D

clindamycin is best choice

What is the most likely classification for Stella’s polycythemia?

a.  polycythemia vera

b.  appropriate secondary polycythemia

c.  inappropriate secondary polycythemia

d.  relative polycythemia

e.  lab artifact/error

What is the mechanism for stella’s inappropriate USG?

a.  central diabetes insipidus

b.  acquired nephrogenic diabetes insipidus

c.  primary renal insufficiency

d.  corticosteroid deficiency

e.  mineralocorticoid deficiency

Which of the following is most likely to result in bloody diarrhea with increased PCV?

a.  parvoviral enteritis

b.  hemorrhagic gastroenteritis

c.  intestinal ulceration

d.  GDV

e.  hookworm infestation

Which of the following is the best conclusion based on a negative 4DX test for anaplasmosis?

a.  anaplasma infection has been definitely excluded

b.  the patient has never been exposed to anaplasma

c.  a blood smear should be evaluated for organisms if clinical signs are suggestive of the disease

d.  negative 4DX should routinely be followed up with molecular testing (PCR)

e.  patients with clinical signs should be treated regardless of test results

Which of the following is the best use of a resting serum cortisol test?

a.  to make a diagnosis of hypoadrenocorticism

b.  to substantiate a diagnosis of hyperadrenocorticism

c.  to exclude a diagnosis of hypoadrenocorticism

d.  to monitor a dog being treated with trilostane for hyperadrenocorticism

e.  all of the above are possible uses

Which of the following fluid therapy choices is most appropriate for stella? (hypoadrenocorticism)

a.  normal saline

b.  half-strength saline

c.  LRS

d.  plasmalyte 148

e.  hypertonic saline

Which of the following statements is false?

a.  mirtazapine is a human antidepressant drug used as an appetitie stimulant in dogs and cats

b.  maropitant is approved to treat vomiting and nausea in dogs & cats

c.  cyclosporine is a veterinary approved drug used to treat atopic dermatitis, perianal fistuals, KCS and some immunologic disorders

d.  azathioprine is used as an adunctive immunosuppressive drug rather that a first-line therapy

e.  azathioprine is dosed very differently in cats than in dogs due to the profound bone marrow suppressive effects in cats

B

nausea is subjective and is not on the label claim

Which of the following is NOT a cause of hypercalcemia in dogs?

a.  atypical hypoadrenocorticism

b.  cholecalciferol rodenticide toxicity

c.  multiple myeloma

d.  pulmonary fibrosis

e.  blastomycosis

Given the following lab results in a 13 year old dog what is the most likely diagnosis?

Ca: 17.1 (high); P 2.4 (low); Albumin = normal; Globulin = high; ALP = mildly elevated

a.  iatrogenic cushings

b.  primary hyperparathyroidism

c. hypercalcemia of malignancy

d.  vitamin D overdose

e.  spurious hypercalcemia

Which of the following are most likely to be directly caused by a high ionized calcium?

a,  constipation and PU/PD

b.  increased liver enzymes and PU/PD

c.  increased liver enzymes and renal failure

d.  isosthenuria and patchy hair loss

e.  hypophosphatemia and cardiac arrhythmias

The next diagnostic steps in evaluating Suz Q’s hypercalecemia are?  (Assume a repeat rectal exam is normal)

a.  PTHrp and PTH assays; diet analysis for vitamin D

b.  Thoracic rads; abdominal ultrasound

c.  US the neck; PTH assay

d.  thoracic rads; bone marrow aspiratation/biopsy

e.  resting cortisol; US of the neck

Which of the following is NOT a treatment for symptomatic hypercalcemia?

a.  furosemide

b.  0.9% NaCl

c.  aluminum hydroxide

d.  sodium bicarbonate

e.  glucocorticoids

Which of the following drugs is NOT an effective treatment for urinary incontinence in spayed female dogs?

a.  PPA

b.  diphenhydramine

c.  incurin

d.  DES

e.  all of the above drugs are used to treat urinary incontinence

Which of the statements is/are true?

a.  metoclopramide is an antiemetic and prokinetic used to treat vomiting, gastroparesis and constipation

b.  metoclopramide is an inexpensive, effective and safe antiemetic for dogs and cats

c.  cisapride exerts a prokinetic effect on smooth muscle in the esophagus, stomach, duodenum, jejunum, ileum and large bowel

d.  cisapride causes QT prolongaion and torsades de pointes leading to sudden death in people; this adverse effect has not been reported in dogs

e.  in the USA, omeprazole is available for oral use, pantoprazole for oral or IV use

What is the significance of the Heinz bodies in “benny”?

a.  normal, no significance

b.  indicate ingestion of a toxin like acetaminophen

c.  indicate an impending hemolytic crisis

d.  artifact

e.  are associated with endogenous metabolic oxidative stress

What is the earliest sign of glomerular disease?

a.  azotemia

b.  hyposthenuria

c.  isothenuria

d.  proteinuria

e.  glucosuria

What acid/base abnormality is expected in severe azotemia?

a.  none, acid base status should be normal

b.  alkalosis due to vomiting

c.  alkalosis due to renal bicarbonate wastage

d.  normal anion gap acidosis

e.  high anion gap acidosis

What is the most appropriate utilization of point of care testing?

a.  as a quicker method when you are busy

b.  as a cheaper method so you can repeat blood tests frequently

c.  as a screening method prior to obtaining reference method results

d.  to verify previously performed laboratory testing

e.  as a more reliable method when you do not have trained staff

Which of the following is least likely to cause acute on chronic decline in renal function?

a.  complete unilateral ureteral obstruction

b.  pyelonephritis

c.  anesthesia induced hypotension

d.  renal scarring due to multiple renal infarctions

e.  reduced function in one kidney due to neoplasia

Which is the best choice for nutritional support for "Benny"? (16.8 lbs)

a. 300 kcal by NE tube with antiemetics

b.  575 kcal by NE tube with antiemetics

c.  300 kcal IV (TPN) as he is vomiting

d.  575 kcal IV (TPN) as he is vomiting

e.  no nutritional plan needed as he was eating recently

Which of the following drug side-effect pairings is INCORRECT?

a.  SMZ/TMP -KCS

b.  SMZ/TMP - polyarthritis

c.  cephazolin - facial pruritis

d.  methimazole - neutropenia

e.  methimazole - jaundice

C

facial pruritis is common in cats on methimazole

Which of the following combinatins are the strongest indicators of a diagnosis of DM?

a.  glucosuria and weight loss

b.  hyperglycemia and weight loss

c.  ketonuria and PU/PD

d.  hyperglycemia and PU/PD

e.  ketonuria and PU/PD

Which of the following endocrinopathies is most likely to have normal liver enzymes?

a.  hyperthyroid in cat

b.  hypothyroid in dog

c.  hyperadrenocorticism in dog

d.  unregulated DM in dog

e.  unregulated DM in cat

Which of the following is not a metabolic consequence of DKA?

a.  obligatory osmotic diuresis

b.  metabolic acidosis

c.  decreased GFR

d.  hyperosmolality

e.  suppression of ketone production

Cats with untreated DKA usually?

a.  are hyponatremic largely due to renal loss of sodium

b.  are hyponatremic largely due to decreased oral intake

c.  are hypernatremic largely due to dehydration

d.  are hypernatremic largely due to altered GFR

e.  have no change in serum sodium

Underlying factors that may precipitate a ketotic state in a diabetic include all except?

a.  UTI

b.  pancreatitis

c.  steroid therapy

d.  dehydration

e.  acromegaly

Complications to watch for in a diabetic once insulin therapy is institutued are:

a.  hyponatremia and hypokalemia

b.  hypophosphatemia and hypokalemia

c.  hypoglycemia and hyperosmolality

d.  hypophosphatemia and hypermagnesemia

e.  hyponatremia and hypocalcemia

What is the significance of reactive lymphocytes on Mookie's CBC?

a.  always seen in young cats, no significance

b.  artifact due to lipemia and icterus

c.  likely related to recent viral exposure or other immune stimulation

d.  suggestive of lymphoid cancer

e.  diagnostic for leukemia

Mookie's anemia is most likely due to

a.  dilution from fluid therapy

b.  GI hemorrhage

c.  anemia of inflammatory disease

d.  immune-mediated hemolysis

e.  DIC 

Which statement about Mookie's urinalysis is  incorrect?

a.  bilirubinuria is expected as serum bilirubin is increased

b.   0-2 granular casts and glucosuria suggest renal tubular disease

c.  lipiduria may be seen in feline hepatic lipidosis

d.  atypical epithelial cells are of unknown significance

e.  there is no evidence of UTI 

Which of the following provide info about liver function?

a. blood ammonia, ALT, albumin

b.  cholesterol, PT/PTT, schistocytes

c.  BUN, albumin, blood ammonia

d.  bilirubinuria, ALP, glucose

e.  PT/PTT, blood ammonia, hepatic FNA 

Which of the following is least likely to have caused or contributed to Mookie's ascites?

a.  hepatic cirrhosis

b.  portal vein thrombosis

c.  hypoalbuminemia

d.  PSS

e.  acute pancreatitis 

Mookie's PT and PTT normalized overnight with vitamin K therapy. Which of the following best explains her coagulopathy at admission?

a.  anticoagulant rodenticide

b.  vitamin K malabsorption

c.  DIC

d.  congenital factor X deficiency

e.  lack of clotting factr production due to functional liver failure 

The best treatment for Mookie's ascites is:

a.  paracentesis

b.  furosemide

c.  spironolactone

d.  corrrecting her coagulopathy

e.  no specific treatment needed 

Which of the following statements is incorrect?

a.  when used to reduce ECF volume, the selection of a diuretic should be based on the cause of the ECF volume retention

b.  furosemide is classified as a loop II diuretic

c.  orally absorbed T4 is converted as needed to T3 by the target cells

d.  levothyroxin inhibits TSH

e.  lethargy is a potential side effect of PPA, an alpha agonist

Thrombocytosis may be associated with which of the following?

a.  Hyperadrenocorticism

b.  Hypothyroidism

c.  biliary mucoceles

d.  diabetes mellitus

e.  IMHA 

Which of the following is NOT known to be associated with fasting hypercholesterolemia?

a.  hypothyroidism

b.  diabetes mellitus

c.  hyperadrenocorticism

d.  high fat diet

e.  familia hyperlipidemia 

Which of the following is most likely to be associated with biliary mucoceles in dogs?

a.  high fat diet

b.  obesity

c.  diabetes mellitus

d.  hyperadrenocorticism

e.  hypothyroidism 

What is a realistic diagnostic expectation for hepatic cytology?

a.  normal result will exclude primary hepatic pathology

b.  a reliable diagnosis of hepatitis can be achieved

c.  portal vein hypoplasia can be confirmed

d.  cholestatic liver disease can be confirmed but the biliary tract cannot be evaluated

e.  a diagnosis of malignancy is likely to have high specificity 

What is the relationship between the degree of increase in serum bile acid and severity of liver dysfunction in a dog with liver disease?

a.  the higher the SBA, the worse the liver disease

b.  a reduction in SBA elevation indicates improved liver function

c.  SBA must normalize to confirm improved liver function

e.  only post-prandial sBA correlates with severity of liver dysfunction 

Which of the following represents the maintenance fluid requirement of Axel (13 kg) and what is his expected urine volume?

a.  1000 ml; 1300 ml

b.  650 ml; 900 ml

c.  650 ml; 650 ml

d.  650 ml; 350 ml

e.  350 ml; 350 ml 

D

Which statement is false?

a.  amlodipine is a calcium channel blocker that decreases total peripheral resistance

b.  amlodipine is usually used in hypertensive cats with CKD as a monotherapy for blood pressure control

c.  despite its widespread use, there is no evidence that SAMe improves liver function or prevents drug-induced hepatotoxicity

d.  the labeled content of SAMe varies greatly from the SAe content in different products

e.  among the bile acids, UDCA has the lowest potential for cell membrane toxicity

How sensitive and specific is serum CK activity as an indicator of muscle damage?

a.  it is both sensitive and specific

b.  it is sensitive but not specfic

c.  it is not sensitive but is specific

d.  it is neither sensitive nor specific 

Which of the following factors most significantly impacts serrum potassium concentration?

a.  anorexia, urine output, muscle mass

b.  diet, urine output, acid/base status

c.  anorexia, urine output, tissue necrosis

d.  diet, azotemia, hydration status

e.  azotemia, acid/base status, muscle mass 

Which of the following is least likely to be present in a cat with primary hyperaldosteronism?

a.  systemic hypertension

b.  hypokalemia

c.  high fractional excretion of potassium

d.  metabolic alkalosis

e.  high renin concentration 

Cervical spine ventroflexion may be seen in cats with all of the following except?

a.  hypokalemic polymyopathy

b.  thiamine deficiency

c.  organophosphate toxicity

d.  thalium intoxication

e.  various causes of neuromuscular weakness 

Which of the following is an appropriate indication for prescribing Hill's feline c/d?

a.  struvite crystalluria

b.  oxylate crystalluria

c.  to help dissolve struvite stones

d.  to help dissolve calcium oxylate stones

e.  to help prevent recurrence of FLUTD signs associated with struvite crystalluria 

If you determined Penguin was consistently hypertensive, what therapy would you use?

a.  enalopril

b.  benazepril

c.  amlodipine

d.  an ace-inhibitor and amlodipine

e.  a low salt diet and an ace-inhibitor 

Which of the following is false?

a.  ace-inhibitors are vasodilators, affect neurohormonal responses associated with heart failure and are positive inotropes

b. ace-inhibitors reduce more preload than afterload

c.  both enalopril and benazepril are prodrugs that require hepatic metabolism

d.  ace-inhibitors are used in dogs to treat heart failure, hypertension and PLN

e.  side effects of ace-inhibitors include hypotension, pre-renal azotemia and hyperkalemia