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SAIM Flashcards

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1
Q

Adrenal tumors

Which one is more common: tumor in the adrenal cortex or medulla?

A

Adrenal cortex! 75% of cases, with 57% being malignant.

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2
Q

Adrenal tumors

Tumors < 2 cm (longitudinal) are more likely to be carcinomas.

A

False. Bigger than 2 cm.

If smaller: adenoma is most likely.

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3
Q

Adrenal tumors

How often we see metastasis with adrenocortical carcinomas?
a) 1%
b) 5%
c) 10%
d) 50%

A

50%.

Liver and lungs most common, other sites algo possible.

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4
Q

Adrenal tumors

When adrenal dependent hyepradrenocorticism (ADH) is suspected, which is the best endocrine screening test?

A

LDDST.

Differentiation from PDH generally is determined by imaging.

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5
Q

Canine adrenocortical tumors

Prognosis for patients after adrenalectomy?

A

Excellent for patients that survived 4 weeks post-op.

Average life expectancy 3 years.

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6
Q

Prognosis with SRT for dogs with adrenocortical tumors with vascular invasion.

A

MST 1030 days.

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7
Q

Feline adrenocortical tumors

T/F. Lab testing often reveals hypokalemia.

A

True.

Also, metabolic alkalosis.

CS are muscle weakenss and hypertension.

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8
Q

Feline adrenocortical tumors

When adrenalectomy is not a choice, medical treatment involves:

A

Potassium supplementation, antihypertensive drugs, and the aldosterone antagonist.

(Amlodipine, spironolactone).

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9
Q

Adrenal medullary tumors

Pheochromocytomas secrete what?

They are neoplastic chromaffin cells.

A

Catecholamines.

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10
Q

Adrenal medullary tumors

T/F. Exercise intolerance is not a CS in dogs with pheochromocytomas.

A

False. It is, along with episodic collapse, panting, anxiety, restlessness.

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11
Q

Adrenal medullary tumors

What is a pathognomonic abnormality in regular lab work in dogs with pheochromocytomas?

A

None.

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12
Q

Adrenal medullary tumors

What is superior to measure catecholamines and their metabolites: plasma or urine?

A

Urine.

Bc there is excretion through urine.

Specially metanephrines. Although reference ranges not well established.

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13
Q

Adrenal medullary tumors

What is the most commonly medication used in dogs with pheochromocytomas?

A

Phenoxybenzamine.

It’s an alpha adrenergic antagonist. Started 20 d before surgery.

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14
Q

Adrenal medullary tumors

Prognosis for dogs with adrenal medullary tumor if surgical treatment and no metastasis.
a) 804 d
b) 128 d
c) 374 d
d) 14 d

A

374 days.

1 year.

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15
Q

Surgical management of adrenal tumors

3 pre-operative considerations:
M………. V……… F……….

A

Evidence of metastatic disease, vascular invasion, functional.

Abdominal CT is very helpful for surgical planning and staging.

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16
Q

Surgical management of adrenal tumors

Prognostic factors

A

Size of tumor >5 cm, tumor thrombus, tumor type, transfusion…

Perioperative mortality is 15-37%.

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17
Q

Surgical management of adrenal tumors

Perioperative mortality:
a) 15-37%
b) 1-3%
c) 30 - 61%

A

15-37%.

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18
Q

Incidental adrenal masses

T/F. Adrenalectomy should be considered for functional masses >2.5 cm.

A

True! And also if locally invasive.

Regular monitoring if these criteria are not met (every 3 months).

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19
Q

Hyperthyroid cats

What’s the percentage of cats with hyperthyroidism that have concurrent CKD?
a) 25 - 75%
b) 5-10%
c) 15 - 50%

Peterson 2024

A

15-50%.

Although diagnosing azotemic CKD is challenging bc untreated hyperthyroidism increases RBF and GFR and decreases body muscle mass, so it lowers creatinine.

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20
Q

Hyperthyroid cats

Why does hyperthyroidism affect the diagnosis of CKD?

Peterson 2024

A

Increased cardiat output –> increased renal blood flow and decreased glomural filtration rate and body muscle mass.

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21
Q

Hyperthyroidism cats

What’s the reported median survival time for cats with hyperthyroidism?

Peterson 2024

A

1.6 to 4 years

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22
Q

Hyperthyroid cats

Euthyroid cats experienced the most significant increase in creatinine how long after the treatment?

Peterson 2024

A

4 weeks.

So after that period of time, we can have a good idea about how his creatinine is.

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23
Q

Hyperthyroid cat

Concurrent azotemia might shorten long-term survival in cats with ‘masked’ azotemic CKD.

Peterson 2024

A

True.

Which makes sense because cats with isolated CKD, even in IRIS stage 2-3, already have shortened survival times.

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24
Q

Hyperthyroid cats

Survival time of hyperthyroid cats that are clearly azotemic prior to treatment is not different from cats without azotemia prior to treatment.

Peterson 2024

A

False. Pretreatment azotemia does decrease survival time.

Crea > 2 mg/dL.

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25
# Hyperthyroid cat Predicting whether an untreated cat with hyperthyroidism has concurrent (but masked) CKD does not matter because it does not affect survival time. ## Footnote Peterson 2024
False. It is crucial because they tend to have shorter survival times.
26
# Hyperthyroid cat What's the median survival time for non-azotemic cats treated with I131? a) 2 years b) 5.1 years c) 3.5 years d) 4.3 years ## Footnote Peterson 2024
4.3 y.
27
Keeping cats hyperthyroid can affect kidney function. ## Footnote Dr. DeMonaco
True.
28
# Hyperthyroid cat Up to how percentage of hyperthyroid cats can have systemic hypertension? ## Footnote Stammeleer, Xifra 2024
48%. ## Footnote Range is 7-48%.
29
# Hyperthyroid cat Hypertension, when present, resolves in many hyperthyroid cats after successful treatment. | Stammeleer, Xifra 2024
Correct. ## Footnote And cats uncommony develop new hypertension after treatment.
30
# Hyperthyroid cat 2 important things to do in the physical exam of hyperthyroid cats. | Stammeleer, Xifra et al 2024
Fundic exam and blood pressure.
31
# Hyperthyroid cat Persistent or newly detected hypertension was related to azotemia or iatrogenic hypothyroidism. | Stammeleer, Xifra et al 2024
False, was not. Most likely 'situational' hypertension, as hyperthyroid-induced hypertension should resolve after treatment.
32
# Pancytopenia Pancytopenia is defined as anemia, neutropenia, and thrombocytopenia, and it's exclusively due bone marrow disease. ## Footnote EClinPath
False, there are very few extramedullary diseases that produce pancytopenia but there are some.
33
# Pancytopenia Name some examples of extramedullary diseases causing pancytopenia. ## Footnote EClinPath
Severe bacterial sepsis, Cytauxzoon felis and FIP. ## Footnote Reasons: anemia of inflammatory disease, left shift, toxic changes, sequestration or consumption of platelets.
34
# Pancytopenia Mechanisms (and causes) of pancytopenia (more than 1 are correct): a) Bone marrow aplasia b) BM hyperplasia c) BM hypoplasia d) Effective hematopoiesis
BM aplasia and hypoplasia. ## Footnote Also, BM necrosis, ineffective hematopoiesis and BM neoplasia.
35
# Pancytopenia Mycotoxins, hormones (estrogen) and infectious organisms can cause bone marrow aplasia. ## Footnote EClinPath
True. ## Footnote Also, Drugs, immune-mediated disease, for infectious Ehrlichia canis.
36
# Pancytopenia Bone marrow necrosis is an uncommon cause of pancytopenia, and can be due to (more than 1 answer is possible): a) Radiation b) Ehrlichia canis c) Vasculitis d) Drugs ## Footnote EClinPath
All but Ehrlichia. ## Footnote Also, viruses (e. g. canine parvovirus).
37
# Pancytopenia Bone marrow hypoplasia can be due to the same causes as bone marrow aplasia, which are...? ## Footnote EClinPath
Drugs, hormones (estrogen), immunemediated disease, infectious disease (E. canis) and mycotoxins.
38
# Pancytopenia Ineffective hematopoiesis can be due to n_____ or non-n_____ conditions.
Neoplastic or non-neoplastic.
39
# Pancytopenia Name some of the neoplastic causes of ineffective hematopoiesis. ## Footnote EClinPath
Histiocytic sarcoma and myelodysplastic syndrome.
40
# Pancytopenia Why does hystiocytic sarcoma cause ineffective hematopoiesis (more than 1 possible)? a) Hemophagocytosis b) Vasculitis c) Necrosis of the bone marrow d) Immune-mediated destruction ## Footnote EClinPath
Most likely hemophagocytosis by the tumor cells, although d) and alterations in the bone marrow microenvironment are also possible.
41
# Pancytopenia Precursor-directed (non-regenerative) immune-mediated anemias cause pancytopenia by means of which mechanism? a) BM necrosis b) BM neoplasia c) BM hypoplasia d) Ineffective hematopoiesis ## Footnote EClinPath
d) Ineffective hemat. It most likely causes immune-mediated destruction of marrow progenitors.
42
# Pancytopenia Phenobarbital can cause pancytopenia by means of ineffective hematopoiesis. ## Footnote EClinPath
True! ## Footnote An altered marrow microenvironment from drug or toxic injury can result in pancytopenia with ineffective hematopoiesis.
43
# Pancytopenia Which of the following are BM neoplasias (more than 1 possible)? a) Lymphoma b) Multiple myeloma c) Acute myeloid leukemia d) Histiocytic sarcoma ## Footnote EClinPath
All of them! Can be divided in 'arising in the bone marrow' (c) or 'infiltrating' the BM (a, b, d).
44
# Gallbladder Gallbladder innervation involves which nerVe? ## Footnote DeMonaco
Parasympathetic and sympathetic via VAGUS nerve and splanchnic nerves respectively.
45
# Gallbladder dogs
Protects from intestinal contents. Sphincter of Oddi.
46
# Gallbladder dogs Erhythromicin is analogue of which hormone
Motilin | Which is important in the XXX phas
47
# Gallbladder dogs When the sphincter of Oddi is opened, what happens to the GB?
It empties.
48
# GB dogs What of these are not component of the bile? a) Bile acids b) Electrolytes and cholesterol c) Phospholipids d) CCK
CCK. ## Footnote CCK stimulates the secretion of bile acids, along with glucagon and secretin.
49
# GB Mucin secretion is important for protection of GB e.............
Epithelium.
50
# GB Bile acids are synthesized by the liver from: a) Mucin b) Cholesterol c) Bacteria
Cholesterol.
51
# GB dogs The most common type of cholangitis is: a) Neutrophilic b) Granulomatous c) Eosinophilic d) Lymphothitic
Neutrophilic cholangitis.
52
# GB dogs Can we see hyperbilirubinemia and elevated liver enzymes in neutrophilic cholangitis in dogs?
Yes, very commonly.
53
Diagnosis of canine cholangitis, which one(s) are indicated?: a) Cholecystocentesis b) Culture bile c) Bile cytology d) Biopsy of the liver
All of them! ## Footnote Complications of percutaneous ultrasound cholecystocentesis: 3.4%. Avoid in mucocele bc it can cause rupture.
54
# GB Can cholecystocentesis be fatal in cats?
Yes, it can cause collapse from vagal stimulation. ## Footnote Confirmar.
55
# GB What are the bacteria typically observed on canine cholangitis or cholecystitis? a) E. coli b) Pasteurella c) Enterococcus d) Clostridium
All but Pasteurella. ## Footnote Clavamox (for Enterococcus), unasyn, baytril if no culture was performed.
56
# GB Why do cats don't get mucocele as much as dogs?
Bc of the number of mucosecretin glands (o algo así, los gatos tienen menos).
57
# GB mucocele What breeds are predisposed? a) German Pointer b) Schnauzer c) Shelties d) Dalmatians
B and c.
58
# GB What's the typical appearance of GB mucocele in the AUS? a) Watermelon b) Orange c) Honeycomb d) Kiwi
Kiwi!! ## Footnote We can't use AUS to exclude GB mucocele rupture.
59
# GB Medical management is not an option for GB mucocele.
False, it is, and they can do okay for a long period of time (as long as no complications). ## Footnote Mainly ursodiol and diet +/- antibiotics. It very rarely will cause resolution (it will stay static or slowly progress).
60
# GB GBM complications: Rupture and obstruction etc etc
61
Cystinuria: is it most likely in male or female dogs?
Intact males. ## Footnote Androgen-dependent cystinuria is likely the most common form of cystinuria, which would explain why the majority occur in intact males.
62
Is castration beneficial for decreasing the risk of cystine urolith recurrence?
Yes, it is likely to be beneficial, even in dogs with reported Type I and Type II genetic variants.
63
What type of uroliths are female dogs predisposed to?
Struvite-containing uroliths because of their increased risk of UTI.
64
Urease-producing bacteria cause UTI in dogs with struvite-containing uroliths. T/F.
True.
65
Male dogs are predisposed to CaOx urolithiasis. T/F.
True.
66
T/F. The Labrador Retriever is recognized as having familial xanthinuria.
False, it's the Cavalier King Charles Spaniel.
67
What's the most common bacteria cultured from uroliths?
Staphylococcus spp.
68
What are the most common uroliths?
CaOx- and struvite-containing uroliths.
69
Is there a difference between culturing urine and culturing the stones?
We don't know! Dr. K doesn't typically culture them but prescribes antibiotic (clavamox) after lithotripsy for 3 days.
70
Is the renal cort responsive to glucagon?
Nope! Leer power point Wilkinson.
71
What are the main counter-regulatory hormones in response to hypoglycemia?
Glucagon and epinephrine. AW.
72
Increases in which hormones occur with prolonged hypoglycemia?
Cortisol and growth hormone. AW.
73
What's the first defense against hypoglycemia?
Insulin secretion inhibition by alpha-adrenergic nervous system and adrenomedullary catecholamines..
74
What's the third defense against hypoglycemia?
Release of catecholamines (by the sympathetic nervous system and adrenal medulla).
75
Peripheral nerv degeneration and demyelination can occur due to hypoglycemia. Y/N.
Yep! With chronic hypoglycemia, which is why dogs with insulinomas can have neuropathies.
76
Zona fasciculata can be on boards
77
Most of the liver gets its blood from...
Portal vein.
78
Types of cells of the liver?
Hepatocyte (60-80%), cholangiocyte, Kupfer cell. (2-5%), stellate cell, natural killer cell, etc etc.
79
Is liver involved in synthesis of cholesterol and lipoproteins and fatty acids?
Yep.
80
Why we see hypoglycemia in liver dysfunction?
Because one of the functions of the liver is glycogen storage, glycogenolysis, and glycogenesis.
81
Copper is excreted mainly in the urinary tract or biliary system?
Biliary system!
82
Excess hepatic copper or iron can lead to...
Oxidative damage.
83
Breeds predisposed to copper hepatopathies?
Labrador and doberman.
84
What is the function of the enzyme glutamine synthetase?
It converts glutamate to glutamine.
85
What is the most common type of inflammation of the hepatic parenchyma?
Lymphocytic, plasmacytic infiltration, mixed.
86
Other types of inflammation of the hepatic parenchyma?
Suppurative, granulomatous,, eosinophilic (the last one very unlikely).
87
Etiology of chronic hepatitis?
Infectious, toxic, drug associated, immune mediated.
88
Infectious causes of chronic hepatitis?
Viral (adenovirus: rare), bacterial (leptospirosis: acute but also chronic hepatitis), tick (ehrlichia), fungal (histoplasmosis), protozoal (leishmania), parasitic.
89
Drugs causing chronic hepatitis or acute injury or cirrhosis.
Phenobarbital (dose dependent), carprofen (idiosyncratic), sulfas, primidone (chronic), phenytoin (chronic), lomustine (chronic).
90
Unbound copper is toxic for the liver. Y/N.
Yep. Causes oxidative stress leading to hepatocellular degeneration and cell death with acute, chronic hepatic inflammation.
91
Breeds with genetic mutations in proteins involved with hepatic copper transport leading to copper hepatitis?
Bedlington terrier (COMMD1 bc of mutation in the ATP7B), Dalmatian, labrador retriever (ATP7B gene and ATP7A gene), doberman pinscher, westies.
92
Breeds associated with chronic hepatitis?
Labrador retriever, American cocker spaniel, English cocker spaniel, doberman, westie.
93
Breeds associated with copper associated hepatitis?
Labrador retriever, Dalmatian, skye terrier, doberman, westi, bedlington.
94
Why does chronic hepatitis cause PU/PD?
Hepatic encephalopathy (psychogenic polydipsia), build up of cortisol, y otra cosa.
95
Why does chronic hepatitis cause melena?
GI bleeding or disorders of coagulation.
96
Treatment of idiopathic canine hepatitis?
Immunosuppression (after other causes have been ruled out): Prednisolone, azathioprine, or cyclosporine.
97
Treatment for copper hepatopathy?
D-penicillamine PO on an empty stomach. Binds up the copper in the tissues and helps excreting it. + Dietary Cu restriction. For months based on their response.
98
Can azathioprine cause hepatotoxicity?
Yep, which is why some people don't use it for the treatment of canine hepatitis. For DeMonaco, mycophenolate como una forma más amigable de azatioprina porque el mecanismo de acción es similar).
99
Functions of denamarin?
Choleretic, immunomodulatory, blablabla
100
Is vitamin E antioxidant?
Yep.
101
Do we restrict protein in the diet of dogs with chronic hepatitis?
Nope, unless hepatic encephalopathy. It can lead to skeletal muscle atrophy which can be a source of ammonia detoxification and can make things worse.
102
Should we severely restrict protein in the diet of dogs with hepatic encephalopathy?
Moderate restriction of protein source or changing the source from animal to dairy or vegetable source. And titrate after. The liver regeneration needs proteins!
103
Mean survival time of dogs with chronic hepatitis?
18 months (561 +/- 260 days). Cirrhosis: shorter survival. Ascites and extent of fibrosis: poor prognosis factor. Same with hyperbilirubinemia and hypoalbuminemia.
104
Complications of liver dysfunction?
Portal hypertension, ascites, GI hemorrhage, HE.
105
Bartonella species more common pathologic in dogs?
B. henselae and B. vinsonii subs. berkhoffi.
106
Most common manifestations of bartonellosis in dogs?
Endocarditis (responsible for 20-30% of culture negative endocarditis in dogs), vascular proliferative lesions, granulomatous or pyogranulomatous disease.
107
Are vascular proliferative lesions related to bartonellosis?
Yes (peliosis hepatis, cavitary effusions, and others).
108
Is Bartonella associated with peliosis hepatis in cats?
Nope.
109
Bartonella's related neuro signs?
Seizures, ataxia, paraparesis, GME, meningoradiculoneuritis.
110
What's the reservoir host for bartonella?
Cats. May be a source of bartonellosis for pet owners.
111
Gold standard test for bartonella?
BAPGM (Bartonella-Alphaproteobacteria growth medium) enrichment with quantitative PCR.
112
Serology for bartonella in cats: clinical value?
High rate of seropositivity but may not be clinical important. (Hay diferentes strains asi que una puede dar positivo en un test y no en otro).
113
PCR for bartonella in cats: clinical value?
Can be positive and still not be causative organism.
114
First line recommendation treatment for bartonellosis?
Fluoroquinolone (enro vs prado) + doxycycline for 4-6 weeks or longer.
115
PCR can be repeated 2 weeks post discontinuation of antibiotics for bartonellosis and can be negative at that point. Y/N.
Yes.
116
SAIM, cardiology
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