Spring 2017

Question 1

A 5-year-old intact canine boxer has the following arterial and venous blood gas values
measured from samples obtained while breathing room air at sea level: PaCO2 = 40 mmHg,
PaO2 = 60 mmHg, SaO2 = 90%, pHa = 7.38, PvO2=50 mmHg, PvCO2=50 mmHg, pHv=7.33.
Calculate the alveolar – arterial gradient:
a) 40 mmHg
b) 30 mmHg
c) 25 mmHg
d) 20 mmHg

Answer 1

a) 40 mmHg

Question 2

A 21 kg, 4-year-old Bulldog presents for frequent coughing and increased respiratory effort.
Physical examination and diagnostics reveal the following: Temperature 40.2 0C (104.4 0F),
Pulse rate: 120 bpm, RR: 36 with increased effort, PCV: 47%, TP 68 g/L (6.8 mg/dl), Azostix 15-
26 mg/dL, Blood glucose 8.0 mmol/L (144 mg/dl), lactate 5.6 mmol/l, Doppler blood pressure of
120 mmHg, SpO2 on oxygen therapy: 90%. An arterial blood gas reveals the following: PaO2:
60 mmHg, PaCO2: 50 mmHg, pH: 7.29, HCO3-: 20 mmol/L
What factors present in this dog would be expected to shift the oxygen dissociation
curve and in which direction would the curve be expected to shift?
a) Acidosis and hypercapnia shift the curve to the left
b) Hyperthermia and acidosis shift the curve to the right
c) Hypercapnia and hypoxemia shift the curve to the left
d) Hyperthermia and hypoxemia shift the curve to the left

Answer 2

Hyperthermia and acidosis shift the curve to the right

Question 3

What is the oxygen cost of breathing, as a % of total oxygen consumption, during normal quiet respirations and how high can this value reach with respiratory distress?
a) 20% at rest and up to 80% with respiratory distress
b) 7% at rest and up to 40% with respiratory distress
c) 15% at rest and up to 60% with respiratory distress
d) 3% at rest and up to 30% with respiratory distress

Answer 3

3% at rest and up to 30% with respiratory distress

Question 4

What is the estimated change in resistance expected when the radius of a trachea goes from
10mm to 5 mm in a dog with partial airway obstruction?
a) The resistance should decrease by approximately 4 fold
b) The resistance should increase by approximately 16 fold
c) The resistance should decrease by approximately 8 fold
d) The resistance should increase by approximately 2 fold

Answer 4

b) The resistance should increase by approximately 16 fold

Question 5

Pulse oximetry differentiates oxygenated hemoglobin from deoxygenated hemoglobin utilizing the different absorption characteristics of red and infrared light. What wavelength of light does
deoxygenated hemoglobin absorb more of compared to oxygenated hemoglobin?
a) 600-750 nm
b) 850-1000 nm
c) 400-550 nm
d) 1100-1250 nm

Answer 5

a) 600-750 nm

Question 6

What type of bacteria is most commonly isolated from necrotizing soft tissue infections in small animals:
a. Clostridium spp.
b. Streptococcus spp.
c. Staphylococcus spp.
d. Candida spp.

Answer 6

b. Streptococcus spp.

Question 7

A 2-year-old male intact German shepherd dog presents to the emergency room with a
48-hour history of progressive weakness and difficulty walking. He is an indoor/outdoor dog that lives on a large farm. General physical examination is normal; the neurologic examination is
provided below.
Mentation: alert, responsive and appropriate.
CN: normal palpebral, pupillary light reflex, & menace bilaterally, normal facial sensation and
motor function, normal gag reflex.
Gait: non-ambulatory tetraplegia, but can wag his tail
Postural reactions: absent placing and hopping in all limbs
Spinal reflexes: absent withdrawal and patellar reflexes in rear limbs, forelimbs have minimal
withdrawal reflex, all limbs are hypotonic during passive motion
Sensory: No pain elicited on spinal palpation, superficial pain sensation is intact in all limbs
Electromyography testing reveals fibrillation potentials and positive sharp waves.
Based on this information the most likely diagnosis is:
a. Tick paralysis
b. Botulism
c. Myasthenia gravis
d. Polyradiculoneuritis

Answer 7

Polyradiculoneuritis

Question 8

An owner presents a 4-year-old Boston terrier because they notice a mass in their dog’s
eye today. The dog’s general physical examination is otherwise unremarkable. The ophthalmic
examination is below:
Parameter: Right eye Left eye
Schirmer tear test 23 mm 20 mm
Intraocular pressure 15 mm Hg 16 mm Hg
Pupillary light reflex (direct/indirect) +/+ +/+
Flare: negative negative
Vision: present present
Right eye: No apparent abnormalities.
Left eye: ~6 mm brown spheroid structure in dorsomedial anterior chamber which
transilluminates. No other apparent abnormalities.
Which is the most likely diagnosis:
a. uveal cyst
b. penetrating foreign body
c. iris melanoma
d. ciliary adenoma

Answer 8

a. uveal cyst

Question 9

Latanoprost ophthalmic drops would be a reasonable choice for the immediate treatment
of which disease process:
a. Glaucoma secondary to uveitis
b. Primary open-angle glaucoma
c. Anterior lens luxation
d. Dendritic corneal ulcers

Answer 9

Primary open-angle glaucoma

Question 10

An owner presents a 10-year-old golden retriever for bumping into objects. Your general
physical examination is normal. The neurologic examination is as follows:
Mentation: alert, responsive, appropriate
Cranial nerves: Pupils are equal in size. Normal palpebral, facial sensation, and gag reflex.
OD: absent menace response and direct pupillary light reflex; indirect pupillary light reflex is
present; absent dazzle.
OS: menace response and direct pupillary light reflex is present; absent indirect pupillary light
reflex
Gait: normal, noted to bump into things on the right side of head.
Spinal reflexes: normal withdrawal reflexes in all limbs, normal patellar and cranial tibial reflexes
bilaterally, and normal perineal and panniculus reflexes Postural reactions: Normal placing and
hopping in all limbs
Sensory: No pain elicited during manipulation of the neck and spinal cord
What is the most likely lesion localization?
a. Right lateral geniculate nucleus
b. Left occipital cortex
c. Optic chiasm
d. Right optic nerve

Answer 10

d. Right optic nerve

Question 11

Which of the following represents the mechanism by which a change in the partial pressure of carbon dioxide (PCO2) can result in a shift in the oxyhemoglobin dissociation curve?
a. Haldane effect
b. Boyle Law
c. Bohr effect
d. Charles’ Law

Answer 11

c. Bohr effect

Question 12

A dog is being ventilated on a critical care ventilator because of congestive heart failure.
The FIO2 is set at 0.70 and an arterial blood gas measurement provides the following
information: PaO2 = 175 mmHg; PaCO2 = 62 mmHg; Capnometry is also being used to monitor the patient, and the PETCO2 = 50 mmHg.
Calculate the physiologic dead space (as a percentage of tidal volume).
A. 5%
B. 9%
C. 19%
D. 22%

Answer 12

C. 19%

Question 13

How is the Free Water effect calculated using the Stewart approach to acid-base
interpretation in a dog?

a. 0.25 (measured [Na+] – normal [Na+])
b. 0.5 (measured [Na+] – normal [Na+])
c. 0.5 (measured [Na+] + normal [Na+])
d. 0.25 (measured [Na+] + normal [Na+])

Answer 13

0.25 (measured [Na+] – normal [Na+])

Question 14

The strong ion approach to acid-base analysis identifies changes in variables that
independently alter acid-base status. Which of the following is not one of the independent
variables?
A. Strong ion difference
B. Partial pressure of carbon dioxide
C. Bicarbonate concentration
D. Non-volatile ion buffer (ATOT)

Answer 14

C. Bicarbonate concentration

Question 15

A 3-year-old MN Pomeranian presents for vomiting and severe hemorrhagic diarrhea due to acute hemorrhagic diarrhea syndrome (AHDS). The following laboratory abnormalities are
noted: PCV: 65% (normal 35-45%); TS: 6.8 g/dl (normal 6-8 g/dl); pH: 7.25 (normal 7.35-7.45);
Na+: 135 mmol/l (mean normal 145 mmol/l); Cl- (corrected): 121 mmol/l (mean normal 110
mmol/l); K-: 3.0 mmol/l (normal 3.5-4.0 mmol/l). Which acid-base abnormality exists based on the strong ion approach to acid-base status?

a. Concentration alkalosis
b. Dilutional acidosis
c. Hyperchloremic acidosis
d. Organic acidosis

Answer 15

b. Dilutional acidosis

Question 16

Serum/plasma phosphorous levels can vary considerably throughout the day as a result
of a number of external factors. Which of the following influences can DECREASE
serum/plasma phosphorous concentrations?
A. Respiratory alkalosis
B. Hemolysis
C. Hyperlipidemia
D. Hyperproteinemia

Answer 16

A. Respiratory alkalosis

Question 17

Magnesium homeostasis is primarily regulated by the gastrointestinal tract and the
kidneys. Within the kidney, which segment of the nephron is responsible for the majority
of magnesium reabsorption?
A. Proximal tubule
B. Loop of Henle
C. Distal convoluted tubule
D. Collecting ducts

Answer 17

B. Loop of Henle

Question 18

Both serum calcium and potassium concentrations play a large role in the establishment
and maintenance of membrane potentials in excitable tissues. Which of the following
combination of disorders will cause cells to be the LEAST excitable?
A. Hyperkalemia and hypercalcemia
B. Hypokalemia and hypocalcemia
C. Hyperkalemia and hypocalcemia
D. Hypokalemia and hypercalcemia

Answer 18

Hypokalemia and hypercalcemia

Question 19

Which of the following hormones has the greatest effect on urinary potassium excretion?

A. Norepinephrine
B. Adrenocorticotropic hormone (ACTH)
C. Aldosterone
D. Renin

Answer 19

Aldosterone

Question 20

Magnesium has a very important role in cardiac excitability, contraction and conduction
through its regulatory effects of calcium. It also can be used in treating arrhythmias.
What is the mechanism of action of magnesium as an antiarrhythmic?
A. Magnesium limits intracellular calcium overload
B. Magnesium acts as a cofactor to help pump sodium and calcium into the cell
and potassium out of the cell
C. Magnesium serves as a “gate” to move calcium back into the sarcoplasmic reticulum
D. Magnesium acts as a co-factor in the calcium-ATPase pump

Answer 20

A. Magnesium limits intracellular calcium overload

Question 21

A recent study published in the Journal of Veterinary Internal Medicine found which of
the following when assessing the placement of endoscopically-guided gastrostomy tubes
in patients currently receiving treatment with corticosteroids versus patients not receiving
corticosteroids?
A. The general prevalence of both minor and major complications was similar in
patients receiving corticosteroids and patients not receiving corticosteroids.
B. The general prevalence of major complications increased in patients
receiving corticosteroids as compared to patients not receiving corticosteroids
C. The general prevalence of both minor and major complications was increased
in patients receiving corticosteroids as compared to patients not receiving
corticosteroids.
D. The general prevalence of major complications was decreased in patients
receiving corticosteroids as compared to patients not receiving
corticosteroids.

Answer 21

The general prevalence of major complications increased in patients
receiving corticosteroids as compared to patients not receiving corticosteroids

Question 22

According to a recent study, which of the following is true with regards to
nasogastric feeding tubes:
A. A lower rate of complication was seen with nasogastric as compared to
nasoesophageal feeding tubes.
B. A higher rate of complication was seen with nasogastric as compared to
nasoesophageal feeding tubes.
C. There was no difference in the rate of complication seen with nasogastric as
compared to nasoesophageal feeding tubes.
D. No complications were noted with either type of feeding tube.

Answer 22

There was no difference in the rate of complication seen with nasogastric as
compared to nasoesophageal feeding tubes.

Question 23

Which of the following is true of patients in a starvation state?
A. Insulin synthesis and secretion will be upregulated
B. Hepatic gluconeogenesis will be induced
C. Increased conversion of thyroxine (T4) to triiodothyronine (T3) will occur
D. Increased levels of serum glucagon will develop

Answer 23

Increased levels of serum glucagon will develop

Question 24

In short bowel syndrome, the removal of the ileum will lead to malabsorption of which of the
following vitamins:
A. Vitamin K
B. Vitamin B6
C. Vitamin B12
D. Vitamin E

Answer 24

C. Vitamin B12

Question 25

A pilot study, published in 2010 in the Journal of Veterinary Internal Medicine, showed which of the following when comparing the use of enteral versus parenteral nutrition in dogs with pancreatitis? A. Patients receiving enteral nutrition had an increased incidence of regurgitation compared to those receiving parenteral nutrition. B. Patients receiving enteral nutrition had a decreased incidence of regurgitation compared to those receiving parenteral nutrition. C. Patients receiving enteral feeding had a significantly increased incidence of post- prandial pain. D. Patients receiving enteral feedings required discontinuation of feedings due to intolerance.

Answer 25

Patients receiving enteral nutrition had a decreased incidence of regurgitation compared to those receiving parenteral nutrition.

Question 26

Timolol, which is often used in the management of acute glaucoma, has been shown to a. reduce intraocular pressure in normotensive eyes by 10%. b. be absorbed systemically leading to bradycardia. c. cause mydriasis in the treated eye. d. Cause ocular discomfort and blepheroconjunctivitis.

Answer 26

be absorbed systemically leading to bradycardia.

Question 27

Which of the following in NOT a true statement regarding ototoxicity caused by aminoglycosides? a. Damage to mitochondria plays an important role in the development of ototoxicity b. Prolonged treatment or high dosing can lead to loss of low frequency sounds. c. Loss of sensory hair cells of the vestibule can lead to balance issues. d. Hearing loss is typically temporary and returns within weeks to months.

Answer 27

Hearing loss is typically temporary and returns within weeks to months.

Question 28

Standard management strategies for melting corneal ulcers include all of the following except... a. Surgical treatment with a temporary tarsorraphy, conjunctival pedicle graft, or corneal transposition graft. b. Use of tetracycline to chelate calcium and zinc, which are cofactors necessary for matrix metalloproteinase (MMPs) activity. c. Autogenous serum to provide sources of alpha-1-antitrypsin, alpha-2-macroglobulin and tissues inhibitors of MMPs. d. Atropine to decrease ciliary spasm and minimize posterior synechiae formation.

Answer 28

Surgical treatment with a temporary tarsorraphy, conjunctival pedicle graft, or corneal transposition graft.

Question 29

A 4-year-old, female spayed Cavalier King Charles Spaniel presents to an emergency service for acute onset deafness. Otic examination revealed a normal external canal. The tympanic membranes appear to be bulging out slightly. Additionally, the dog has marked cervical pain with no conscious proprioceptive deficits or abnormal spinal reflexes. The patient ambulates normally. What is the most plausible differential for this pet? a. Middle ear inflammatory polyp b. Primary secretory otitis media (PSOM) c. Caudal occipital malformation d. Schwannoma

Answer 29

Primary secretory otitis media (PSOM)

Question 30

Fill the blank: The upregulation of ___________ in chronic kidney disease results in early calcitriol deficiency, which initiates renal secondary hyperparathyroidism. a) Parathyroid hormone b) Klotho c) 1-alpha hydroxylase d) Fibroblast growth factor 23

Answer 30

d) Fibroblast growth factor 23

Question 31

A 2015 retrospective study of risk factors and outcome predictors in cats with diabetic ketoacidosis found that the presence of increased concentrations of serum creatinine, urea nitrogen, _________ and bilirubin at the time of initial examination was associated with a poor outcome a) Ionized calcium b) Total magnesium c) Phosphorous d) Total calcium

Answer 31

b) Total magnesium

Question 32

Fill the blank: Independent of its effects on electrolytes, ________ therapy may be of benefit in chronic kidney disease because it also downregulates renin biosynthesis. a) Aluminum hydroxide b) Potassium citrate c) Calcitriol d) Amlodipine

Answer 32

Calcitriol

Question 33

Membrane excitability is determined by the difference between resting and threshold cell membrane potentials. Considering the major role each electrolyte plays in the establishment and maintenance of these transmembrane potentials, abnormal serum potassium and/or ionized calcium concentrations may impact the excitability of cardiomyocytes. In this regard, which of the following statements is correct? a) Hypokalemia increases the resting cell membrane potential (i.e., makes it more negative), thereby decreasing membrane excitability. b) Hyperkalemia increases the threshold cell membrane potential (i.e., makes it less negative), thereby increasing membrane excitability. c) Ionized hypercalcemia decreases the threshold cell membrane potential (i.e., makes it more negative), thereby increasing membrane excitability. d) Ionized hypocalcemia decreases resting cell membrane potential (i.e., makes it less negative), thereby increasing membrane excitability.

Answer 33

Hypokalemia increases the resting cell membrane potential (i.e., makes it more negative), thereby decreasing membrane excitability.

Question 34

A 17-year-old spayed female domestic shorthaired cat presents for evaluation of weakness, lethargy and hyporexia. She is indoor only and the only pet in the home. Her owner reports no significant prior medical history; however, she has not seen a veterinarian in approximately five years. When queried about water intake, her owner reports chronic and progressive polyuria and polydipsia at home. She is in thin body condition with moderate sarcopenia and cervical ventroflexion on physical examination. She is moderately dehydrated and hypertensive (180mmHg via Doppler). A venous blood gas obtained on triage documents hypernatremia (174 mmol/L), hypokalemia (2.0 mmol/L) and a hyperglycemia (225 mg/dl. What is the most likely primary cause for the patient’s clinical signs? a) Pyelonephritis superimposed upon chronic kidney disease b) Aldosterone-secreting adrenal tumor c) Diabetes mellitus d) Chronic kidney disease with renal secondary hyperparathyroidism

Answer 34

b) Aldosterone-secreting adrenal tumor

Question 35

Which of the following statements is NOT a proposed mechanism underlying the purported beneficial therapeutic effects probiotics? a) Immunomodulation b) Stimulation of mucin production and therefore inhibition of pathogenic bacterial invasion and attachment to the gut epithelium c) Induction of host cell antimicrobial peptides d) Induction of antibiotic-sensitivity by transferring plasmids to pathogenic bacteria

Answer 35

d) Induction of antibiotic-sensitivity by transferring plasmids to pathogenic bacteria

Question 36

Which of the following clinical situations would describe a patient at known risk for refeeding syndrome? a) Acute on chronic renal failure in an adult dog with anorexia of three days duration. b) Parvovirus enteritis in a puppy that has been clinically ill for approximately 24 hours. c) An adult cat with diagnosed with secondary hepatic lipidosis due to pancreatitis. d) An adult cat with a fever caused by a herpesvirus-associated upper respiratory tract infection.

Answer 36

c) An adult cat with diagnosed with secondary hepatic lipidosis due to pancreatitis.

Question 37

When choosing an enteral feeding device for a patient, there are many factors to consider. Which of the following is NOT a reason to abandon immediate placement of an enteral feeding device? a) The presence of respiratory distress. b) Evidence of severe facial trauma. c) Evidence of shock, hypotension or hypothermia. d) Small patient size.

Answer 37

d) Small patient size.

Question 38

Partial parenteral nutrition (PPN) can be administered through a peripheral intravenous (IV) catheter. Which statement best summarizes why this is feasible? a) Peripheral IV catheters are large-bore devices and allow for PPN dilution as it passes into peripheral veins. b) The osmolality of PPN solutions is less than 700 mOsm/kg and can therefore be delivered through a peripheral vein. c) The kilocalories provided in PPN are less likely to cause phlebitis than those of total parenteral nutrition. d) PPN solutions have a pH of greater than 4.0 and are therefore better tolerated by peripheral veins.

Answer 38

The osmolality of PPN solutions is less than 700 mOsm/kg and can therefore be delivered through a peripheral vein.