In veterinary patients with thyrotoxicosis
A. the absolute T4 values is the primary determinant of the clinical signs and severity of these signs.
B. there is rarely an inciting event that can be identified.
C. the degree and rate of change in the thyroid hormone is more important that the actual value itself.
D. there is a difference in total T4 and free T4 compared to patients with stable hyperthyroidism.
C. the degree and rate of change in the thyroid hormone is more important that the actual value itself.
In a recent study investigating urine sodium concentrations to distinguish between hypoadrenocorticism and nonadrenal causes of hyponatremia, a urine sodium value less than _________ suggests that hypoadrenocorticism is unlikely the cause.
A. 40 mmol/L
B. 20 mmol/L
C. 55 mmol/L
D. 30 mmol/L
D. 30 mmol/L
Cardiovascular manifestations of thyrotoxicosis include
A. a 50% decline in systemic vascular resistance through dilation of the resistance arterioles.
B. a decrease in cardiac output due to concentric hypertrophy of the myocardium.
C. increased concentrations of plasma and urine catecholamines.
D. increased mean arterial blood pressure due to an increased diastolic pressure.
A. a 50% decline in systemic vascular resistance through dilation of the resistance arterioles.
Which of the following may be indicated as part of perioperative treatment for a patient with a suspected pheochromocytoma?
A. Patient ideally receives two weeks of beta blockade prior to alpha-adrenergic blockade.
B. Anesthetic protocol to include premedication with an anticholinergic drug and acepromazine.
C. Post-operative anticoagulant therapy with heparin to reduce risk of thromboembolic complications.
D. Administration of calcium gluconate to promote vasodilation and to control ventricular arrhythmias.
Post-operative anticoagulant therapy with heparin to reduce risk of thromboembolic complications.
A prospective, observational study of 27 client-owned dogs with naturally occurring septic peritonitis was published in 2013. Investigators measured coagulation profiles including platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer and fibrinogen concentrations, total protein C (PC) and antithrombin (AT) activities, and thromboelastography (TEG) pre-operatively and on days 1 and 3 post-operatively. The major findings of this study included:
A. PC and AT deficiencies were more common, and mean activities were lower, in nonsurvivors compared to survivors
B. The maximum amplitude, α angle and coagulation index from preoperative TEG were significantly greater in survivors compared to nonsurvivors
C. Both A and B.
D. None of the above
C. Both A and B.
A prospective, observational study comparing 31 cats with naturally occurring sepsis to 33 healthy control cats was published in 2016. Investigators compared history; clinical signs; results of hematologic, serum biochemical, and hemostatic tests; diagnosis; and outcome between the two groups. The major findings of this study included:
A. Protein C and antithrombin were significantly lower in the septic group.
B. Disseminated intravascular coagulopathy was common in the septic group.
C. Median prothrombin time and activated partial thromboplastin time were both longer in the septic group.
D. On multivariate analysis, disseminated intravascular coagulopathy was associated with death in the septic group.
A. Protein C and antithrombin were significantly lower in the septic group.
According to the cell-based model of coagulation, which is the sole relevant initiator of coagulation in vivo?
A. Tissue factor
B. von Willebrand factor
C. Thrombin
D. Factor VIIa
A. Tissue factor
Which of the following does not control thrombin generation, according to the cell-based model of coagulation?
A. Activated protein C (aPC)
B. Tissue pathway factor inhibitor (TFPI)
C. Factor XIIIa (FXIIIa)
D. Thrombomodulin (TM)
C. Factor XIIIa (FXIIIa)
QuikClot Combat Gauze is the primary hemostatic dressing used by all branches of the military, per Committee on Tactical Combat Casualty Care (CoTCCC) guidelines. What are its primary active ingredient and mechanism of action?
A. Chitosan; cross-links red blood cells and platelets to form a mucoadhesive physical barrier
B. Kaolin; activates factor XII (FXII)
C. Smectite; absorbs plasma water, forms a clay substance that adheres to site of injury
D. Microporous polysaccharide derived from potato starch; absorbs plasma water, thereby concentrating platelets and clotting factors at the site of injury
B. Kaolin; activates factor XII (FXII)
A randomized cadaveric ex vivo study recently evaluated the mechanical strength of three regions of ventral abdominal wall in cats (preumbilical, umbilical and postumbilical) following full-thickness vs fascia-only closure. The major findings included which of the following?
A. Load to failure was lowest in the post-umbilical group.
B. Load to failure was similar in males and females.
C. There was no difference between fascia-only and full thickness closure.
D. Both A and C are correct.
D. Both A and C are correct.
A retrospective study recently evaluated the influence of preoperative septic peritonitis (PSP) and stapled vs hand-sewn anastomoses on the incidence of intestinal resection and anastomosis (IRA). The major findings included which of the following?
A. Risk factors for dehiscence included stapled anastomoses in a PSP patient
B. Risk factors for dehiscence included hand-sewn technique in a PSP patient
C. PSP was a risk factor for dehiscence; there was no association between technique and risk for dehiscence in dogs with PSP.
D. Indication for IRA significantly influenced risk for dehiscence.
B. Risk factors for dehiscence included hand-sewn technique in a PSP patient
A randomized nonblinded controlled crossover study of surgical personnel (veterinary students, technicians, interns, residents and faculty in a veterinary teaching hospital (n=21) recently evaluated the influence of nail characteristics on surface bacterial counts. Major findings included which of the following?
A. Duration of nail polish application was a risk factor for increased bacterial counts.
B. Chipped nail polish was a risk factor for increased bacterial counts.
C. Nail biting was a risk factor for increased bacterial counts.
D. Nail length was a risk factor for increased bacterial counts.
D. Nail length was a risk factor for increased bacterial counts.
What type of surgical needle is designed to pierce tissue with a sharp tip and spread the tissue without cutting it and may be best used in the intestines?
A. Cutting
B. Reverse cutting
C. Taper
D. Blunt point
C. Taper
In a 2018 study by Grimes et al of dogs with uroabdomen, what was the prognosis for dogs that had surgical intervention for a uroadomen?
A. Good, 79% of dogs with surgical intervention survived to hospital discharge
B. Fair, 58% of dogs with surgical intervention survived to hospital discharge
C. Excellent, 91% of dogs with surgical intervention survived to hospital discharge
D. Guarded, 49% of dogs with surgical intervention survived to hospital discharge
C. Excellent, 91% of dogs with surgical intervention survived to hospital discharge
The security of a suture knot is determined by multiple factors. Which of the following is NOT one of those factors?
a. Tissue tension
b. Length of the cut ends
c. Structural conformation of the knot
D. Material coefficient
a. Tissue tension
A 25 kg 3-year-old male neutered Golden Retriever presents 30 minutes following ingestion of 43 mg/kg of carprofen. Emesis is induced via administration of apomorphine, the dog is administered Toxiban (activated charcoal with Sorbitol) and started on Misoprostol, an H2 blocker and intravenous lactated Ringer’s solution at 100 ml/hr. A physical examination and complete blood work performed 6 hours following admission reveals a lactate of 5.4 mmol/l (< 2.5 mmol/l), pH 7.32 (7.35-7.45), HCO3 18 mmol/l (20-24 mmol/l), PvCO2 32 (35-40 mmHg), heart rate 96 BPM, respiratory rate 22 bpm, temperature 38.4o Celsius (101.1 o Fahrenheit) with all other parameters, including blood pressure, within reference limits. The most likely cause of hyperlactatemia in this patient is type…
B1 lactic acidosis
B2 lactic acidosis
B3 lactic acidosis
B4 lactic acidosis
B2 lactic acidosis
In a recent retrospective study of 67 critically ill dogs with hypotension hospitalized in the intensive care unit (JAVMA, Vol 246, No. 1, January 1, 2015), what were the odds of survival in dogs that did not have hyperlactatemia compared to dogs that did have hyperlactatemia?
2.41 times as likely to survive
4.16 times as likely to survive
3.23 times as likely to survive
5.52 times as likely to survive
3.23 times as likely to survive
A 2-year-old mix breed female spayed dog weighing 20 kg presents for vomiting. The dog is diagnosed with a septic abdomen secondary to a foreign body causing GI perforation. Following initial resuscitation and therapy the dog is taken to surgery. While receiving positive pressure ventilation under anesthesia the dog’s mean arterial blood pressure falls to 45 mmHg, heart rate is 156 BPM, and the pulse pressure variation (PPV) is calculated at 8%. Based on these findings and recent veterinary literature, what can you conclude about this patient’s intravascular volume status? The patient is most likely…
A fluid non-responder
A fluid responder
Difficult to ascertain based on the information given
Both A and B
A fluid non-responder
The 3 causes of death commonly reported in cats with hypertrophic cardiomyopathy are congestive heart failure, arterial thromboembolism and sudden death. What are two risk factors associated with increased risk of death for all three causes?
left atrial fractional shortening and left ventricular septal wall thickness
spontaneous echo-contrast and an auscultable gallop rhythm
left atrial to aortic root diameter and left atrial emptying fraction
systolic anterior motion of the mitral valve and regional wall hypokinesis
left atrial to aortic root diameter and left atrial emptying fraction
To minimize the adverse effects of reperfusion injury after achieving return of spontaneous circulation (ROSC) following cardiopulmonary arrest (CPA), supplemental oxygen should be titrated to what arterial partial pressure of oxygen (PaO2)?
200 – 300 mmHg
100-200 mmHg
80-100 mmHg
60-80 mmHg
80-100 mmHg
Which of the following statements is MOST CORRECT in describing the mechanisms of microparticle formation?
A. When the cell becomes activated the enzyme complex, floppase, transports the negatively charge aminophospholipids from the outer membrane leaflet to the inner membrane leaflet.
B. Intracellular calcium increases as a consequence of cellular activation and this results in the increased activity of scramblase and floppase and reduction in the activity of flippase.
C. Increased intracellular cytosolic calcium originating uniquely from the endoplasmic reticulum results in reorganization of the cytoskeletal structures and membrane blebbing.
D. Cellular activation results in disruption of the phospholipid asymmetry, leading to membrane contracture and budding resulting in internalization of the biologically active aminophospholipids within the microparticle.
Intracellular calcium increases as a consequence of cellular activation and this results in the increased activity of scramblase and floppase and reduction in the activity of flippase.
Which of the following statements MOST ACCURATELY describes the role microparticles have in the activation of the coagulation cascade.
A. Microparticles are derived from the plasma cell membranes of platelets which contain tissue-factor and activate the extrinsic coagulation pathway.
B. Microparticles are derived from the plasma membrane of multiple cell types and express negatively charged aminophospholipids, which support the enzymatic reactions involved in various hemostatic processes.
C. Microparticles are derived from the plasma membrane of endothelial cells and express endothelial protein C receptor (EPCR) which binds protein C , resulting in its inactivation.
D. Microparticles are not implicated in the pathophysiological state of coagulation.
Microparticles are derived from the plasma membrane of multiple cell types and express negatively charged aminophospholipids, which support the enzymatic reactions involved in various hemostatic processes.
What is the MOST ACCURATE description of the pathophysiological state of this patient?
A. There is a state of overwhelming proinflammatory immune reaction mediated by cytokines creating a cytokine storm.
B. There is an appropriate initial host response to the microbial infection with localization of the infection and the immune response to the peritoneal cavity.
C. There is a state of hyperinflammation which has evolved into disseminated intravascular coagulation.
D. There is a state of dysregulation in the immune system, with the presence of both proinflammatory and anti-inflammatory cytokines.
D. There is a state of dysregulation in the immune system, with the presence of both proinflammatory and anti-inflammatory cytokines.
Which is the MOST CORRECT description of how the immune system response is initiated in this patient with a bacterial infection?
A. Toll-like receptors on innate immune system cells recognize the extracellular “Alarmins”, which are released due to tissue damage secondary to the invading microbes.
B. Pathogen-associated molecular patterns (PAMPS) are recognized by the innate immune system by pathogen recognition receptors (PRRS) which results in the activation of signal transduction cascade.
C. DAMPS (damage–associated molecular patterns) are released from damaged and apopotic cells and bind to the innate immune system cells via nuclear factor kappa beta (NF-Kβ).
D. RANTES (regulated upon activation, normal T cell expressed and secreted) is secreted by the innate immune system when a monocyte-antigen presenting cell binds to dendritic cells.
Pathogen-associated molecular patterns (PAMPS) are recognized by the innate immune system by pathogen recognition receptors (PRRS) which results in the activation of signal transduction cascade.
