Spring 2019

Question 1

1. Which of the following statements regarding the compensatory mechanisms for hypovolemic shock is correct?
   a. Activation of the renin-angiotensin aldosterone system (RAAS) to increase sodium and water retention is the primarily mechanism responsible for increased cardiac output.
   b. Hypotension with poor pulse quality is the hallmark of compensated hypovolemic shock.
   c. Marked vasoconstriction and mobilization of fluid from the interstitial space into the intravascular space contributes to increased intravascular volume.
   d. In distributive shock, SVO2 is a consistent indicator of the adequacy of DO2.

Answer 1

c. Marked vasoconstriction and mobilization of fluid from the interstitial space into the intravascular space contributes to increased intravascular volume.

Question 2

2. When determining oxygen content of arterial blood (CaO2) which of the following components is the most significant contributor?
   a. PaO2
   b. CO2
   c. Hgb
   d. VO2

Answer 2

c. Hgb

Question 3

3. Which of the following conditions increases the oxygen extraction ratio (O2ER)?
   a. Oxygen supplementation
   b. Hypovolemia
   c. Increased cardiac output
   d. Mitochondrial dysfunction

Answer 3

b. Hypovolemia

Question 4

Which of the following statements regarding the shock index (SI) is correct?
a. The shock index is defined as the ratio of heart rate (HR) to packed cell volume (PCV)
b. A shock index of > 0.9 -1 has been shown to be both sensitive and specific for the detection of moderate to severe shock.
c. In people, the shock index is not reliable in the determination of those at higher risk of needing massive transfusions.
d. Shock index did not correlate with volume status in an anesthetized canine model of hemorrhagic shock while traditional parameters including central venous pressure, heart rate and mean arterial pressure did.

Answer 4

b. A shock index of > 0.9 -1 has been shown to be both sensitive and specific for the detection of moderate to severe shock.

Question 5

When a mandatory assisted breath is delivered during mechanical ventilation, the initiation, termination and inspiratory flow are controlled by…
Ventilator, ventilator, ventilator
Patient, ventilator, ventilator
Patient, patient, patient
Patient, patient, ventilator

Answer 5

Patient, ventilator, ventilator

Question 6

7. Which mode of ventilation reduces the work of breathing by overcoming the resistance created by ventilator tubing?
   A. Controlled Mandatory Ventilation
   B. Synchronous Intermittent Mandatory Ventilation
   C. Assist Control Mode
   D. Pressure Support Mode

Answer 6

D. Pressure Support Mode

Question 7

In the recent consensus statement published in JVECC on the use of antithrombotics, the authors proposed that for dogs and cats at risk for thrombosis and undergoing an elective surgical procedure, an antiplatelet agent should be discontinued 5-7 days prior to the procedure. What physiologic principle is this recommendation based on?
a. Approximate decline in drug concentration below 50% steady state.
b. Regeneration of fibrinogen.
c. Platelet life span.
d. Regeneration of COX-1 that was irreversibly inhibited.

Answer 7

c. Platelet life span.

Question 8

11. Which of the following is a main conclusion of the Hogan et al FAT CAT study, comparing two antiplatelet drugs in cats with heart disease
    Prevention of cardiogenic arterial thromboembolic events (CATE) can be achieved in all cats with the administration of clopidogrel
    b. Congestive heart failure and CATE are prevented with the use of clopidogrel over aspirin
    c. Clopidogrel is the agent of choice over aspirin to extend mean survival time in cats with heart disease
    d. Clopidogrel, as compared to aspirin, reduced recurrent CATE in cats with heart disease

Answer 8

d. Clopidogrel, as compared to aspirin, reduced recurrent CATE in cats with heart disease

Question 9

Which statement best reflects the mechanism of action of adenosine diphosphate (ADP) receptor antagonists?
a. Reversible inhibition of binding of the GP IIb/IIIa receptor to fibrinogen
b. Irreversible binding of exposed vWF at the site of endothelial injury
c. Decreased platelet fragmentation from bone marrow megakaryocytes
d. Reversible or irreversible inhibition of the P2Y12 receptor

Answer 9

d. Reversible or irreversible inhibition of the P2Y12 receptor

Question 10

Nonsteroidal anti-inflammatory drugs have antiplatelet effects that can be highly variable depending on their degree of specificity for which of the following enzymes in the platelet cytosol?
a. cyclooxygenase 1
b. lipoxygenase
c. leukotrienase 2
d. Endolipase

Answer 10

a. cyclooxygenase 1

Question 11

Which of the following is NOT a manifestation of target organ damage as a result of systemic hypertension?
Cardiomegaly
Concentric LV hypertrophy
Seizures
Pulmonary Hypertension

Answer 11

Pulmonary Hypertension

Question 12

Which of the following is true about blindness in dogs and cats due to systemic hypertension:
Retinal reattachment can occur after treatment of systemic hypertension
Restoration of vision occurs in about 80% of blind cats after treatment of systemic hypertension
The frequency of ocular lesions in systemic hypertension is generally about 40% in affected cats
Chronic onset of blindness as a result of bilateral exudative retinal detachment may be a presenting clinical sign in both species.

Answer 12

Retinal reattachment can occur after treatment of systemic hypertension

Question 13

According to the 2018 ACVIM Consensus Statement on hypertension, hypertensive emergencies requiring immediate, parenteral intervention should be managed in which fashion?
To decrease to normal blood pressure as quickly as possible.
To decrease the blood pressure approximately 10% per hour.
To decrease the blood pressure by 10% in the first hour and then to normal within 12 hours.
To decrease the blood pressure by 10% in the first hour, then by another 10-15% over the next few hours.

Answer 13

To decrease the blood pressure by 10% in the first hour, then by another 10-15% over the next few hours.

Question 14

. According the 2018 ACVIM Consensus Statement on hypertension, fenoldopam may be used to treat hypertension. This medication is a:
Dopamine A1-antagonist
Dopamine A1-agonist
Dopamine A2-antagonist
Dopamine A2-agonist

Answer 14

Dopamine A1-agonist

Question 15

Botulinum toxin induces flaccid paralysis by affecting which part of the neuromuscular junction:
a. Inhibition of acetylcholine binding to acetylcholine receptor
b. Prevention of presynaptic vesicle binding to the presynaptic membrane and release of acetylcholine into the synaptic cleft
c. Stimulating acetylcholine esterase degradation of acetylcholine
d. Increased degradation of the acetylcholine receptor

Answer 15

b. Prevention of presynaptic vesicle binding to the presynaptic membrane and release of acetylcholine into the synaptic cleft

Question 16

A functional test for myasthenia gravis can be performed by giving a patient which of the following drug and monitoring for immediate resolution of weakness.
a. Edrophonium
b. Pancuronium
c. Neostigmine
d. Pyridostigmine

Answer 16

a. Edrophonium

Question 17

Of the following snakes, which is most likely to result in paralysis and possible respiratory failure:
a. Copperhead snake
b. Eastern diamond back rattlesnake
c. Corn snake
d. Mojave rattlesnake

Answer 17

d. Mojave rattlesnake

Question 18

A 2 year-old, male castrated mixed breed dog who normally lives on a farm in Missouri presents in March with mydriasis and absent PLR with a positive menace response, regurgitation, fecal incontinence, distended urinary bladder with urinary incontinence, and bradycardia. What is your top differential diagnosis?
a. Tick paralysis
b. Dysautonomia
c. Tetanus
d. Addison’s disease

Answer 18

Dysautonomia

Question 19

Neuromuscular blockade induced by aminoglycoside antibiotics may be at least partially reversed by the administration of:
a. Dantrolene
b. 2-PAM
c. Roncuronium
d. Calcium

Answer 19

Calcium

Question 20

Which of the following is the main mechanism for developing vasodilation as a result of sepsis?
Nitric oxide increases cGMP concentration leading to vasodilation
Nitric oxide increases cAMP concentration leading to vasodilation
Nitric oxide decreases cGMP concentration leading to vasodilation
Nitric oxide decreases cAMP concentration leading to vasodilation

Answer 20

Nitric oxide increases cGMP concentration leading to vasodilation

Question 21

Which of the following is the correct statement regarding the relationship between mixed venous oxygen saturation (SmvO2) and central venous oxygen saturation (ScvO2) in healthy and septic shock patients?
ScvO2, sampled from the cranial vena cava tends to be higher than SmvO2 in healthy patients because of low O2 extraction ratio in the cerebrum
ScvO2 sampled from the cranial vena cava tends to be lower than SmvO2 in healthy patients because of high O2 extraction ratio in the kidney
ScvO2 sampled from the cranial vena cava tends to be higher than SmvO2 in septic shock patients because of high O2 extraction ratio in splanchnic and renal circulation
ScvO2 sampled from the cranial vena cava tends to be lower than SmvO2 in septic shock patients because of low O2 extraction ratio in splanchnic and renal circulation

Answer 21

ScvO2 sampled from the cranial vena cava tends to be higher than SmvO2 in septic shock patients because of high O2 extraction ratio in splanchnic and renal circulation

Question 22

What is the main component(s) of neutrophil extracellular traps induced by systemic inflammation or sepsis?
Cell-free DNA
Myeloperoxidase
Histone
All of the above

Answer 22

All of the above

Question 23

Which of the following is a proposed mechanism of hyperlactatemia in septic patients?
Epinephrine administration to septic patients induces hyperlactatemia via alpha-1 adrenergic stimulation
Mitochondrial oxidative stress damage and dysfunction due to sepsis can contribute to hyperlactatemia
Rapid infusion of large volume lactate Ringer’s solution to septic patients can induce a transient lactic acidosis
All of the above

Answer 23

Mitochondrial oxidative stress damage and dysfunction due to sepsis can contribute to hyperlactatemia

Question 24

Which of the following is a synthetic analog of dopamine with strong β1-agonist activity, some β2 and α1 activity, and no dopaminergic effects? Net effects of this drug generally include increased cardiac output, modest vasodilation, and little change in blood pressure.
a. Dobutamine
b. Dopexamine
c. Isoproterenol
d. Angiotensin

Answer 24

a. Dobutamine

Question 25

Which of the following is a potent β-receptor agonist with no α-receptor activity? Net effects generally include increased heart rate and cardiac output, vasodilation, and decreased blood pressure. a. Angiotensin II b. Isoproterenol c. Dopexamine d. Phenylephrine

Answer 25

Isoproterenol

Question 26

Which of the following may be noted with exogenous catecholamine administration? a. Increased blood glucose b. Increased lactate c. Increased shear-induced platelet reactivity d. All of the above

Answer 26

d. All of the above

Question 27

Which of the following statements regarding vasopressin receptors is correct? a. Activation of V2 receptors in vascular smooth muscle causes vasoconstriction at high doses and vasodilation in cerebral, renal, pulmonary and mesenteric vascular beds at lower doses b. Activation of V2 receptors in the kidney triggers fusion of aquaporin-2-bearing vesicles into of the principal cells of the collecting duct, leading to free water absorption c. Activation of V1 receptors in the bone marrow and endothelium inhibits release of platelets, von Willebrand factor and factor VIII. d. Activation of V1 receptors in the pituitary inhibits the release of adrenocorticotrophic hormone.

Answer 27

b. Activation of V2 receptors in the kidney triggers fusion of aquaporin-2-bearing vesicles into of the principal cells of the collecting duct, leading to free water absorption

Question 28

Hyperlactatemia is commonly associated with a change in acid-base balance. Which of the following statements is most correct in terms of the effects of lactate on the acid-base balance? a. As blood lactate levels increases there is a predictable and consistent decrease in pH b. The presence of increased blood lactate levels is referred to as lactic acidosis c. The conversion of pyruvate to lactate results in the production of hydrogen ions and is the cause of the acidifying effect. d. In the Stewart acid-base analysis method, increased lactate will decrease the strong ion gap and has an acidifying effect

Answer 28

d. In the Stewart acid-base analysis method, increased lactate will decrease the strong ion gap and has an acidifying effect

Question 29

Which of the following statements about aldosterone is correct? a. Aldosterone increases the sodium permeability of the basolateral aspect of the intercalated cells of the cortical collecting tubule b. Aldosterone decreases potassium excretion in the cortical collecting tubule c. The most important stimulus for aldosterone release is increased extracellular potassium concentration d. The most important stimulus for aldosterone release is increased angiotensin II levels, typically secondary to hyponatremia, hypovolemia or hypotension

Answer 29

c. The most important stimulus for aldosterone release is increased extracellular potassium concentration

Question 30

Which of the following stimuli DECREASES ADH secretion? a. Morphine administration b. Nausea c. Hypoxia d. None of the above

Answer 30

None of the above

Question 31

Which of the following statements is incorrect? a. Carbonic anhydrase catalyzes blood CO2 and intracellular red blood cell water to form carbonic acid. b. RBC carbonic acid dissociates into hydrogen and bicarbonate ions, with hydrogen ions then being largely combined with hemoglobin c. The chloride content of venous red blood cells is greater than that of arterial red blood cells d. Bicarbonate ions diffuse out of red blood cells and chloride ions diffuse in along their respective concentration gradients

Answer 31

Bicarbonate ions diffuse out of red blood cells and chloride ions diffuse in along their respective concentration gradients

Question 32

Furosemide acts on which co-transporter located in the luminal membrane of epithelial cells in the thick ascending limb of the loop of Henle? a. 2-sodium, 2-chloride, 1-potassium b. 1-sodium, 1-chloride, 2-potassium c. 2-sodium, 1-chloride, 2-potassium d. 1-sodium, 2-chloride, 1-potassium

Answer 32

d. 1-sodium, 2-chloride, 1-potassium

Question 33

According to the Aroch, I. et al study in 2009 (JVIM), regarding prognostic indicators for heat stroke in dogs, the following was noted regarding nRBCs? a. Dogs presenting with >18nRBC/100WBC had increased mortality b. Dogs presenting with elevations in PT/aPTT had increased mortality c. Dogs presenting with a platelet count <150K/uL had increased mortality d. Dogs presenting with leukopenia (<6K/uL WBC) had increased mortality

Answer 33

a. Dogs presenting with >18nRBC/100WBC had increased mortality

Question 34

According to the results of several studies (Bruchim Y. et al. JVIM 2006, Segev G. et al. Vet J 2015), mortality rate of dogs suffering severe heat stroke is generally around: a. 80-90% b. 70-80% c. 40-50% d. 10-20%

Answer 34

c. 40-50%

Question 35

There are 4 mechanisms of heat loss from the body. The definition of convection is: a. Electromagnetic, or heat exchange between objects in the environment b. Exchange between the body and environmental objects that are in direct contact with the skin, as determined by relative temperatures and gradients c. Disruption of heat by the energy required to convert the material from a liquid to a gas d. The movement of fluid, air or water over the surface of the body

Answer 35

d. The movement of fluid, air or water over the surface of the body

Question 36

Which of the following is true regarding adverse effects of treatment with alkylating agents? a. Chlorambucil causes severe bone marrow toxicity, which limits its use b. Idiopathic hepatotoxicity secondary to lomustine administration is generally mild and resolves with minimal intervention. c. Vomiting commonly occurs during administration of cyclophosphamide. d. Cyclophosphamide can result in hemorrhagic cystitis

Answer 36

d. Cyclophosphamide can result in hemorrhagic cystitis

Question 37

Which of the following is true regarding drug-induced infiltrative lung disease (ILD)? a. Treatment of ILD in dogs is centered around immunosuppression b. Drug-induced ILD has been reported in dogs receiving radiation therapy and cytarabine. c. Drug induced ILD occurs as a result of immune mediated pneumonitis and may be diagnosed by detecting antibodies against type II pneumocytes in an endotracheal wash sample d. ILD occurs commonly in veterinary patients receiving chemotherapy

Answer 37

b. Drug-induced ILD has been reported in dogs receiving radiation therapy and

Question 38

Hyperammonemic encephalopathy (HE) is a rare complication of intensive chemotherapy. Which of the following statements regarding this complication is true: a. HE is characterized by normal serum ammonia, respiratory acidosis, and elevated bilirubin. b. HE is treated prior to definitive diagnosis because of the rapidity of progression and associated grave prognosis. c. Pruritus is the most common clinical sign first reported in human patients with HE d. HE can be treated with supportive care in dogs, often times on an out-patient basis

Answer 38

HE is treated prior to definitive diagnosis because of the rapidity of progression and associated grave prognosis.

Question 39

According to the systemic evaluation of evidence on veterinary viscoelastic testing (PROVETS, JVECC 24(1) 1-56, which of the following statements were found to be true? TEG was superior to ROTEM in repeatability and accuracy of results ROTEM is the more cost effective system, as automatic pipetting reduces need for repeating the test Sampling sites (jugular vs. saphenous) had no significant effect testing results (such as R, K, α angle, MA or G Evidence supports standardization of temperature (at 37oC) to be used when performing TEG or ROTEM in veterinary patients

Answer 39

Sampling sites (jugular vs. saphenous) had no significant effect testing results (such as R, K, α angle, MA or G

Question 40

According to an original study in 2018 (JVECC) by Marschner, et al, prospective analysis of thromboelastography in dogs suffering from diseases which predispose them to thrombosis, which of the following was significantly associated with clot strength in dogs with a hypercoagulable TEG tracing? Interleukin-10 Hematocrit Interleukin-4 White blood cell count

Answer 40

Hematocrit

Question 41

In the 2015 study by Ward et al published in J Vet Intern Med, what was the effect on major complications and outcome when pacemakers were implanted during business hours (BH) versus after-hours (AH)? a. Higher rate of major complications (especially infectious) in AH; no difference in survival between groups b. Higher rate of major complications (especially infectious) in AH; higher mortality in AH group c. Lower rate of major complications (especially lead dislodgement) in AH; no difference in survival between groups d. Lower rate of major complications (especially lead dislodgement) in AH; higher mortality in BH group

Answer 41

Higher rate of major complications (especially infectious) in AH; no difference in survival between groups

Question 42

Pacemaker implantation should be considered in all dogs with: a. Persistent ventricular tachycardia b. Sinus node disease (asymptomatic sick sinus syndrome) c. Third degree and high-grade second degree atrioventricular block, only if symptomatic d. Third degree and high-grade second degree atrioventricular block, regardless of whether asymptomatic or symptomatic

Answer 42

d. Third degree and high-grade second degree atrioventricular block, regardless of whether asymptomatic or symptomatic