VTNE Critical Care

Pre-renal azotemia is most commonly caused by which of the following?

Chronic renal failure

Dehydration

Urethral obstruction

Acute renal failure

Pyelonephritis

Dehydration

Dehydration is the most common cause of pre-renal azotemia. Azotemia is the term for elevated renal values (BUN and creatinine). When a patient is dehydrated, renal values may be elevated. When re-hydration occurs, renal values should return to normal.

Renal failure (acute or chronic) causes primary renal azotemia.

Post-renal azotemia is most often caused by obstruction either in the bladder or urethra, which prevents urine from being voided.

You are working in the large animal ward at the hospital. You are receiving a horse that needs immediate treatment for dehydration. The vet asks you to calculate the fluid deficit for this horse. He is a 950-pound horse that is about 7% dehydrated. What is his fluid deficit?

63 L

15 L

5 L

30 L

30 L

You can estimate the fluid deficit by the following formula:

Body weight in kg X % dehydration = Liters needed to re-establish hydration

So for this horse:

950 pounds/2.2 pounds per kilogram (pounds cancel out) = 431.8 kg (will round up to 432kg)

Now, multiply by percent dehydrated:

432 kg X 0.07 (which is 7%) = 30 Liters

A client calls to schedule an appointment and tells you his male cat is straining to urinate in his litter box but no urine is seen in the box. He wants to know if it would be okay to give him some leftover Clavamox from when he had a skin infection last month. What should you tell him?

Bring the cat in immediately for an exam

Have him pick up some non-absorbable litter from the clinic so that he may collect a urine sample at home when the cat finally urinates

Give 1/2 teaspoon of cod liver oil because although it appears he is straining to urinate, he is likely constipated

Tell him to give the leftover Clavamox he has in his cabinet and come in first thing tomorrow

morning so the doctor can collect a urine sample

Orally syringe water to keep him hydrated and schedule an appointment for tomorrow morning since there are no open appointments today

Bring the cat in immediately for an exam

A male cat straining to urinate is always an emergency. If the cat has a urethral obstruction, this can be immediately life-threatening. The cat needs to be examined so that the doctor can assess the cat and palpate his bladder.

Performing an abdominocentesis involves which of the following?

Withdrawing fluid from the abdomen

Removing an organ from the abdomen

Obtaining a urine sample from the abdomen

Making an incision into the abdomen

Withdrawing fluid from the abdomen

"Centesis" is the act of puncturing a body cavity or hollow organ in order to remove fluid; therefore, abdominocentesis implies the removal of fluid from the abdominal cavity. Similarly thoracocentesis would be removal of fluid from the chest cavity. A cystocentesis describes the removal of fluid from the urinary bladder. Terms that involve the removal of an organ usually end with "-ectomy". Examples of terms would include splenectomy, nephrectomy, and lung lobectomy.

A large canine patient that has been in the hospital developed a decubital ulcer. What is likely causing this?

Improper nutrition

Kidney function is declining

Pressure from laying in one position for too long

MRSA infection

Pressure from laying in one position for too long

A decubital ulcer is the proper term for a pressure sore. This is more common in patients that are not ambulatory and lay in the same position for too long; this is why patients must be turned and moved regularly.

A Dachshund presents for back problems and the dog is ambulatory but very unsteady in both hindlimbs. The doctor suspects an intervertebral disk protrusion that is affecting the spinal cord. Regarding the gait, this dog has:

Vestibular syndrome

Paralysis

Hypermetria

Plegia

Paresis

Paresis

Paresis is partial loss or impaired movement; this is when motor is still present. A dog with paresis of both hindlimbs would have "paraparesis".

Paralysis and plegia are terms used to describe lack of any voluntary motor.

Hypermetria is an exaggerated gait caused by cerebellar disease.

Pets with vestibular syndrome often have an abnormal gait and will veer toward one side or the other and have difficulty standing, but this is not a lack of motor.

A 12-year old flat coated retriever presents early for an appointment with a 24-hour history of lethargy. The patient is alert and responsive, has very strong pulses, and a heart rate of 160 beats per minute. The veterinarian has just begun a new pet appointment with a long-term client. This patient should be:

Brought into the treatment area and be immediately examined by the veterinarian.

Started on IV fluids immediately, prior to the veterinarian's examination

Allowed to stay in the lobby until the patient's appointment time

Transferred to the local emergency clinic immediately

Brought into the treatment area and monitored until the veterinarian is finished with the current appointment

Brought into the treatment area and be immediately examined by the veterinarian.

This patient is most likely in compensatory shock and should be examined by a veterinarian immediately. A heart rate of 160 is well over the normal range for a large dog and very strong pulses are often bounding pulses indicating hypovolemia. Sending this patient to another clinic will delay treatment, and that decision should be left to the attending veterinarian. Intravenous fluids may or may not be indicated depending on the dog's diagnosis, and the decision to administer them should also be left up to the veterinarian.

You have a bottle of 50% Dextrose. You are asked to add it to a bag of LRS for a pet in diabetic ketoacidosis to create a 2.5% solution. The pet has 800 mL left in his bag. How much will you add to his bag?

60 mL

40 mL

20 mL

25 mL

80 mL

40 mL

800 mL X 0.025 = 20 mL. If this were 100% dextrose, adding 20 mL to the bag would create the 2.5% concentration. Since it is 50% dextrose, this number must be doubled: So, 20 mL X 2 = 40 mL

Draw out 40 mL from the bag (now there are 760 mL left in the bag). Add in 40 mL of 50% Dextrose. Now, 2.5% of the total 800 mL is Dextrose. Double check the math: 40 mL/ 800mL = 0.05 (i.e. 5%) divided by 2 {because it was 50% dextrose that was added) = 0.025 = 2.5%.

You are working in the emergency clinic and are assisting with treating a dog that has been hit by a car. You are asked to set up for a blood transfusion, and the doctor would like you to give whole blood. A whole blood transfusion would include which of the following components?

Plasma, red blood cells, white blood cells, and platelets

Plasma and red blood cells only

Platelets, plasma, and red blood cells

White blood cells and red blood cells only

Plasma, red blood cells, white blood cells, and platelets

The correct answer is plasma, red blood cells, white blood cells, and platelets (everything that is found in whole blood).

You are working at an emergency practice and a woman brings in her ferret "Macy" who is obtunded. The ferret is very weak and appears neurologic. The veterinarian suspects an insulinoma, which is the third most common tumor in the ferret. If this is the case, what laboratory finding would you expect?

Hypoglycemia

Hypokalemia

Hyperglycemia

Ketones in the urine

Hypoglycemia

An insulinoma is a tumor on the pancreas. The tumor causes the pancreas to secrete excess insulin. Insulin causes the blood sugar to decrease. A low blood sugar is called hypoglycemia. This can lead to neurologic symptoms and extreme weakness seen in this patient.

Ketones in the urine would be more common in a chronic diabetic (hyperglycemic) patient. Hypokalemia is a low potassium and can cause extreme weakness and ventroflexion of the neck.

You are checking the fax machine and get a report from the local emergency clinic that a patient from the hospital where you work presented overnight for severe urticaria. What did this patient have?

Tremoring

Limping

Nasal discharge

Hives

Diarrhea

Hives

Urticaria are hives. They are often itchy, red, raised welts on the skin surface. They are typically caused by an acute allergic reaction.

A 6-year old collie presents after falling out of a moving vehicle. The dog has an open tibial fracture and pulmonary contusions. What would be the best way to immediately stabilize the fracture?

Splint

Tourniquet

Internal stabilization

External stabilization

Robert-Jones bandage

Robert-Jones bandage

Definitive stabilization, internal (plate or screws), or external fixation cannot be performed until the patient is stable for anesthesia; these would not be recommended immediately following the accident due to the presence of pulmonary contusions. Temporary stabilization with a Robert-Jones compression bandage would be best. Placing a Robert-Jones bandage on a broken femur is contraindicated as this could act as a fulcrum and cause further displacement of the fragments. Tourniquets for long periods of time can be dangerous.

A 2-year old dachshund presents with acute urticaria and facial swelling. Which of the following would be a most likely cause for this presentation

Drug eruption

Insect sting

Flea allergy dermatitis

Contact dermatitis

Insect sting

While any of these choices may cause hives, the most common cause for an acute reaction such as this is an insect bite or sting. This patient should be assessed and treated for an allergic reaction, which most often includes administration of diphenhydramine (Benadryl) and dexamethasone. Epinephrine may be used in cases of anaphylaxis when the patient is collapsed in a state of shock.

Your clinic has decided to start harvesting blood from volunteer donors to administer to patients. How long can whole blood units be stored in the refrigerator if properly collected?

35 days

3 months

45 days

1 year

21 days

35 days

Whole blood units may be stored for 35 days if the unit is collected aseptically, stored appropriately and mixed daily.

Anemia would likely result from a heavy infection with which parasite?

Dipylidium

Ancylostoma

Toxocara

Cystoisospora

Ancylostoma

The most significant risk to an animal with hookworms is anemia. Hookworms live in the small intestine and ingest blood. Ancylostoma and Uncinaria are the two hookworms in dogs and cats (hookworm eggs are shown in this photo).

Cystoisospora (coccidia) can cause a significant bloody diarrhea in some cases, which could lead to anemia, but this is not as likely as with hookworms.

A 3-year old female Yorkie presents to your hospital as an emergency for seizures and tetany. In the history, you learn that the bitch had a litter of 3 puppies about 2 weeks ago. What is the most likely treatment this dog will need to correct the cause of its problem?

Calcium gluconate IV

Tetanus anti-toxin

Diazepam IV

Phenobarbital

Calcium gluconate IV

The correct answer is calcium gluconate IV. Puerperal tetany (eclampsia) is often seen in post-partum toy breed dogs. Emergency treatment for these patients is IV calcium in the form of calcium gluconate. Diazepam (either IV or per rectum) can be given to stop the seizures, but does not treat the problem of hypocalcemia. Tetanus intoxication is less likely in this patient.

An 11-year old intact male Golden Retriever presents with respiratory distress and a temperature of 106.7 F. The attending veterinarian has gone to talk to the client and has requested that the patient be cooled. To what temperature should the dog be cooled?

104.0

99.0

100.0

103.0

102.0

103.0

A patient will continue to cool despite cessation of active cooling, so a patient should not be cooled past the high end of the normal temperature range. Normal temperature range is 101-102.5F in dogs and cats.

An 8-month old Siamese kitten presents for ataxia, and the veterinarian suspects the kitten has "water on the brain" due to her enlarged head size. What is the term for this?

Hydrocephalus

Paracervical edema

Brachycephalus

Craniostosis

Hydrocephalus

Hydrocephalus is a build-up of cerebrospinal fluid inside the skull, leading to brain swelling. Hydrocephalus means "water on the brain".

A butterfly catheter is most commonly used to:

Administer an IV injection

Give intraosseous fluids

Collect a urine sample

Give tube feedings

Administer an IV injection

Butterfly catheters have a smaller gauge needle with plastic "wings" attached below the hub that are used to help stabilize the needle on insertion. These catheters are often used to administer IV medications or to draw blood from the medial saphenous vein in cats.

A 60 lb Bulldog is to receive intravenous fluids at a maintenance rate. Assuming the maintenance rate can be calculated as 60 ml/kg/day, what would the fluid rate be per hour? Round answer to the closest milliliter/hour.

150

68

108

163

30

68

The answer is 68. 60 lb/2.2 kg/lb = 27.27 kgs in weight. 27.27 x 60 ml/kg = 1636 ml/day.

1636 ml/day / 24hrs/day = 68 ml/hour

You are working in the ICU; a dog on a high rate of fluids has a very sudden drop in urine production in his urine collection bag. What do you do first?

Perform a urine sediment examination

Immediately notify the veterinarian on call immediately

Run a BUN and creatinine to check kidney function

Flush the urinary catheter with sterile saline

Flush the urinary catheter with sterile saline

First, flush the catheter and make sure the line didn't get kinked, etc. If the urine production had been good and suddenly urine production slowed dramatically, it is likely a result of some mechanical issue. If the catheter flushes normally and all appears OK, call the veterinarian immediately.

When performing CPR in the neonatal calf which are the two most critical procedures to begin?

Establishing an airway and venous access

Establishing venous access and cardiac compressions

Cardiac compressions and establishing an airway

Cardiac compressions and administration of drugs

Establishing venous access and administration of drugs

Cardiac compressions and establishing an airway

Establishing an airway and adequate cardiac compression rate first contribute to positive outcomes when performing CPR in the neonatal calf.

A dog is hit by a car and presents in a Schiff-Sherrington posture. Which is true regarding this condition?

It causes paralysis of the hindlimbs

It is caused by a brain lesion, usually from trauma

It causes hindlimb hypertonicity

The lesion is located at C1-C5

It causes forelimb paralysis

It causes paralysis of the hindlimbs

The Schiff-Sherrington response is an autonomic reflex that is seen when the animal is in lateral recumbency (lying on its side). The propriospinal tract in the T3 to L3 spinal cord is damaged in this condition, and the forelimbs exhibit extensor hypertonicity (they are stiff). The forelimbs are not paralyzed but, when left alone, will extend. Also, paralysis caudal to the lesion is often seen (hindlimbs are paralyzed).

If both forelimb extensor hypertonicity and hindlimb paralysis are seen, it is generally due to a very severe spinal cord injury described as causing Schiff-Sherrington posture.

A dog presents with Gastric Dilatation and Volvulus (GDV), and you have tried multiple times to pass an orogastric tube to no avail. If this is not working what else can be done?

Trocharize the stomach ventrally

Flip the patient over

Prep the dog for surgery and not decompress the stomach

Trocharize the stomach on the right side

Trocharize the stomach on the right side

Decompression should be performed; the best place for the trocharization is on the right side. Trocharization involves passing a large sterile needle or catheter through the abdominal wall into the stomach to relieve the gas within the stomach. This is necessary in order to make the patient more stable prior to surgery.

You are new on the ICU floor and are taking time to look through the crash cart so you will be prepared when emergency arises. You find a 60 cc syringe attached to a 3-way stopcock and extension set with a 22-gauge needle attached. What might this setup be used for?

Decreasing intracranial pressure

Tracheal drug administration

Jugular catheter placement

Thoracocentesis

Thoracocentesis

This is commonly used for removing fluid from the pleural space (pleural effusion).

A 10-year old Golden Retriever presents with a distended abdomen, and when you touch his belly you notice a fluid wave. What is the medical term for free fluid in the abdomen?

Ascites

Pericardial effusion

Pleural effusion

Hemoabdomen

Ascites

Ascites is free fluid in the abdomen.

Pleural effusion is fluid around the lungs in the pleural space.

Pericardial effusion is fluid surrounding the heart in the pericardial sac.

Hemoabdomen is one type of ascites, specifically blood in the abdomen.

What is an expected finding in a patient with Hypervitaminosis D, or Vitamin D toxicity?

Hypoglycemia

Hyperkalemia

Hypocalcemia

Hypokalemia

Hypercalcemia

Hypercalcemia

Vitamin D is the building block of calcitriol, which works with parathyroid hormone. Calcitriol increases absorption of calcium and phosphorus from the intestines and decreases their excretion in the urine. In so doing, calcium levels in the blood rise and PTH levels drop.

So, when vitamin D is too high from intake, calcium is too high (there is no negative feedback mechanism with PTH).

A patient presents with rodenticide toxicity and is hemorrhaging. The doctor decides the animal needs a transfusion. What blood product is most likely to help stop the patient's bleeding?

Packed red blood cells

Stored plasma

Any blood product will do

Fresh frozen plasma

Fresh frozen plasma

Rodenticide toxicity causes hemorrhage by inhibiting vitamin K1 clotting factors. Fresh frozen plasma provides coagulation factors. Fresh whole blood could be used as well because it also contains coagulation factors; however, this was not an option in this question.

Packed red blood cells don't have any coagulation factors since the plasma has been removed.

Stored plasma has plasma proteins only. Platelets or coagulation factors are no longer present at significant levels.

In a cow that is having difficulty calving and seems to have her legs splaying out from underneath her, you are most concerned about damage to which nerve?

Peroneal

Tibial

Obturator

Femoral

Obturator

Obturator nerve paralysis (ONP) is most common. This nerve is responsible for adducting the hind limbs and runs from the spinal cord into the birth canal before it innervates the inner thighs. During birthing, this nerve can become crushed and lead to this problem.

Circling is usually a result of which type of disease?

Renal

Brain

Spinal cord

Cardiac

Brain

Circling is when an animal circles to the right or left and is usually a sign of brain/neurologic disease.

A rancher pulls into the clinic you are working at and rushes in to say his horse is having difficulty breathing. You assist the vet in examining the horse and note that the horse is in respiratory distress. He has dilated pupils and bright red mucous membranes. You are asked to pull blood for testing which you note is also bright red in color. Which of the following may cause this in the horse?

Choke

Walnut toxicity

Cyanide toxicity

Chronic Obstructive Pulmonary Disease (COPD)

Cyanide toxicity

The correct answer is cyanide toxicity. The bright red-colored blood and mucous membranes with signs of respiratory distress are typical findings for cyanide toxicity. There are many plants that can accumulate cyanide to levels that are toxic to horses. They include Sudan and Johnson grasses, cherries (chokecherries), and Sorghum. Treatment is with sodium nitrate or sodium thiosulfate IV.

Use of black walnut shavings in horse bedding can cause laminitis. Choke is an obstruction in the esophagus. It may cause coughing or distress, but not bright red blood. COPD, also called heaves due to heavy expiration, can be caused by dusty or moldy hay, dust and molds in bedding, or pollens, dust and other irritants in the environment. Horses housed with these symptoms should be led out to pasture to remove them from the irritating environment.

A multi-lumen jugular catheter must be placed in a canine with renal disease for CVP monitoring. To what anatomical landmark should the catheter be inserted to?

Caudal vena cava

Aorta

The heart

Third thoracic vertebrae

Thoracic inlet

Third thoracic vertebrae

Central venous pressure, or CVP, monitoring must be performed according to specific guidelines to reduce the possibility of inappropriate readings. The third thoracic vertebra is the anatomical landmark that the normal values are based on.

Electrical activity that serves as the pacemaker in the heart originates from what specific area?

Bundle of His in the left ventricle

Atrioventricular node in the right atrium

Bundle of His in the right ventricle

Sinoatrial node in the left atrium

Atrioventricular node in the left atrium

Sinoatrial node in the right atrium

Sinoatrial node in the right atrium

In health, the pacemaker of the heart is the sinoatrial node within the right atrium. This impulse is transmitted to the atrioventricular node located at the top of the interventricular septum, followed by the bundle of His (within the walls of the interventricular septum) and through the Purkinje system.

A 3-year old female cow presents with a decreased appetite, decreased manure production, and decreased milk production. She calved three weeks ago and has been less active than normal. You auscultate the GI tract and elicit a pinging noise on the left side of the abdomen. Which of the following emergencies is most likely to be occurring?

Left displaced abomasum

Right displaced abomasum

Mastitis

Uterine prolaps

Left displaced abomasum

Symptoms of left displaced abomasum include decreased appetite, activity, manure production, and milk production. Eliciting a pinging noise while flicking the abdominal area is an indication of a displaced abomasum. Because the pinging was found on the left, it is most likely a left displaced abomasum.

Which part of the brain coordinates motor activity? Disease of this part of the brain can cause a hypermetric gait.

Brainstem

Cerebellum

Cerebral cortex

Frontal lobe

Cerebellum

The cerebellum has a major role in motor control. It helps to coordinate voluntary movement and is located just above the brainstem. Hypermetria is an exaggerated gait in which the movements extend beyond what is intended.

Generally, how much time do you have before cardiac arrest causes irreversible brain damage?

Seven minutes

Three minutes

Ten minutes

Thirteen minutes

Three minutes

That is why it is imperative that cardiac arrest is identified quickly, CPR status is clear for each patient, and that high-risk cases should be discussed at the time of admission.

An animal presents with difficulty breathing. You take the animal to the treatment area. The doctor is on the way. What do you do first?

Place an IV catheter and start IV fluids

Don't do anything until the doctor arrives, just restrain the animal

Start taking chest radiographs

Administer supplemental oxygen

Administer supplemental oxygen

All animals in respiratory distress can benefit from supplemental oxygen. If the patient is stressed, then blow-by oxygen can be used if a mask isn't tolerated. The technician should never attempt to do other treatments such as starting fluids, performing radiographs, etc. without instruction from the veterinarian.

The acronym DIC stands for which of the following?

Disseminated intravascular coagulation

Disseminated inflammatory cardiomyopathy

Dissipated infectious coagulopathy

Dilated immune-mediated cardiomyopathy

Disseminated intravascular coagulation

DIC, or Disseminated intravascular coagulation is the condition in which coagulation factors are excessively consumed. This prevents additional clots from being formed and also impairs the breakdown of existing clots. Patients in DIC are both pro-thrombic (producing micro-clots that get trapped in the capillaries) and anti-thrombic (unable to create new clots). These patients have severe bleeding tendencies. DIC most often follows severe trauma, inflammatory conditions, or sepsis.

A 10-year old domestic short hair presents with a history of vomiting and inappetance and is severely dehydrated. His CBC shows a hematocrit of 22%. What can be said about this cat?

His true hematocrit is likely higher than 22%

The cat is likely in renal failure

His true hematocrit is likely lower than 22%

The cat is losing blood

His true hematocrit is likely lower than 22%

A hematocrit of 22% tells us that the cat is anemic. Dehydration causes a falsely elevated hematocrit or PCV. This means that because this cat is dehydrated, the hematocrit is likely actually lower than 22%. The hematocrit or PCV often goes down when hydration is restored.

While chronic renal failure can lead to anemia of chronic disease, this assumption cannot be made based on the information given in the question. Even though the hematocrit is low, this doesn't mean the cat is losing blood. To know whether blood loss or chronic disease is causing the anemia, a reticulocyte count would be needed to see if this cat is regenerating (making new red blood cells). In cases of blood loss or lysis, the anemia is usually regenerative (reticulocytes greater than 60,000). In cases of chronic disease, the anemia is usually non-regenarative (reticulocytes less than 60,000).

A 4 year old male neutered domestic shorthair cat presents to your clinic with a history of straining to urinate. The owner is unsure how long it has been since the cat urinated. What is the first thing you should check while waiting for the doctor?

PCV (Packed cell volume)

Blood pressure

Pupillary Light Response

Temperature

Heart rate

Heart rate

Cats with a urethral obstruction can develop hyperkalemia (high potassium) due to decreased glomerular filtration rate (GFR) and the inability of the kidneys to excrete potassium from the body through the urine. Hyperkalemia can slow down the heart rate which can be fatal if it is severe enough, so it is very important to check the heart rate immediately. An ECG can also be of benefit to further assess the heart rhythm.

Body temperature can decrease if the patient is in shock and the patient may need to be warmed until the body can maintain a normal temperature on its own.

A packed cell volume and blood pressure could be useful in the overall assessment of the patient, but these would not be assessed immediately on presentation.

A 5-year-old female spayed Shih Tzu presents to your emergency hospital with a several-day history of vomiting and diarrhea. On presentation, she is dehydrated with pale and dry mucous membranes and a prolonged capillary refill time. Her heart rate is 220 bpm, and she has weak femoral pulses. What type of shock is she in?

Cardiogenic shock

Anaphylactic shock

Hypovolemic shock

Distributive shock

Hypovolemic shock

Hypovolemic shock is characterized by a critical reduction in intravascular volume (severe dehydration, hemorrhage, third-space loss). The decrease in intravascular volume (preload) results in a decrease in stroke volume and subsequently cardiac output, which will eventually result in decreased tissue perfusion and oxygenation.

Cardiogenic shock is the result of a decrease in myocardial contractility with subsequent decrease in oxygen delivery. It is always associated with primary heart disease.

Distributive or vasogenic shock is typically secondary to sepsis and anaphylactic reaction, causing vasodilatation.

A Yorkshire Terrier who has given birth 2 weeks ago presents with a history of tremoring. She is febrile and not eating well. On her electrolyte panel which of the following would you expect to see?

Hyponatremia

Hypomagnesemia

Hypokalemia

Hypocalcemia

Hypocalcemia

Eclampsia, also known as "milk fever" is caused by a low calcium level. It most often occurs around 3 weeks after whelping due to losing calcium in the milk and the inability of the body to keep up with demand. It is most common in small-breed dogs with larger litters. It is treated with calcium gluconate IV in an acute crisis and oral supplementation is then required.

Milk fever is also seen more commonly in dairy cows that are close to calving. It typically causes a LOW temperature and often causes staggering and recumbency. It can also cause tremors and dilated pupils. It is also treated with injectable calcium. When cows are dry (not lactating), they should be kept on a LOW calcium diet so that calcium can be mobilized more rapidly from the bone when it is needed during calving and lactation.

"Pablo", a 66 pound Labrador mix, is in oliguric renal failure. The veterinarian has asked you to start a constant rate infusion of dopamine at 5 micrograms per kilogram per minute (ug/kg/min) and a fluid rate of 120 mL per hour. Dopamine comes in a concentration of 40 mg/mL. How much dopamine will you add to a liter of 0.9% sodium chloride solution?

19.5 mL

5.6 mL

1.86 mL

0.78 mL

1.86 mL

Constant rate infusions are not something that an entry level technician would typically perform. However, the VTNE may have some questions on CRI and it will benefit you to know how to do these calculations. To solve this problem, break down the basic parts to make it less overwhelming:

1) Convert pounds to kilograms- 66 pounds/2.2 pounds per kg = 30 kg

2) Calculate the number of hours an infusion will last by dividing the volume in the bag (1 Liter, or 1,000 mL) by the rate per hour: 1,000 mL/120mL/hr = 8.3 hours

3) Now take the number of hours (8.3) and multiply by 60 to calculate how many minutes this is: 8.3 X 60 = 498 minutes

4) Now plug into the equation: 5 ug/30kg/498min= 74,700 ug

5) Now convert the ug into mg by dividing by 1,000: 74,700/1,000 = 74.7 mg

6) Calculate the quantity of dopamine to add by now dividing the 74.7 mg by the concentration of the drug (40mg/mL) : 74.7mg/40mg/mL = 1.86 mL

To be truly accurate when adding drugs to a bag like this, you should discard 1.86 mL of fluids from the bag prior to adding the 1.86 mL of dopamine.

A 3-year old male neutered Labrador Retriever presents for lethargy and inappetence of a few days in duration. The dog is approximately 7% dehydrated with pale and dry mucous membranes, a capillary refill time > 2 sec, heart rate > 170 bpm and weak femoral pulses. The veterinarian diagnoses the dog with hypovolemic shock and orders isotonic crystalloid fluid therapy. What is the isotonic crystalloid total "shock dose" in dogs?

10-20 ml/kg

180 ml/kg

40-60 ml/kg

90 ml/kg

5 ml/kg

90 ml/kg

The isotonic crystalloids shock dose in dogs is 90 ml/kg. 1/4 to 1/3 of this volume should be administered initially and the patient reassessed. In cats, the isotonic crystalloids shock dose is 40-60 ml/kg. Synthetic colloids can be administered at a dose of 10-20 ml/kg in dogs and 5-10 ml/kg in cats; hypertonic saline can be administered at a dose of 5 ml/kg.

A dog with bradycardia and a low albumin on a high rate of IV fluids is at risk for developing which of the following?

Pulmonary edema

Thromboembolism

Seizures

Syncope

Pulmonary edema

Albumin provides oncotic pressure which helps maintain fluid in the vasculature. If the oncotic pressure is decreased from low albumin and movement of blood through the body is slow due to a low heart rate (bradycardia), fluid can build up in the lungs (pulmonary edema).

A 13-year old diabetic cat arrests during hospitalization during a blood glucose curve. During resuscitation efforts, an emergency blood panel is run which reveals a blood pH of 6.4. What drug may be requested by the veterinarian to help correct this abnormality but would not be used as a long-term therapy?

Darbopoetin

Insulin

Sodium bicarbonate

Potassium gluconate

Methylprednisolone

Sodium bicarbonate

A blood pH of 6.4 is low, or acidic. Sodium bicarbonate can increase the cat's blood pH but ultimately the underlying problem (the diabetes) must be treated. Insulin may be used in both resuscitation efforts and long-term therapy. Darbopoetin causes an increase in red blood cell production and has no effect on blood pH. Potassium gluconate is administered orally to correct hypokalemia. Methylprednisolone can cause an increase in blood glucose levels and is not a drug used to correct pH. Corticosteroids such as this should be avoided in diabetic patients when possible.

A Boston terrier puppy presents lethargic and minimally responsive at your clinic. The owner says he hasn't been eating very well; his gums are a little pale, temperature is 99.1F. What is the likely cause of his acute symptoms?

Head trauma

Parvovirus

Intestinal parasites

Hypoglycemia

Hypoglycemia

When a young puppy or kitten presents lethargic and minimally responsive, or has symptoms of weakness or pale gums, hypoglycemia should be at the top of your list of suspected afflictions. You should draw a blood sample to check the glucose level, and be ready to administer dextrose when the veterinarian gives the order. Parvovirus and intestinal parasites can also cause hypoglycemia (what he is acutely presenting for), so additional diagnostics will be necessary to determine the underlying cause of this puppy's problem.

Which heart rhythm is a flatline, or a state of no cardiac electrical activity?

Atrioventricular block

Asystole

Arrhythmia

Ventricular fibrillation

Asystole

Asystole is defined as the complete absence of electrical activity in the myocardium.

A very tiny kitten presents with severe dehydration and is hardly responsive to handling. You are unable to place a peripheral IV catheter. Which of the following routes could be used as a fast or most efficient way of administering fluids and medications to such a small animal?

Intraperitoneal

Subcutaneous

Intraosseus

Orogastric tube

Intraosseus

Intraosseus fluid administration is delivery of fluid directly into the bone/bone marrow. It can be very beneficial and life saving in a tiny animal with poor peripheral veins when a catheter cannot be placed.

Intraperitoneal means inside the abdominal cavity; this route has very slow absorption.

Oral/orogastric absorption is very slow, especially in an animal that is obtunded; this may put the patient at an increased risk for aspiration.

Subcutaneous fluid administration could be used but may be poorly absorbed in a patient this dehydrated and is not the most efficient.

Which of the following techniques should NOT be performed when trying to stimulate breathing in a newborn calf?

Hang the calf off the ground by its back legs and shake or swing it to stimulate breathing.

Use of a respiratory stimulant such as doxapram.

Use of acupuncture points on the muzzle.

Place a finger or piece of straw in the calf's nose.

Pour cold water over the calf's head.

Hang the calf off the ground by its back legs and shake or swing it to stimulate breathing.

Recent data suggests that hanging calves to clear the airway is unnecessary. Placing a finger or piece of straw in the nose will elicit a gasping reflex and help aerate the lungs. Pouring cold water over the head will stimulate a hypothermal respiratory response. A pharmacological initiation of respiration can be achieved with medications like doxapram (Dopram). Acupuncture points on the muzzle are also useful for stimulation of respirations.

A ferret presents to your hospital in lateral recumbency. A blood glucose test confirms hypoglycemia, and dehydration is making venous access very difficult. The veterinarian directs you to administer subcutaneous fluids. Which of the following fluids can not be given via this method?

5% dextrose in 0.9% Sodium Chloride

Lactated Ringer's Solution

0.9% Sodium Chloride

Plasma-Lyte

5% dextrose in 0.9% Sodium Chloride

5% dextrose in 0.9% NaCl is a hypertonic solution and can not be given subcutaneously because it can cause sloughing of the skin and increases risk for bacterial infections at the injection site. The other solutions are safe to be given subcutaneously.

Upon examining this 7 year old female spayed Dachshund, you notice her mucous membrane color is abnormal. What term would your write in the medical record to describe your findings?

Hemoptysis

Cyanosis

Hyperemic

Icterus

Icterus

Icterus, or jaundice, is the yellowing of the mucous membranes, skin, or sclera. It is often seen in patients with liver dysfunction or immune mediated hemolytic anemia.

Cyanosis is the blue, purple, or grey tinge seen in the mucous membranes of patients with low oxygen levels.

Hemoptysis is the coughing up of blood or blood tinged fluid.

Hyperemic mucous membranes are bright or brick red and are usually caused by sepsis, allergic reactions, or shock.

You are assisting with thoracocentesis and the fluid removed from the chest has a very foul odor. Which of the following types of pleural effusions is most likely?

Chylothorax

Pyothorax

Pneumothorax

Hemothorax

Pyothorax

Pyothorax is purulent fluid (pus) in the pleural space and most often has a very foul odor.

Chylothorax is chyle (lymphatic fluid) in the pleural space. Hemothorax is blood in the pleural space. Pneumothorax is air in the pleural space.

A cat presents in respiratory distress and displays very rapid and shallow breathing. Which of the following is an accurate description of this breathing pattern?

Tachycardic

Agonal

Obstructive

Tachypneic

Tachypneic

Tachypnea is rapid breathing.

Tachycardia is a rapid heart rate.

Agonal breathing is characterized by shallow, slow, irregular inspirations followed by irregular pauses.

Obstructive breathing is characterized by a slow inspiratory phase followed by a rapid expiratory phase and can sometimes have respiratory noise (i.e. stertor) associated with breathing.

A patient has come into the hospital after being stung by a bee. The patient's muzzle is severely swollen, and the doctor has ordered a dose of dexamethasone sodium phosphate to be given intravenously. The patient weight is 30 kg, and the dose is 0.5 mg/kg. The concentration of the dexamethasone is 4 mg/ml. How many milliliters is this patient to receive?

8 ml

1.7 ml

12 ml

3.75 ml

3.75 ml

First calculate the amount of milligrams to be given.

30 kg x (0.5 mg/kg) = 15 mg

Next calculate the amount of milliliters to be administered.

15 mg / (4 mg/ml) = 3.75 ml

Septic shock may cause the gums to appear:

Cyanotic

Dark red

Pale pink

Icteric

Orange

Dark red

A dark brick-red color or injection of the gums can be seen with septic shock.

A dog presents with a history of coughing and rapid breathing. Radiographs confirm congestive heart failure (see image). You are asked to administer 2 mg/kg of furosemide IV. The concentration of furosemide is 50 mg/mL. The dog weighs 25 pounds. How many milliliters should you administer to this patient?

2.0 mL

0.44 mL

0.12 mL

1.2 mL

0.44 mL

The dog is 25 pounds.

25 pounds/2.2 pounds per kg= 11.3 kg

Now multiply the dog's weight in kg by the dose you need (2mg/kg):

11kg X 2mg = 22 mg

The dog needs 22 mg. Now divide this dose by the concentration of furosemide (50 mg/mL):

22mg/ 50 = 0.44 mL

It is a very busy day at the clinic. Multiple emergencies walk in all at the same time. Choose the order in which the following cases should be seen.

Dyspnea, status epilepticus, stranguria, cervical pain, fracture, abscess

Dyspnea, fracture, status epilepticus, cervical pain, abscess, stranguria

Stranguria, status epilepticus, dyspnea, fracture, abscess, cervical pain

Status epilepticus, dyspnea, fracture, stranguria, cervical pain, abscess

Status epilepticus, dyspnea, fracture, stranguria, cervical pain, abscess

In a perfect situation both the seizuring pet and the pet with difficulty breathing would be treated immediately. Sometimes this may not be possible and triage is necessary.

Status epilepticus is a state of seizuring that is continuous. This is life-threatening, and the seizures must be stopped immediately or permanent brain and organ damage can occur.

Dyspnea or difficulty breathing is always a top priority emergency. The dyspneic animal should be assessed and placed on oxygen while the seizuring dog is being treated.

Fractures, while painful, are not immediately life-threatening as long as there is no bleeding vessel that needs to be controlled, which is sometimes the case with an open fracture.

Straining to urinate is not usually life-threatening unless it is a "blocked cat", or urethral obstruction. If this were a blocked cat, it should be seen before the fracture.

Neck pain and abscesses are not life-threatening and should be seen last if the patients are stable.

An owner rushes in with her Labrador retriever who is having non-productive retching, is lethargic, and has a distended abdomen. She wants to know if he has "bloat". Which condition is she concerned about?

Ascites

Splenic mass

Gastric dilation volvulus

Mesenteric volvulus

Gastric dilation volvulus

Gastric dilation and volvulus (GDV) is when the stomach dilates and then rotates around itself on the short axis. It is a life-threatening emergency to which owners often refer to as "bloat".

A dog has snail bait poisoning (metaldehyde) and presents with seizures. His temperature is 109F, and you begin cooling techniques while the veterinarian treats the seizures. At what temperature should you stop trying to cool him?

He should not be cooled

102F

100F

107F

103F

103F

When the temperature reaches 103F, it is time to cease the cooling techniques, as the temperature can continue to drop and get dangerously low.

A 5-year-old female spayed domestic short hair cat presents on emergency for acute vomiting, weakness, hypersalivation, and tremoring. Her heart rate is 240 bpm and her temperature is elevated at 104.2F. The owner applied an over-the-counter flea control product to her skin earlier in the day. What toxicity is suspected?

Coumadin

Ethylene glycol

Permethrin

Metaldehyde

Permethrin

Permethrin (a synthetic pyrethroid) is very toxic to cats and can be found in some topical flea prevention medications. It can cause neurologic side effects, tremoring, and may even cause seizures. Cats are treated by washing the product off immediately, placing an intravenous catheter, administering IV fluids, and giving muscle relaxants such as valium and/or methocarbamol.

Metaldehyde is most commonly found in snail bait and is not part of flea control products. Ethylene glycol is antifreeze and coumadin is Warfarin (an anticoagulant found in some rat poisons); these are not found in flea control products.

A 40 kg dog presents to your hospital and is approximately 5% dehydrated. What is the replacement fluid volume needed for this dog?

1,200 mL

500 mL

2,000 mL

1.5 L

2,000 mL

To calculate the replacement fluids use the following formula:

Body weight (in kg) X percent dehydration= fluid deficit (in Liters)

For this dog: 40 X 0.05 = 2 L

If you want the fluid measurement in milliliters, just multiply by 1,000 (since there are 1,000 mL in 1 L).

For this dog, it would be 2,000 mL (the same as 2 Liters).

What is the minimum volume of water required by mammals to sustain life?

2 - 4 mls/kg/hr

10 - 12 mls/kg/hr

20 - 25 mls/kg/hr

30 - 35 mls/kg/hr

2 - 4 mls/kg/hr

In neonatal calves and foals, what is the most common reason that these animals succumb to disease and death?

Failure of passive transfer

Iron deficiency

Gastrointestinal parasitism

Infection acquired by the mother from the placenta

Failure of passive transfer

Newborns require essential maternal antibody absorption from the colostrum to help protect against infectious diseases. If they do not get these precious immunoglobulins, they can suffer from increased morbidity and mortality from infections. There are now field test kits that can detect blood levels of IgG in calves and foals to help determine if failure of passive transfer has occurred.

A 7-year-old Lab mix presents to your hospital with a very swollen muzzle. The vet suspects the swelling is from a rattlesnake bite. How could you support this suspicion?

Perform an aspirate of the swelling for cytology

Perform a blood smear and look for spherocytes

Perform a blood smear and look for echinocytes

Perform a buccal mucosal bleeding time

Perform a blood smear and look for echinocytes

Echinocytes are often seen in rattlesnake envenomation. While rattlesnake bites may cause coagulopathies, an increased bleeding time would not be diagnostic for rattlesnake bite or support the suspicion as strongly the as presence of echinocytes. Spherocytes are most often seen in cases of autoimmune hemolytic anemia. Aspirating the swelling would not be helpful, as the swelling is most often occurring due to edema (swelling within the cells) and not free fluid.

Which of the following terms describe a dilated pupil?

Miotic

Fixed

Sympathetic

Mydriatic

Mydriatic

Mydriasis is the term for dilated pupils. Miosis is the term for constricted pupils. Fixed pupils are not moving (not dilating or constricting).

The sympathetic nervous system is responsible for pupil dilation, but this is not a term given to a dilated pupil.

A 2-year old bulldog presents with respiratory distress, specifically on inhalation, and stertor. What, of the following, would be the most common cause of respiratory distress in this patient?

Tracheal mass

Tracheal foreign body

Laryngeal paralysis

Asthma

Brachycephalic syndrome

Brachycephalic syndrome

As a young bulldog, this patient would be suspected of having an elongated soft palate, stenotic nares, and (as a result of turbulent airflow), everted laryngeal saccules, or a combination of the three. Laryngeal paralysis is typically seen in large breed, older dogs. Asthma is nonexistent in dogs. A tracheal mass would be uncommon in such a young dog. While a tracheal foreign body is possible, brachycephalic syndrome is a better fit considering the breed and presence of stertor.

A low packed cell volume could occur due to which of the following?

Low phosphorus

Iron deficiency

Hyperkalemia

Iron toxicity

Iron deficiency

A low packed cell volume indicates anemia. Iron deficiency is also known as hypochromic microcytic anemia. It is most often suspected in patients with chronic blood loss but could also result from poor nutrition.

A 6.7 kg Chihuahua has been prescribed a 2 mg/kg/day constant rate infusion of metoclopramide. The metoclopramide is to be added to the intravenous fluids. If the metoclopramide is 5 mg/ml and the Chihuahua's fluid rate is 17 ml/hr, how many milliliters of metoclopramide should be added to a 250 ml bag of intravenous fluids?

13.4 mL

0.56 mL

4.6 mL

1.6 mL

1.6 mL

Even though this may not seem like an entry level question, there may be a constant rate infusion question on the VTNE. Let's walk through the math in this question:

6.7 kg x 2 mg/kg/day = 13.4 mg/day

13.4 mg/day / 24 hours/day = 0.56 mg/hour

0.56 mg/hr / 5 mg/ml (conc. of metoclopramide) = 0.11 ml metoclopramide/hour

250 ml/bag / 17 ml/hr = 14.7 hours of intravenous fluids/bag

14.7 hours/bag x 0.11 ml metoclopramide/hour = 1.6 ml of metoclopramide/250 ml bag

An injury to what region of the brain is most likely to result in respiratory arrest?

Cerebrum

Cerebellum

Brain stem

Diencephalon

Brain stem

The brain stem consists of the midbrain, pons, and medulla oblongata. The pons contains important respiratory centers. The medulla also influences the respiratory rate as well as heart rate.

The cerebellum is responsible for coordination and balance. The diencephalon contains the thalamus and hypothalamus. The thalamus behaves as a relay station for sensory input. The hypothalamus is involved in helping regulate many endocrine functions of the body. Motor control and interpretation of sensory impulses occurs at the cerebrum.

"Bernie," a 4-year-old Maltese mix presents to your clinic after having ingested a full milk chocolate bar about 20 minutes prior to his arrival; this means he consumed about 1.55 ounces, according to the package the owner brought. How many milligrams of theobromine would this be? (Hint: Milk chocolate contains about 60mg per ounce of theobromine, the toxin we are concerned about.) Bernie weighs 15 pounds.

240 mg

900 mg

93 mg

74 mg

93 mg

This question is asking about how many mg he ingested, so his body weight is irrelevant for this particular problem.

He consumed 1.55 oz X 60 mg/oz (oz cancel out)= 93 mg ingested

The toxic dose of chocolate can vary per patient. At 20mg/kg may be hyperactive, agitated, and have GI symptoms. Around 50mg/kg may start to have cardiac effects such as tachycardia or arrhythmias. Doses above 60 mg/kg may start to cause neurologic symptoms such as tremoring, seizures, etc.; in severe cases death may occur.

To see what effects Bernie might have, let's take it one step further:

He weighs 15 pounds/2.2 pounds/kg = 6.8 kg

93 mg ingested/6.8kg = 13.6 mg/kg dose ingested (this is well below the 20mg/kg that may cause hyperactivity)

Going off the information about side effects above, Bernie is not likely to have any severe effects other than possibly some GI upset. If he just ate the chocolate, the vet may still wish to induce vomiting, or just monitor.

Which bacteria are known for causing a head tilt and neurologic symptoms in ruminants?

Salmonella

Listeria

Campylobacter

E. coli

Listeria

Encephalitis is the most readily recognized form of Listeriosis in ruminants and a droopy face or head tilt are frequently observed symptoms. If encephalitis is severe enough, death will typically occur. Encephalitis is treated with high doses of antibiotics.

Listeria monocytogenes is a small motile coccobacillus (bacteria) causing neurologic symptoms due to localized lesions in the brainstem. Grazing animals ingest the organism and continue to further contaminate the soil through their feces.

During which cardiac status would a defibrillator most likely be used and effective?

Asystole

Ventricular tachycardia with a pulse

Normal sinus arrhythmia

Ventricular fibrillation

Ventricular fibrillation

Ventricular fibrillation usually occurs just prior to asystole, when there is uncoordinated contraction of the ventricular muscles (uncontrolled quivering of the muscle fibers). It is during the ventricular fibrillation that a defibrillator is most often used to try to induce a normal rhythm to the heart.

Defibrillation delivers a dose of electrical energy to the heart. This depolarizes the heart muscle, stops the arrhythmia, and allows normal sinus rhythm to be reestablished in the sinoatrial node (the "pacemaker" of the heart).

The heart will generally not respond to defibrillation in asystole because it is already depolarized. Defibrillation only works if electrical activity is occurring.

If a pulse is present, defibrillation for ventricular tachycardia is not indicated.

Normal sinus arrhythmia is a normal rhythm in which there is mild acceleration and slowing of the heart rate that occurs during inhalation and exhalation; many normal pets have this rhythm.

Blood lactate is a marker of what?

Blood perfusion and oxygen delivery to tissues

Activity of muscle

Activity of the liver

Amount of tissue carbon dioxide production

Blood perfusion and oxygen delivery to tissues

Blood lactate is a marker of perfusion and oxygen delivery to the tissues. When there is adequate oxygen present in the patient, aerobic metabolism (oxidative phosphorylation) occurs, producing energy. When there is lack of oxygen delivery to the body or a specific tissue/organ, anaerobic metabolism occurs and produces lactate as a by-product. Instances in which lactate may be elevated include sepsis, GDV in dogs, and strangulating intestinal lesions in horses.

You are instructed to administer 12 liters of sterile isotonic IV fluids via a fluid pump over the next 24 hours. What is the appropriate fluid rate to administer this volume of IV fluids?

1 liter/hour

12 liters/hour

500 mL/hour

250 mL/hour

500 mL/hour

12 liters (12000 mLs) divided by 24 hours would equal 500 mLs/hour.

A 12-pound cat has presented with diabetic ketoacidosis and is currently in shock. The doctor orders that a 40 ml/kg bolus of 0.9% saline be administered. How many milliliters will this patient receive?

220 ml

9 ml

36 ml

480 ml

220 ml

The body weight needs to be converted to kilograms.

12 lb / (2.2 lb/kg) = 5.5 kg

5.5 kg x (40 ml/kg) = 220 ml

The dog enters the clinic having an allergic reaction to an unknown allergen. The correct term for the skin condition shown in the photograph is:

Erythema

Pemphigus

Dermatophytosis

Urticaria

Urticaria

Urticaria is also known as "hives" or "wheals". It is frequently a symptom of an allergic reaction to vaccines or other allergens.

Erythema is redness of the skin, which can be seen in allergic reactions, but is not demonstrated in the photo.

Pemphigus is the shortened name for a number of different auto-immune skin diseases which usually show up as crusting or ulceration of the skin, particularly on the nose and paw pads.

Dermatophytosis is another term for ringworm, which is a fungal infection of the skin that causes alopecia and red, circular, itchy plaques.

A foal has petechial hemorrhages on its pinna, injected sclera, and brick red mucous membranes. These are signs of which of the following?

Failure of passive transfer

Milk allergy

Cryptosporidiosis

Sepsis

Sepsis

Depression, cold limbs, aural petechiations, injected tongue and mucous membranes, hypoglycemia, increased respiration, decreased suckling of the mare, hypothermia, and recumbency are all symptoms of sepsis in the foal.

Failure of passive transfer predisposes the foal to sepsis.

Increased input from the vagus nerve can result in which of the following responses?

Vomiting

Tachycardia

Bradycardia

Seizures

Bradycardia

Excessive vagal tone can cause a slower heart rate (bradycardia). Vomiting can sometimes stimulate the vagus nerve but vagal nerve stimulation should not cause vomiting. The vagus nerve carries parasympathetic fibers.

A dog has a high fever, is lethargic, and is diagnosed with peritonitis. What does this dog have?

Inflammation of the internal abdominal lining

Fluid in the pericardial sac around the heart

Inflammation of the pleura

A ruptured bladder

Inflammation of the internal abdominal lining

The peritoneum is a membrane that lines the abdominal cavity. It also covers most of the abdominal organs. The peritoneum helps support the organs and helps to facilitate blood and lymph flow to these organs.

Peritonitis is inflammation ("itis") of the peritoneum. The most common causes of peritonitis include infection (such as a leak in the GI tract or a ruptured gall bladder). In cats, FIP causes a viral peritonitis.

Fluid in the pericardial sac is termed pericardial effusion.

The pleura is the tissue that protects the lungs.

For which of the following emergency situations would you most likely pass a stomach tube in a dog?

Mesenteric torsion

Perforated stomach

Gastric-dilatation-volvulus

Intestinal intussusception

Gastric-dilatation-volvulus

Of the answer choices provided, the only condition which results in life-threatening distension of the stomach is gastric-dilatation-volvulus. This condition results in abnormal positioning of the stomach such that blood flow to the stomach is disrupted and gas accumulation within the stomach occurs. The more gas that accumulates, the less blood is able to flow through the stomach walls. In time, this will cause necrosis of the stomach wall. Eventually, there is enough distension that the stomach begins to compress the caudal vena cava, and blood return to the heart is impeded. This results in shock, and if patients are not treated immediately they will die. One of the emergency procedures used to help stabilize the patient is the passing of a stomach tube. The tube is measured to the level of the stomach and then passed through the mouth. Decompression of the stomach will save the patient's life. However, the stomach should be anchored in a normal anatomical position by performing a gastropexy so that a GDV could never recur.

Which is true of "red bag" during birth in the mare?

It indicates a breech position of the foal, and assistance for delivery is needed

It indicates a tear of the uterus, and a c-section needs to be performed immediately

It is a protrusion of the chorioallantois and is an emergency

It is the appearance of a normal placenta as the mare is giving birth

It is a protrusion of the chorioallantois and is an emergency

Red bag is a protrusion of the chorioallantois and indicates premature placental separation. It is an emergency situation in which the chorioallantois needs to be broken down manually to assist in delivery of the foal, or death of the foal can occur.

Which of the following may be a cause of post-renal azotemia?

Primary loss of nephrons

Urethral obstruction

Infection in the kidney

Severe dehydration

Urethral obstruction

Post-renal azotemia is an elevation in BUN and creatinine due to pathology located after the kidney (in the ureters, bladder, or urethra).

A urethral obstruction means that the outflow from the bladder is obstructed. This could be from severe inflammation, uroliths, or neoplasia. This puts ascending pressure on the kidneys because the urine has no way of being voided. This may cause an elevation of renal values (BUN and creatinine) and is referred to as azotemia. Treatment of post-renal azotemia depends on relieving the obstruction and subsequent IV fluid diuresis.

Pre-renal causes of azotemia include dehydration and lack of perfusion (as could occur in shock from hypotension).

Renal azotemia is caused by a primary problem with the kidneys (acute or chronic renal failure).

A 2-year old cat presents 15 minutes after being attacked by a dog. The cat is in cardiac arrest. The owner wants CPR to be undertaken, and the veterinarian is not currently on the premises. What course of action should be taken?

The cat may be intubated but chest compressions should not occur.

The cat should receive no medical care without the supervision of a veterinarian.

The cat should be transferred to the closest emergency facility.

The owner should be told the cat is beyond saving.

The cat should be immediately intubated and CPR should commence.

The cat should be immediately intubated and CPR should commence.

In the event of a life-threatening emergency, a licensed veterinary technician is allowed to intervene with life saving care. However, a veterinarian should be immediately notified of the situation. If the cat is in full cardiac arrest, transferring the cat to even the closest emergency facility would take too long to result in effective aid. If the owner requests that life-saving measures be taken, they should be initiated at that time.

During calving, the rupture of the umbilical cord before birth causes which of the following?

Fetal sepsis

Septic peritonitis in the cow

Hypoxia in the calf

Hyperemia in the calf

Hypoxia in the calf

Hypoxia is inadequate tissue oxygenation. The umbilical cord supplies oxygen from the mother's blood to the calf, therefore, if the umbilical cord ruptures, the calf will not receive oxygen and it is a life threatening emergency. Hyperemia is the increase of blood flow to different tissues in the body. Sepsis is caused by infection and does not result from a ruptured umbilical cord.

A 65-pound Golden Retriever "Marley" presents with a history of gastroenteritis over the past 48 hours. He is approximately 5% dehydrated and the attending veterinarian would like to hospitalize him on IV fluids for the day. Calculate the volume deficit in this patient.

1500 mL

480 mL

3 L

325 mL

1500 mL

Formula- kg X % dehydration = volume (memorize this)

For Marley: 65 pounds/ 2.2 pound/kg (pounds cancel out) = 30 kg

30 kg X 0.05 (which is 5%) = 1.5 L volume deficit

Since 1.5 L is not an answer choice, continue converting into mL:

There are 1000 mL in 1 liter:

1.5 L X 1000mL/liter (liters cancel out)= 1500 mL total volume deficit

Cardiac Output (CO) is determined by what variables?

Systolic pressure X Stroke volume

Systemic vascular resistance X Systolic pressure

Stroke volume x Heart rate

Heart rate X Systemic vascular resistance

Stroke volume x Heart rate

The correct formula for cardiac output (the amount of blood pumped by the heart per minute) is Stroke volume x Heart rate.

You are instructed to add 40 mEq of potassium chloride (KCl) to a 1 Liter bag of 0.9% sodium chloride for a patient. The patient to receive fluids weighs 50 pounds and will be on a rate of 85 mL/hr. You know that the maximum potassium a patient should receive is 0.5 mEq/kg/hr. What is his potassium intake, and is it too high?

3.4 mEq/hr; No

2.0 mEq/hr; No

5.6 mEq/hr; Yes

12.7 mEq/hr; Yes

3.4 mEq/hr; No

The correct answer is 3.4 mEq/hr, which is only about 1/3 of his maximum potassium dose per hour, so it is not too high. Let's do the math on this problem:

First, calculate how many mEq/hr he will be receiving with this dose and rate: (There are 1,000 mL in 1 Liter)

40 mEq/1000 mL = 0.04 mEq/mL

Next multiply by his fluid rate:

0.04 mEq/mL X 85 mL/hr (mL cancel out) = 3.4 mEq/hr he is receiving currently

Now calculate his maximum dose: Convert his body weight to kg: 50 pounds/2.2 pounds/kg = 22.7kg

0.5 mEq X 22.7 kg = 11.3 maximum mEq/hr he can have

He is getting 3.4 and his max is 11.3, so he is only getting about 1/3 of his maximum.

Four patients present to your emergency clinic at the same time:

a) 2-year old male domestic short hair with a urethral obstruction

b) 5-year old female Labrador with a tracheal foreign body and cyanosis

c) 10-year old male standard poodle with a laceration on its forelimb

d) 4-year old male hamster with elongated teeth

In what order should these patients be triaged?

a, b, c, d

c, d, a, b

a, c, b, d

a, d, b, c

b, a, c, d

b, a, c, d

A patient with an airway obstruction is in immediate danger of respiratory arrest and therefore takes priority over all other patients. A cat with urethral obstruction would be the next priority due to the possibility of a bladder rupture. A laceration needs care within a few hours. Elongated or overgrown teeth in a hamster, while needing treatment, would have the lowest priority in this group of emergency patients.

A patient has developed a severe run of ventricular premature contractions. The clinician asks you to immediately pull up a 4 mg/kg dose of lidocaine for to administer intravenously. The lidocaine in the hospital comes in a 2% solution. How many milliliters should you draw up for this 20 kg patient?

8 ml

2 ml

12 ml

4 ml

4 ml

To determine how many milligrams are need, do the following math:

20 kg x (4 mg/kg) = 80 mg.

Now the difficult part is determining how to calculate how many milliliters of a 2% solution of lidocaine is equivalent to 80 mg.

Percent is equal to weight (in Grams) / 100 parts volume (in mLs)

(This is based on water, since 1 mL weighs 1 Gram):

Example: A 2% solution: 2 Grams/100 mL or 2000 mg/100 mL or 20 mg/mL

The easiest way to remember is to just add a zero onto any percentage for the milligrams (i.e. 2% solution = 20 mg; 10% solution = 100 mg; 25% solution = 250 mg).

Therefore,

80 mg / (20 mg/ml) = 4 ml

A 50-kg Golden Retriever has presented with extremely pale mucous membranes and is diagnosed with a hemoabdomen. A blood transfusion has been requested, and the doctor would like a 10ml/kg/hr transfusion rate for 4 hours. How many milliliters of blood will you need?

20 ml

1000 ml

40 ml

2000 ml

2000 ml

The patient is receiving 500 ml/hr.

50 kg x (10 ml/kg/hr) = 500 ml/hr

In four hours, the patient will receive 2000 ml

4 hr x (500 ml/hr) = 2000 ml.

A kitten presents to the emergency service for burns in the mouth after biting into an electrical cord. Aside from the oral burns, what organ system would you most be concerned about?

Lungs

Heart

Brain

Kidneys

Lungs

In addition to causing painful burns in the mouth, most pets will develop non-cardiogenic pulmonary edema when electrocuted. The fluid in the lungs can be life threatening and most of these pets will need extended hospitalization with oxygen and careful monitoring.

You are riding along on an emergency call to assist the vet with a sick foal who was born two days ago. The foal appeared normal at birth, but is now lethargic and icteric. It has a fever of 102 F. The packed cell volume is down to 15%. Which of the following diseases leads to jaundice and anemia in young foals?

Congenital portocaval shunt

Viral hepatitis

Neonatal isoerythrolysis

Bacterial hepatitis

Neonatal isoerythrolysis

This foal is hemolyzing its own red blood cells as a result of antibody it acquired in colostrum which is directed at the red cells. This is the best answer choice to explain the low hematocrit and signs of icterus. Only vigorous and effective treatments can save foals which are severely affected.

A patient is having a seizure in middle of the treatment room. The doctor quickly asks for some diazepam at a dose of 0.5 mg/kg. The patient's body weight is approximately 24.2 lbs. How many milliliters do you need to draw up?

Valium is available as a 5 mg/ml solution.

2.4 ml

8 ml

1.1 ml

0.5 ml

1.1 ml

As always convert the body weight into kilograms.

24.2 kg/ (2.2 lbs/kg) = 11 kg

Next, determine the amount of milligrams necessary.

11kg x (0.5 mg/kg) = 5.5 mg

Finally, determine the amount of milliliters necessary.

5.5 mg / (5 mg/ml) = 1.1 ml

An owner rushes her dog to your hospital because she noticed his eye looked red. This condition is sometimes referred to as which of the following (see image)?

Exophthalmus

Cherry eye

Meibomian gland prolapse

Raisin eye

Cherry eye

"Cherry eye" is a prolapsed gland of the third eyelid. This gland is responsible for producing about a third or more of the tear film. If this gland is resected, the patient is at a higher risk for developing dry eye. The recommended treatment is to surgically tack or tuck the gland back in place.

Which of these dog breeds is most predisposed to development of gastric dilatation and volvulus?

Great Dane

Cocker Spaniel

Dalmatian

Chihuahua

Great Dane

The correct answer is Great Dane. Large and giant breed pure-bred dogs, particularly with deep chests, are very predisposed to developing GDV. Great Danes are a classic example; other common breeds include Weimaraner, Saint Bernard, and Irish Setters.

A dog is having continuous runs of ventricular premature contractions following splenectomy and they seem to be happening with greater frequency (see image of his electrocardiogram). Which of the following drugs can be used to treat this condition?

Pimobendan

Epinephrine

Lidocaine

Atropine

Lidocaine

Ventricular premature complexes (VPCs) are the most common arrhythmia after GDV or splenectomy surgeries. Treatment of VPCs occurs IF:

1. They continue to occur with increasing frequency

2. The continuous heart rate is greater then 180bpm (in an adult animal)

3. R on T phenomenon is observed

4. There is evidence of decreased or impaired cardiac output- the dog is laterally recumbent and minimally responsive, poor arterial pulses, pulses are not synchronous with heart beats.

If any of the above are seen beginning treatment with a lidocaine intravenously is strongly considered. If the VPCs persist, a lidocaine CRI may be necessary for up to 24-48 hours post-operatively.

None of the other medications listed treat VPCs.

A hypotonic solution will do what to a red blood cell?

Cause the red blood cell to shrink

Will have an unpredictable effect on red blood cell size

Cause the red blood cell to burst

Will have no effect on red blood cell size

Cause the red blood cell to burst

In a hypotonic solution, the extracellular fluid is less concentrated than the intracellular fluid. This will result in movement of water into the area of higher concentration (the intracellular fluid). In this case the red blood cell would swell and eventually burst.

A hypertonic solution will result in fluid movement from the extravascular space into the blood stream. If the hypertonic solution is extremely concentrated, it can cause movement of water out of the red blood cell and cause the cell to shrink.

You are called to a pig operation where some of the adult pigs are experiencing sudden death. The vet points out purple skin lesions that look like a "diamonds." What organism causes "Diamond Skin Disease" in pigs?

Streptococcus suis

Staphylococcus hyicus

Haemophilus parasuis

Erysipelas rhusiopathiae

Erysipelas rhusiopathiae

Erysipelas may cause diamond shaped purple skin lesions in pigs. This bacterium is commonly found in the tonsils of pigs, but may cause disease and death if the pigs experience stress, poor sanitation or feed, causing the bacteria to invade the bloodstream and cause sepsis.

Staphylococcus hyicus causes greasy pig disease (exudative epidermitis). Haemophilus parasuis causes Glasser's disease (polyserositis/arthritis/cyanotic ears and skin). Streptococcus suis is more common in weaning pigs (may cause meningitis, and also has similar symptoms to Glasser's disease).

"Grass tetany" may been seen in sheep or goats due to a deficiency in which mineral?

Copper

Sulfur

Magnesium

Potassium

Magnesium

Magnesium deficiency may lead to "grass tetany" in sheep or goats, and sometimes in cows. It occurs when animals graze on pastures that are low in magnesium, or during lactation when demand for magnesium is higher. Treatment is with magnesium and calcium supplementation but can be a very serious and life-threatening condition. Symptoms can include restlessness, staggers, an over-alert appearance, being excitable, falling down, or convulsions and death.