RPM: practice questions (week 2)

OVH procedure, failure of pregnancy, female infertility, surgery of the equine male + female, peds/neonates, neoplasia of repro tract, male infertility

A canine patient is being draped for a routine OVH procedure. What landmark needs to be visible to the surgeon to ensure an accurate midline incision? 

Umbilicus

The correct scalpel grip is important based on the procedure being performed to ensure stability + control. What scalpel grip is recommended for long incisions in OVH procedures? 

Violin grip

To ligate an ovarian pedicle, the suspensory ligaments need to be stretched or ruptured. What direction should traction be applied using an index finger to achieve this? 

Caudomedial traction

A patient is scheduled to be spayed in JSAL, & the procedure is anticipated to take 4 hours. What are the common anesthetic complications most likely associated with a longer procedure? 

Nociception, hypotension, hypothermia 

A five-day-old kitten has been admitted to the clinic for depression, lethargy, & anorexia. They weigh 110g or 0.110kg. What is the maximum amount of blood that can be taken from this patient over a 7-day period? 

1.10mL (110g in Kg = 0.11kg , 0.11kg x 10% = 1.1ml)

What is the benefit for using the Quadratus Lumborum Block (QLB) for a spay procedure?

Decreases nociception

During an ovariectomy in a mare, a surgeon identifies the major vascular supply within the broad ligament that must be carefully ligated to minimize hemorrhage. What artery must be ligated to prevent hemorrhage?

Ovarian artery

During a surgical procedure on the mare's uterus, the surgeon identifies a double-layered peritoneal fold that suspends the reproductive tract & contains blood vessels, nerves, + connective tissue. What is this structure?

Broad ligament

What SpO₂ reading in an anesthetized dog would indicate a need for immediate investigation?

<96%

A dairy herd experiences increased late-term abortions. Investigation reveals several cows were fed moldy hay containing mycotoxins for 6 weeks. Aborted fetuses show no evidence of infectious agents on laboratory testing. What pathophysiological mechanism best explains this non-infectious pregnancy failure?

Toxic interference with maternal or fetal metabolic processes → mycotoxins disrupt placental function, cause vascular or cellular damage, alter endocrine function, & directly impair fetal development, ultimately resulting in abortion

A breeder reports that a 3yo queen has consistently resorbed embryos at approximately 25-30 days of gestation over three consecutive breeding attempts with different toms. The queen appears healthy with normal estrous cycles. What type of cause should be prioritized in the diagnostic investigation?

Non-infectious endocrine or genetic factors

-ex: luteal insufficiency, endocrine abnormalities, chromosomal abnormalities, uterine factors

A 5yo Holstein dairy cow has failed to conceive after four artificial insemination attempts over the past 6 months. She has a BCS of 2/5, produces 45 liters of milk daily, & shows regular estrous cycles every 21 days. Blood analysis reveals low progesterone levels during the luteal phase + elevated non-esterified fatty acids. What is the most likely underlying cause of infertility in this cow?

Negative energy balance impairing reproductive hormone synthesis

A 4yo German Shepherd female dog has failed to conceive after three natural matings during optimal breeding times confirmed by vaginal cytology + progesterone testing. She has a history of chronic kidney disease managed with a protein-restricted diet & demonstrates mild azotemia. Physical + vaginal examinations are unremarkable, & ovulation has been confirmed in each cycle. What maternal factor is most likely responsible for her infertility?

Systemic disease affecting embryo survival & the uterine environment

A 6yo intact female mixed-breed dog presents with a bloody vulvar discharge + excessive licking of the perineal area. The owner reports the dog had a normal estrous cycle 4 months ago. Vaginal examination reveals a friable, reddish, cauliflower-like mass protruding from the vulva. The dog has not been bred & has no access to intact male dogs. What is the most likely diagnosis?

Transmissible venereal tumor

During a transrectal examination of a stallion, the vet palpates a paired, elongated glandular structure located caudodorsal to the urinary bladder & adjacent to the pelvic urethra. Which structure is being examined?

Seminal vesicles

A stallion is examined before breeding, & the vet evaluates the scrotal contents. Which structure is primarily responsible for the maturation + storage of sperm after they leave the testis?

Epididymis

A 12yo intact male Shetland Sheepdog presents with unilateral scrotal enlargement. Physical examination reveals one testicle that is markedly enlarged, firm, & non-painful, while the contralateral testicle is small + soft. The owner reports no systemic signs of illness. What additional clinical finding would most strongly support a diagnosis of a Sertoli cell tumor?

Bilaterally symmetric alopecia with hyperpigmentation

A 7yo stallion has a progressive decline in pregnancy rates despite normal libido & successful mating. Semen evaluation reveals decreased sperm concentration, poor progressive motility, & increased numbers of abnormal sperm. Both testes feel smaller + softer than expected. What underlying cause is most likely?

Bilateral testicular degeneration

A 10yo intact male dog has unilateral testicular enlargement. The affected testicle is firm + non-painful, while the contralateral testicle is markedly smaller. The dog also has symmetric truncal alopecia + hyperpigmentation. Which mechanism most likely explains his infertility?

Estrogen production causing suppression of the contralateral testis

What two structures is the uterine body lodged between in the body?

Urinary bladder + Colon

Where do all vessels that are important during an OVH live?

Within the mesovarium + mesometrium

What instrument should you use to bluntly create a “tunnel” in the subcutaneous tissue during an OVH procedure?

Metzenbaum scissors

What structure located lateral to the uterine vessels must be cut or torn prior to locating the uterine body?

Mesometrium (broad ligament)

What are the natural retractors of the abdomen on either side, which can help you check for bleeding after an OVH procedure?

Right: Mesoduodenum

Left: Mesocolon

What urinalysis result would be consistent with pregnancy toxemia?

Ketonuria but no glucosuria

What problem that occurs in bitches with large litters in late gestation is associated with a lack of carbohydrates or altered carbohydrate metabolism, which can lead to anorexia or hepatic lipidosis?

Pregnancy toxemia → ketosis

In a case of pregnancy toxemia in the bitch, when should you consider terminating the pregnancy?

In severe illness with increased liver enzymes

Why is diabetes mellitus diagnosed more often during pregnancy than not in small animals?

Progesterone causes altered carbohydrate metabolism + insulin requirements increase during diestrus or pregnancy (which have increased progesterone)

What condition that (uncommonly) occurs during the first week post-partum in the bitch causes severe inflammation of the uterus via bacteria entering the open cervix as well as systemic illness?

Puerperal metritis

-associated with retained placentas/pups, macerated pups, or prolonged delivery

What are the main clinical signs associated with puerperal metritis in the bitch?

High rectal temp. (103.5-105F), Malodorous/putrid lochia (contains severely degenerate neutrophils), Depression, Shock due to dehydration/septicemia/endotoxemia

What is the most common bacterial cause of metritis in bitches?

E. coli

What drug can be given for a range of post-partum conditions?

Oxytocin → induces contractions, expels RFMs, aids uterine involution, stimulates milk letdown

In a case of mastitis that is being treated with broad-spectrum antibiotics (ex: amoxi-clav) + analgesics, you can continue to allow the pups to feed as long as no _______ or _______ is present.

Abscessation, Gangrene

What non-life threatening post-partum condition seen ONLY in bitches presents as hemorrhagic vulvar discharge for several weeks (4-15 weeks) post-partum due to invasion of the endometrium by fetal trophoblastic cells which erode the blood vessels?

Subinvolution of placental sites (SIPS)

How can we confirm a diagnosis of subinvolution of placental sites (SIPS) in a primiparous bitch with hemorrhagic vulvar discharge for the past 6 weeks post-partum?

Vaginal cytology → will see trophoblast cells

What is the recommended treatment for mild vs. severe cases of subinvolution of placental sites (SIPS) in the bitch?

Mild blood loss: Spontaneous remission w/ supportive therapy

Severe blood loss: Blood transfusions + OVH

What category of dog does hypocalcemia most commonly occur in?

Young, small breed bitches with large litters during 2-3rd week of lactation (when milk production is at its peak)

What are the main clinical signs associated with hypocalcemia in the bitch?

Increase in HR + temp, poor maternal care, cannibalism, panting, restlessness, trembling, weakness, etc.

What is the treatment for hypocalcemia in the bitch?

10% calcium gluconate IV slowly to effect → monitor HR continuously as may cause bradycardia or arrhythmias

-take pups off + bottle feed until resolution

Why might a bitch that has undergone a C-section have poor maternal instincts at first?

Progesterone may not have dropped quite yet to induce maternal behavior

What are the main differential diagnoses for a bitch that has a fever (>103.5F) post-partum?

Metritis, Mastitis, or Hypocalcemia

What is the recommended treatment for a bitch experiencing a pseudopregnancy?

Cabergoline → dopamine agonist that decreases prolactin

A client calls about a bitch that whelped 5 weeks ago. The client is concerned about the fact that the otherwise healthy bitch still has an intermittent bloody discharge from her vulva. What is the most likely diagnosis?

Subinvolution of placental sites (SIPS)

The majority of cats have Type A blood type. Which cat breeds have a higher percentage of having Type B blood type?

Abyssinian, Birman, British shorthair, Himalayan, Scottish Fold

Neonatal isoerythrolysis occurs when Type ___ queens mate with Type ___ or ___ toms.

This is because Type ___ queens have high levels of anti-___ antibodies.

B, A, AB

B, A

What should you NEVER give to cats as it can cause pyometra or benign mammary hypertrophy, also predisposing them to mammary neoplasia?

Exogenous progestins

A 2yo queen that was in heat 3 weeks ago is presented with enlargement of the mammary glands. What is the best treatment for this condition?

OVH → will completely spontaneously regress this benign mammary hypertrophy

Early embryonic death applies to death of the fetus occurring from the day of conception until day ____ of gestation in the cow.

45

Abortion applies to death of the fetus occurring from day ___ up to day ___ of gestation in the cow.

45, 260

If a fetus is aborted (abortus), what is the best sample to send to a pathologist for evaluation?

ENTIRE placenta + fetus if possible → send fresh chilled in 10% formalin, never frozen as this can kill organisms

Campylobacter fetus venerealis (Vibrio) + Tritrichomonas foetus (Trich) are both spread mainly via natural service in beef cattle, are maintained in preputial crypts of bulls, cause transient endometritis, & result in EED/occasional abortion. What is essentially the only difference between the two venereal diseases?

Trich may cause pyometra, Vibrio does not

What clinical signs are typically seen in bulls with Trich or Vibrio?

No clinical signs (so no warning)

What are our general expectations about pregnancy rates & stages while conducting pregnancy checks in a beef cattle herd? What might happen to the stages of the herd is infected with Vibrio or Trich?

Normal: 60-70% at 2-5 months pregnant

Infected: Most at just 2-3 months pregnant (earlier than expected gestational age)

What is the recommended treatment for Trich in both cows & bulls?

No treatment, most resolve spontaneously or become chronic carriers

During preg checks in a beef cattle farm 2 months after the end of a 3-month breeding season, about 40% of the cows are pregnant & most of the cows that are pregnant are in the 2nd to 3rd month of gestation. What are the most likely causes of this scenario?

Tritrichomonas fetus or Campylobacter fetus venerealis

What might the upper respiratory strain (IBR) of Bovine Herpesvirus-1 (BHV-1) cause in an infected herd

Abortion storms in months 4-8 of gestation

How can we diagnose Bovine Herpesvirus-1 (BHV-1) in a cow?

Microscopic exam of fetal tissues → herpes viral intranuclear inclusion bodies

When does a calf become a persistently infected (PI) calf if infected with Bovine Viral Diarrhea virus (BVDV)?

Mid-gestation → will be antigen positive, but antibody negative

How can we diagnose Bovine Viral Diarrhea virus (BVDV) in cows?

IHC or antigen-capture ELISA on ear notches

What would be the most logical diagnostic test for initial screening of a cattle herd for Bovine Viral Diarrhea virus (BVDV)?

PCR testing of pooled ear notch samples

What protozoal disease is known to cause even more abortions than Brucella canis now?

Neospora caninum

A farmer in California recently brought in a few heifers to his herd all the way from Kentucky. The farmer finds that many of these heifer’s first born calves are aborted & present with petechial hemorrhage in the conjunctiva, generalized lymphadenopathy, as well as severe ascites. What should be your main differential diagnosis?

Epizootic Bovine Abortion (Foothill abortion)

What sign found on pathology will tell you that an abortion in a cow occurred due to a mycotic agent?

Leathery thickening of intercotyledonary space

-also look for fungal hyphae on impression smear

What may cause “crooked calf disease”?

Toxic plants

-ex: Poison Hemlock, Locoweeds (swainsonine)

Early embryonic death applies to death of the fetus occurring before day ___ of pregnancy in the mare.

45

What approaches would reduce the chances of persistent breeding-induced endometritis in a susceptible mare?

Single breeding/insemination, Uterine lavage 6-12hrs after breeding, or Oxytocin every 4-6hrs starting 6hrs after breeding

What is the main cause of abortions in mares?

Twins

How can we diagnose Equine Herpesvirus-1 (EHV-1) in cases of aborted foals?

Multifocal white hepatic necrosis in fetus, Fibrin cast in trachea, Pleural fluid, Virus isolation in placenta

When should mares be vaccinated for Equine Herpesvirus-1 (EHV-1)?

At 5, 7, 9 months of gestation

-does not provide complete protection, however

How is Equine Viral Arteritis (EVA) transmitted & how does it present?

Transmitted: Venereally from carrier stallions or via chilled/frozen AI semen (resistant to cold!)

Presents: Subclinically/inapparent in most cases, may see resp disease, rhinitis, or conjunctivitis from targeting blood vessels

Why do only stallions develop a carrier status for Equine Viral Arteritis (EVA)?

It is testosterone-dependent + survives in the ampulla

What is the most important thing to consider before vaccinating a breeding stallion with the EVA vaccine for the first time?

Make sure the stallion is tested serologically for EVA antibodies before vaccination

What is typically the fate of asynchronous twins (different sized twins that ovulated at different times) in mares?

80% will fix in the same horn + 100% of these will resorb to a singleton

On a 14-day preg check in a standardbred mare, two embryos are observed right next to each other in the left uterine horn. What is the best approach to manage this case?

Try to reduce immediately OR Try to reduce later on the same day

A panicking mare owner calls you after noticing sanguineous discharge in a 16yo pregnant mare. The owner thinks that the mare might be aborting. What is the most likely tentative diagnosis?

Vaginal varicose veins

A 5yo Holstein cow has been bred 3 times during the current breeding season but has not become pregnant. The farmer reports that she had retained fetal membranes after her previous calving & developed a mild uterine infection that was treated. She is currently cycling normally, but no pregnancy has been detected (repeat breeder).

What is the possible cause of Infertility in this cow?

What diagnostic procedures would you perform?

Cause: Endometritis

Diagnostic: Metri-check device or cupped hand into uterus to check fluid for pus

How would you diagnose & treat anestrus in cattle?

Diagnose: Transrectal exam → small inactive ovaries with no CL or large sized follicles

Treat: Address underlying cause (nutrition) or Estrus synch with progestagens (CIDR)

How would you diagnose & treat silent heat/unobserved estrus in cattle?

Diagnose: Serum or milk progesterone test OR Transrectal exam → active ovaries with large sized follicles ± a CL

Treat: Estrus synch with vigorous heat detection (OvSynch) or Fixed Time-AI

What is the best treatment for cystic ovarian disease (luteal or follicular) in cows?

OvSynch → GnRH, then PGF2a, then GnRH, then insemination

What is the best treatment for pyometra in a cow?

PGF2a

What are a few of the causes + treatments of anestrus in mares?

1. Behavioral anestrus (silent heat) → better teasing plan + transrectal exam

2. Seasonal anestrus → artificial light

3. Anovulatory follicles → spontaneous regression or PGF2a after luteinization

What will you see on ultrasound in a case of endometritis (PBIE) in mares?

Free fluid in the uterus + Excessive uterine edema/edema during diestrus from inflammation

What is the recommended treatment for persistent breeding-induced endometritis in mares?

-Breed once at optimal time (induce ovulation with hCG or Deslorelin) with minimal contamination

-Uterine lavage with saline or LRS 4-6hrs after breeding

-Give oxytocin every 4hrs until no fluid in uterus on U/S

What is practically the only reason for giving intrauterine infusion of antibiotics in animals?

Chronic endometritis in mares

If a small animal has not shown any signs of estrus by 2 years of age (primary anestrus), what are some of the causes that should be considered?

-Owner unaware that pet is spayed (from shelter?)

-Owner unaware of signs of estrus/missed the signs

-Previous exogenous hormonal treatments (ex: greyhound racing)

-Intersex

-Stressed or over-athletic, causing infertility

What are some of the methods we can use to diagnose primary anestrus/delayed puberty in small animals?

-Examine teats/vulva for enlargement, indicating previous heat

-Expose to estrous bitches or teaser males

-Vaginal cytology! → see superficial + anuclear cells if under influence of estrogen

-Serum progesterone measured every 6 weeks → rules out silent/unobserved heat

-Ovarian gonadotropin simulation via GnRH implant or Cabergoline

-Gonadotropin assays

What are some of the methods of treatment for primary anestrus/delayed puberty in small animals?

-Housing with other dogs (dormitory effect)

-Estrus induction

-Stress reduction

-Discontinue estrus suppressing drugs (ex: greyhound racing)

Secondary anestrus has all of the same differentials as primary estrus, plus a few more. What are these additional differentials?

Hypothyroidism, Pituitary disorders, Systemic diseases, Poor BCS

A 2.5yo Bull Terrier bitch is presented with a history of not having ever shown any signs of heat. Her vaginal cytology indicates predominantly parabasal + intermediate cells & serum progesterone concentration is 21 ng/mL (HI). What is the most likely cause of primary anestrus in this case?

Unobserved estrus/silent heat

Is it normal for dogs to show split heat during their pubertal estrous cycle?

Yes

What are the two most common differentials for small animals with shortened interestrus intervals (IEI)?

Split heat + Abbreviated diestrus/anestrus

What are the two possibilities for split heat in small animals?

1. Split proestrus → no progression to estrous the first time

2. Split estrus → progression to estrus but no ovulation the first time

How can we attempt to treat + prolong interestrus intervals (IEI) in cases of split heat in GSDs?

-Progestagens → warn O about potential for cystic endometrial hyperplasia leading to pyometra

-Androgens → warn O about potential for enlarged clitoris

How long does a bitch have to display signs of heat in order to be considered in persistent heat/prolonged heat?

More than 30 days

In cystic ovarian disease, what signs will you see in an bitch with a luteal cyst?

Signs of anestrus → progesterone-secreting

In cystic ovarian disease, what signs will you see in an bitch with a follicular cyst?

Persistent signs of estrus → estrogen-secreting

A bitch presents with bilaterally symmetrical alopecia, an enlarged vulva, non-regenerative anemia, leukopenia, as well as thrombocytopenia. Based off these clinical signs, what should be your top differential diagnosis?

Hyperestrogenism

What are some of the tools we can use to diagnose Ovarian remnant syndrome?

-Vaginal cytology → differ false heat from true heat (superficial + anuclear cells tell us estrogen present)

-Serum progesterone 10-14 days later → if increased, CL is present still, meaning ORS is likely

-AMH/LH test → LH is low in ORS due to negative feedback, AMH is high in intact dogs or ORS

What is the most important infectious cause of Infertility in dogs?

Brucella canis

What clinical sign unrelated to reproduction will we sometimes see in both males + females infected with Brucella canis?

Discospondylitis