RPM: practice questions (week 4)

mutilations, HQHV S/N, euthanasia LA, bacterial/viral disease control, teratogenesis/toxicities, parasite control SA, electrolyte disturbances, equine euthanasia

A healthy 2yo indoor cat is presented to a veterinary clinic in California. The owner requests bilateral forelimb onychectomy solely to prevent the cat from scratching furniture. The owner provides informed consent & accepts responsibility for potential complications. What is the veterinarian's most appropriate response?

Decline to perform the procedure because California law prohibits elective onychectomy of cats, with limited exceptions

A HQHV Spay/Neuter clinic is experiencing bottlenecks. Animals are frequently waiting under anesthesia while surgical preparation is completed. What operational change would best improve efficiency?

Use a staggered workflow with parallel induction, preparation, & surgery

A high-volume spay/neuter clinic is updating its perioperative protocol to improve patient safety & reduce complications during feline ovariohysterectomy procedures. A healthy 8-month-old queen is presented for elective surgery. The attending veterinarian reviews the Association of Shelter Veterinarians & emphasizes the importance of evidence-based practices for perioperative care in shelter medicine settings. Which of the following actions best reflects the ASV recommendation for improving patient safety in this case?

Administer perioperative analgesia before surgical stimulation

A vet is called to a dairy farm to evaluate a mature cow with a catastrophic pelvic fracture. Transport is not possible, & immediate euthanasia is indicated. A penetrating captive bolt is used correctly, resulting in immediate collapse + unconsciousness. What is the most appropriate next step to assure a successful death in this case before carcass disposal?

Use an adjunctive method such as exsanguination or pithing after unconsciousness

A vet is planning euthanasia of an adult beef steer in a remote field. The owner requests IV barbiturate overdose because it is commonly used for companion animals. However, carcass disposal options are limited & scavenger access is likely. Which factor regarding the use of barbiturates is the most important reason to consider an alternative method?

Barbiturate residues can contaminate the environment

What is the recommendation for unvaccinated humans exposed to the rabies virus? 

Wound cleaning, treatment with human rabies immunoglobulin soon after the exposure, & rabies vaccination

At what stage of the lactation are cows prone to hypocalcemia?

The periparturient period

Which hormone release is triggered by a low blood calcium concentration?

Parathyroid hormone

What change on a blood biochem could account for a low calcium reading?

Hypoalbuminemia

Why might increased PTH lead to hypophosphatemia?

Increased phosphorus excretion via the kidneys

What electrolyte is needed for PTH release?

Magnesium

When a cow is diagnosed as having hypomagesemia, where is magnesium absorbed from?

The rumen

What test would indicate that a DCAB diet is working?

Low urine pH

A dairy farmer reports an increased incidence of early embryonic death, reduced conception rates, & occasional abortions in cattle grazing near a battery recycling facility. Lab analysis reveals elevated concentrations of a heavy metal in the animals' blood + tissues.

Which heavy metal is the most likely cause of the reproductive toxicity?

Lead

What term is described by procedures which interfere with sensitive tissue or bone structure that are performed for purposes other than medical treatment?

Mutilation

What are some examples of exempt mutilations that may have long term benefits?

Branding, S/N, Dehorning, Disbudding, Removal of supernumerary teats

What are some examples of purely cosmetic procedures or procedures solely for convenience of the owner?

Ear cropping, Declawing, Tail docking, Devocalization, Testicle implants

What is being removed in an onychectomy procedure?

Amputation of P3

What is the primary purpose of patient classification in a HQHV S/N clinic?

To improve patient flow, safety, & resource allocation

Daily surgical capacity within a HQHV S/N program is most strongly influenced by the operational bottleneck within the workflow. Which factor is most likely to create such a bottleneck?

Availability of surgical packs + support staff

When do kittens’ permanent incisors typically erupt (to help us age them for HQHV S/N)?

12-24 weeks

When do puppies typically have full adult dentition (to help us age them for HQHV S/N)?

7-8 months

How long should pediatric animals (6-16 weeks old) be fasted prior to surgery for HQHV S/N programs?

2-4 hours

-do not fast longer than 4 hours prior to surgery due to risk of hypoglycemia

How long should juvenile + adult animals (>16 weeks old) be fasted prior to surgery for HQHV S/N programs?

4+ hours

-but not necessary to fast longer than 6 hours unless have to

A HQHV S/N clinic performs surgery on a dog owned by a client with limited transportation & no established relationship with a primary care vet. At discharge, the dog is stable, but the clinic will be closed overnight. What discharge plan is most likely to support patient safety + continuity of care while minimizing barriers to follow-up?

Provide written instructions, review home care verbally, & include clinic, emergency, + referral contact information

A HQHV shelter clinic is considering adding vaccination, parasite control, & selected minor procedures to its S/N program. Some team members are concerned that offering additional services will reduce efficiency + increase costs. Which strategy would best allow the clinic to expand services while maintaining the principles of HQHV medicine?

Bundle commonly indicated services & use standardized protocols to improve efficiency + reduce unnecessary variation

A HQHV clinic receives a large group of shelter cats for sterilization. Several cats have unknown vaccination histories. The clinic manager reviews procedures for minimizing disease spread while maintaining surgical efficiency. What is the best population health strategy?

Applying standardized intake screening + separating higher-risk patients from the general population

A dog undergoing castration receives an injectable general anesthetic protocol. The clinic has limited access to inhalant anesthetic & wants to reduce the amount of systemic anesthetic needed while improving perioperative analgesia. What is an appropriate anesthetic protocol strategy to address pain control in a low-resourced HQHV clinic setting?

Add an appropriate local anesthetic technique to the multimodal analgesic plan

A HQHV clinic reviews an anesthetic emergency in which emergency drugs were available, but staff were uncertain about their responsibilities during CPR. What is the most appropriate quality improvement measure for the team?

Conduct regular team training with predefined CPR roles + emergency response protocols

What are the contraindications for using chemical castration in HQHV S/N clinics?

Cryptorchids, TVT, Scrotal dermatitis, Testicular disease