PCS ! Written Exam

What is flunixin meglumine?

An equine NSAID

What are subtypes of gastric ulcers that occur in equids?

EGUS (ESGD and EGGD)

What sedation options are available for a gastroduodenalendoscopy?

Standing sedation: an alpha-2 agonist (xylazine or dexdomidiine), plus or minus opiod (butorb)

What restraint should I use and how many staff do I need to perform a gastroduodenal endoscopy?

Maybe stocks and a twitch, need a minimum of three people (one person to be a passer, one person to be a handler, one person to be a driver

How long of an endoscope should you use for an equine’s stomach?

3 meters

What management practices would you suggest for the owner of an equine that is recoverinf from stomach ulcers?

Recommend giving a feed that is high in fiber and low in starch, promotes gastric healing, and has a positive effect on microbiota. Also recommend feeding frequently in smaller amounts, feeding alfalfa

is pahracotherapy indicated for a patient with multiple deep gastric ulcers?

Yes, treatment should be aimed at acid suppression

Ranitidine MOA

H2 antagonist, competitive inhibition of H2 cell receptors to reduce acid secretion

Famotidine MOA

H2 antagonist, competitive inhibition of H2 cell receptors to reduce acid secretion

Omeprazole MOA

Irreversible inhibition of parietal cell, ATP pump to reduce acid secretion

Pantoprazole

Irreversible inhibition of parietal cell, ATP pump to reduce acid secretion

Esomeprazole MOA

Irreversible inhibition of parietal cell, ATP pump to reduce acid secretion

Misoprostol MOA

increases gastric mucosal blood flow, stimulates parietal cell with PGE receptor to reduce acid secretion, anti-inflammatory properties

Sucralfate MOA

Biobandage, induce PGE1 synthesis, promotes mucous secretion, inactivate pepsin, absorbs bile acids

Al- or Mg hydroxide Calcium carbonate MOA

direct buffering of gastric fluid

Maropitant

Neurokinin-1 receptor antagonist, inhibits substance P binding to brainstem emetic receptor centers

Misoprostol side effects

May compromise the acid-suppressive effect of PPI; therefore, their concurrent use is

controversial. Co-therapy effects with sucralfate are not currently known. Rarely, mild and self-limiting diarrhea and abdominal pain has been reported with high doses in equids. Potential for abortion in HUMANS and possibly EQUIDS; therefore, given our current lack of clarity, it should not be used in pregnant mares. Humans should take proper precautions (including gloves) when handling and administering this medication.

Sucralfate side effects

Concurrent administration may affect the bioavailability of other orally administered

medications

Best way to monitor success of therapies involving gastric ulcers in equines

Repeat gastropy prior to continuing medications (endoscopic resolution may not be possible for EGGD), clinical response should occur in four days for EGSD and 80 percent improvement after 28 days

Metoclopramide MOA

In CNS: Antagonizes dopamine receptors at the CRTZ Peripherally: Increases smooth muscle effects of Ach and serotonin (5-HT4) in the upper GIT

Is cerenia usually indicated for gastric ulcers in a dog?

Maybe; nausea may help secondary clinical signs (anorexia, vomiting) but does not heal ulcer itself

odansetron MOA

5-HT3 receptor antagonist Centrally: Acts at CRTZ Peripherally: Acts on vagal nerve

terminals

Is ondansetron indicated for gastric ulcers in dogs?

Not indicated because they are poorly absorbed from the GI tract of dogs

Is famotidine indicated for gastric ulcers in dogs?

Not very effective at acid suppression in dogs

Is misoprostol indicated for treating gastric ulcers in dogs?

indicated for NSAID-related ulcers

Is omeprazole indicated for gastric ulcers in dogs?

Yes, decreases gastric acid activity

Is sucralfate indicated for treating gastric ulcers in dogs?

Possibly, can protect ulcerated areas but not treat ulcers themselves

List (in order) the primary layers of the ocular fundus

Internal: Neurosensory retina

Retinal pigmented epithelium (RPE)

Choroid

Sclera

Neurosensory retina

9/10 total layers in the retina, contains retinal blood vessels, sends axons that converge at the optic nerve, where retinal detachment occurs

RPE

Most external retinal layer (10th retinal layer), can be pigmented or non-pigmented

Choroid

Contains the tapetum which may be present of absent in dogs, cats, horses

Sclera

Can be visualized when not obscured by other structures

Purpose of blocking the supraorbital nerve

Blocks sensory function to the upper eyelid

Purpose of blocking auriculopalpebral nerve

Blocking function to the orbicularis oculi muscle (responsible for closing eyelids)

Difference between application of applanation tonometer and rebound tonometer

An applanation tonometer can be held at any angle as long as it is held flat against the surface of the cornea. The rebound tonometer must be held vertically at all times

What tonometry levels and clinical signs are associated with Glaucoma in dogs and cats?

more than 25 mmhg with concurrent vision loss is associated with Glaucoma

What is low intraocular pressure associated with in dogs and cats?

Uveitis

What is considered a normal ocular pressure for dogs and cats?

10-20 mmhg normal, greater difference than 8 mmhg between different eyes in abnormal

What intraocular pressures and clinical signs is associated with glaucoma in horses?

more than 30 mmhg and vision loss is associated with Glaucoma

What is the normal intraocular pressure for equines?

10-30 mmhg is considered normal, greater than 8 mmhg difference between eyes is considered abnormal

Signs of primary hemostatic disorders

Petechiae, hemorrhage, bleeding at mucous membranes, bleeding after venipuncture

Signs of secondary hemostatic disorders

Bleeding in abdomen, hematomas, bleeding into muscles, joints, delayed bleeding after venipuncture

What tests will evaluate for primary hemostatic disorders?

Platelet count, buccal mucosal bleeding time, vWF concentration

What is the main test that evaluate secondary hemostasis disorders?

Prothrombin time (PT), Partial thromboplastin time (PTT), individual factor concentrations

PT >165 sec (reference range 6.0-7.5)
PTT 102 sec (reference range 7.1-10.0)
Fibrinogen 890 mg/dl (reference range 116-364)
D-dimer 255 ng/ml (reference range 116-371)

What is the most likely diagnosis?

A) von Willebrand disease

B) Inherited factor VIII deficiency

C) DIC

D) Rodenticide toxicity

Rodenticide toxicity

Bleeding in the abdomen

His CBC showed a regenerative anemia (PCV 23% with reference range 37-56; reticulocyte count 168,700/uL). He had a leukocytosis (34,700/uL with reference range of 6.0-17.0) due to a neutrophilia with a left shift. His platelet count was 197,000/uL with 3+ clumping.

PT 13 secs (reference range 11-14)
PTT 182 secs (reference range 60-93)

What is the likely differential?

A) Von willebrand

B) Inherited FVII deficiency

C) Factor VIII deficiency

D) Heridetary combined vitamin K clotting factor deficiency

Factor VIII deficiency

Experiencing Epistaxis

CBC showed leukopenia (WBC 100/uL; reference range 5,500-19,500) with moderate toxic change, thrombocytopenia (manual count 2,000/uL; reference range 300,000-800,000) and a normal hematocrit (39%; reference range of 24-45).

His chemistry panel showed a mild elevation in ALT (159 U/L; reference range 26-84) and bilirubin (0.8 mg/dL; reference range 0-0.6).

PT 14 sec (reference range 13-22)
PTT 101 sec (reference range 60-115)

What is the likely differential?

A) Immune-mediated thrombocytopenia

B) Factor XII deficiency

C) Splenic sequestration of platelets

D) Bone marrow neoplasia

D) Bone marrow neoplasia

She had petechiae on her pinnae and petechiae/ecchymoses on her abdomen. She was bleeding from her gingival margins.

Her manual platelet count was 1,000/uL. Her PCV was 26% with a total protein of 6.0 g/L. Her reticulocyte count was 49,400/uL. She had a mild mature neutrophilia (13,172/uL).

What is the most likely cause of her thrombocytopenia?

A) Blood loss

B) Immune-mediated thrombocytopenia

C) Sequestration

D) Bone marrow disease

B) immune-mediated thrombocytopenia

This 5-year-old spayed Cocker spaniel presented with gingival bleeding and ecchymoses on her ventral abdomen. She was alert and responsive and her vital parameters were normal.

Her hemogram and leukogram were normal. Her manual platelet count was 4,000/uL. Her chemistry panel was unremarkable. Urinalysis was not performed.

Consider your most likely differential diagnosis for this dog. Which test could help to confirm your differential diagnosis?

A) Anti-platelet antibody test

B) D-dimers test

C) Bile acids test

D) BMBT

A) Anti-platelet antibody test

What are common clinical signs in the equine if the cerebrum is affected?

Altered mental state, circling, inappropriate behavior, seizures

In the equine, what clinical signs will you see if the cerebellum is affected?

loss of fine coordination, hyper/dysmetria, vestibular signs, intention tremors, loss of coordinated, voluntary movement

In the equine, what clinical signs would you see in the equine if the vestibular system is affected?

central vs peripheral, postural and balance abnormalities, nystagmus, ataxia, circling, proprioception deficiencies

In the equine, what clinical signs would you see in the equine if the cervical vertebrae (C1-C5) are affected?

All four limbs affected, the hindlimbs are affected more than the front limbs, UMN paresis, ataxia

In the equine, what clinical signs would you see in the equine if the brachial plexus is affected?

All four limbs affected, hind limbs affected more than forelimbs, LMN signs in front and UMN signs in back, ataxia and weakness

In the equine, what clinical signs would you see in the equine if the T3-L3 is affected?

Hindlimbs affected, UMN paralysis, elongated stride, ataxia

In the equine, what clinical signs would you see in the equine if the L4-S2 is affected?

Hindlimbs affected, LMN paralysis, short choppy stride, pronounced weakness behind

In the equine, what clinical signs would you see in the equine if the S3-caudal is affected?

Normal or LMN hindlimbs, cauda equine signs, urinary/rectal incontinence, soft/full bladder