Answer is a

 

Which of the following congenital cardiovascular defects is most likely associated with an auscultable murmur?

a)    Right to left ventricular septal defect

b)    Right to left persistent ductus arteriosus Botalli

c)    Atrial septal defect

d)    Cor triatrium dexter

e)    Persistent right aortic arch

 

Answer is c

 

Which of the following is NOT associated with hyponatraemia and hyperkalaemia?

a)    Trichuris vulpis enteritis

b)    Hypocortisolaemia

c)    Heart failure

d)    Nephrotic syndrome

e)    Liver failure

 

Answer is b

 

All of the following statements regarding canine acute pancreatitis are correct EXCEPT:

a)    Hypertriglyceridaemia is a risk factor rather than a consequence

b)    Both hypoglycaemia and / or hyperglycaemia may occur

c)    Increases in serum TLI activity precedes elevations of serum lipase and amylase

d)    Dextran therapy is useful to reactivate protease inhibitors

e)    Death is usually caused by failure of other organs.

 

Answer is d

 

Which of the following glucocorticoid preparation induces LEAST suppression of the adrenal cortex after one injection?

a)    Triamcinolone acetonide

b)    Dexamethasone sodium phosphate

c)    Prednisolone succinate

d)    Methylprednisolone acetate

e)    Betamethasone

 

Answer is c

 

The most common cause of erythrocyte destruction in immune-mediated haemolytic anaemia is:

a)    Direct intravascular haemolysis from complement activation.

b)    Direct intravascular haemolysis as a result of large quantities of IgM on the erythrocyte membrane.

c)    Autoagglutination of erythrocytes with subsequent loss in the reticuloendothelial system.

d)    Phagocytosis of opsonized erythrocytes by macrophages of the reticuloendothelial system

e)    Failure of erythropoiesis in the bone marrow due to autoantibody formation against erythroid precursor cells.

 

Answer is d

 

Which one of the following substances works to directly reverse bronchoconstriction and hence is the treatment of choice in severe, allergic respiratory distress?

a)    Dexamethasone

b)    Antihistamines

c)    Epinephrine

d)    Blocking antibody

e)    Calcium channel blocker

 

Answer is c

 

Which of the following statements best describes unilateral cortical disease?

a)    Blindness, ataxia, intention tremor.

b)    Contralateral proprioceptive deficits, seizures, unilateral decreased pupillary light response.

c)    Contra lateral proprioceptive deficits, lower motor neuron signs, unilateral blindness.

d)    Decreased menace reflex, proprioceptive deficits, decreased pupillary light response.

e)    Circling, unilateral absent menace, proprioceptive deficits.

 

Answer is e

 

B.    Essay questions

 

Question 1: PRIMARY HEMOSTASIS IN DOGS

 

a) What are the primary hemostatic components? (1.5 points)

 

b) How do you reach a diagnosis of primary immune-mediated thrombocytopenia (pITP)? (2 points)

 

c) How do platelet count and size help in the diagnosis of pITP? (1 point)

 

d) What is the survival of platelets in healthy dogs and dogs with ITP? (1 point)

 

e) Are immunologic tests for pITP available and/or useful? (2 points)

 

f) Are blood transfusions indicated and useful in pITP? (1 point)

 

g) What preferred and other alternative therapy are you considering in a dog with pITP refractory to immunosuppressive doses of prednisone? (3 points)

 

h) Name an example and briefly describe the mechanisms of three drugs that differently interfere with primary hemostasis in dogs. (3 points)

 

i) Name two hereditary intrinsic platelet defects that have been described in dogs and an associated breed and the most appropriate screening test. (3 points)

 

k) How does von Willebrand factor function and affect hemostasis? (1 point)

 

l) How is von Willebrand disease (vWD) diagnosed clinically? Indicate your preference and reasons. (2 points)

 

m) What blood component is ideal to treat a bleeding dog with vWD? Explain how it is prepared and why it is better. (2 points)

 

n) What drug has been shown to treat or prevent bleeding in dogs with vWD disease? Explain its action and when it is used. (1 point)

 

o) Provide three differentials for severe thrombocytosis in dogs. (1.5 points)

 

Essay sample question, answer key

 

1. PRIMARY HEMOSTASIS IN DOGS

 

a) What are the primary hemostatic components?

platelets, vasculature, and  vonWillebrand factor

 

b) How do you reach a diagnosis of primary immune-mediated thrombocytopenia (pITP)?

rule out other causes of thrombocytopenia, often associated with severe thrombocytopenia, micro- and macrothrombocytosis,

 immunological: positive  direct  platelet antibody test with flow cytometry, megakaryocytes increased, response to treatment

 

c) Does the platelet count and size help to differentiate pITP from other thrombopenias?

In pITP: often very low, microthombocytes/plt fragments suggest immune destruction. Macroplatelets suggest active bone marrow (increased megakaryocytes)

 

d) What is the survival of platelets in healthy dogs and dogs with ITP?

normal 7 days vs hours to a couple of days in ITP

 

e) Are immunologic tests for pITP available and/or useful?

Various plt-antibody tests have been tried and used (ELISA, FACS, RIA), direct anti-plt antibody test is better than indirect, FACS requires fewest plts. Anti-megakaryocyte antibody test and PF-3 appear not helpful. Anti-plt antibody test is generally positive in pITP cases, but a positive test result is not specific for pITP, rule out other causes.

 

f) Are blood transfusions indicated and useful in pITP?

Rarely fresh whole blood or plt concentrates (PRP) used with life-threatening bleeding. Packed RBCs to correct anemia.

 

g) What preferred and other alternative therapy are considering in a dog with pITP refractory to immunosuppressive doses of prednisone?

Doxycycine because it is difficult to exclude tick born diseases

Vincristine is preferred as it is the only alternative treatment to prednisone that has been evaluated; pulse desamethasone, danazol, azathioprine, and human IVIG may be tried in refractory cases; cytoxan may also be considered, but may be associated with serious side effects and its effect has not been documented. Splenectomy has been show in humans to be highly effective, but there is little experience in dogs with ITP

 

h) Name an example and briefly describe the mechanisms of three drugs that differently interfere with primary hemostasis in dogs.

 

Three examples are presented; these drugs could be substituted by others that act similarly

Aspirin              cyclooxygenase inhibitor®plt dysfunction

Sulfonamide      ITP

Estrogens          aplastic anemia

 

i) Name two hereditary intrinsic platelet defects that have been described in dogs and an associated breed and the most appropriate screening test.

 

k) How does von Willebrand factor function and affect hemostasis?

vWF is required for platelet-platelet and platelet-endothelial adhesion under high shear forces and is a carrier protein for FVIII. vWF is not involved in the coagulation cascade.

 

l) How is von Willebrand disease (vWD) diagnosed clinically? Indicate your preference and reasons.

ELISA plasma vWF is simple and best to detect affected dogs.

An accurate simple DNA tests (where for a breed available) is useful for breeding purposes as affected and carriers can be identified.

BMBT is a relatively insensitive and unspecific screening test. In most vWD cases the BMBT is prolonged, whereas the apt remains normal.

Multimer and vWF function assays are not readily available.

 

m) What blood component is ideal to treat a bleeding dog with vWD? Explain how it is prepared and why it is better.

Preference of cryoprecipitate is based on several studies. Contains high levels of FVIII, vWF and fibrinogen, thus, small volumes can be given. Other components of the donated unit of blood can be used for other dogs. It is prepared from FFP by slowly thawing it over 6-8 hours and collecting the precipitate by centrifugation and removal of cryo-poor fraction (cryo-poor plasma contains all coagulation factors except FVIII).

 

n) What drug has been shown to treat or prevent bleeding in dogs with vWD disease? Explain its action and when it is used.

Desmopressin (DDAVP) shortly before surgery or at time of bleeding; should  not be used alone for life threatening bleeding. Acts by slightly increasing plasma vWF(50%) and improving vascular integrity by selectin and other vascular protein expression.

 

o) Provide three differentials for severe thrombocytosis in dogs.

Chronic blood loss anemia

Vincristine administration

Essential thrombocythemia

 

(http://www.ecvim-ca.org/Sample%20questions%20certifying%20IM.htm)