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A 9 year-old male neutered domestic shorthair cat is presented with a 4 week history of occasional disorientation and bumping into things. The cat does not visually track a ball rolled in front of him and has decreased pupillary light reflexes OU.

On fundoscopic exam, the retinal vessels and disc are obscured by something in the way. (see image, below)

What testing is indicated to assess the two most common underlying causes of this condition in cats?

A - Hepatic function, Serum globulins
B - Adrenal function, Arterial pressure
C - Thyroid function, BUN/Creatinine
D - Urinalysis, Pancreatic function, fasting blood glucose
E - CSF analysis, CBC
C - Thyroid function, BUN/Creatinine
Thyroid function, BUN/Creatinine. This presentation of vision loss in an older cat suggests retinal detachment, typically secondary to HYPERTENSION.

Chronic renal disease may lead to HYPERtension and retinal detachment-Physical exam, history and BUN/creatinine will rule this disease in or out.

HYPERthyroidism can ALSO cause HYPERtension. Your physical exam and history, plus a measure of T4 will help you evaluate this condition.

Other diseases associated with retinal detachment include your alphabet diseases and 2 T's:
FIP, FeLV, FIV
Toxoplasmosis and Trauma

Follow these links to see classic retinal detachment in a dog with renal disease and focal retinal detachment in a cat with cryptococcosis.

Remember you can see hemorrhage with retinal detachment, as in this example from a young dog with Collie-eye anomaly.

For comparison, see this example of another big retinal disease, Progressive retinal atrophy (PRA)- think of SLOW loss of vision, starting with night vision loss and progressing to blindness over MONTHS.
An associate veterinarian is paid on a commission-only basis of 18%.

Last month the net gross production was $25,000 and the gross salary was
$4500.

How much does the gross production need to be this month in order to increase the gross salary to $6000 ?
E - $33,333
$33,333.

Just write it out, one step at a time.

If ($25,000 gross production)X(0.18)=$4500 monthly salary

then ($ ? gross production)X(0.18)=$6000 monthly salary

gross production = $6000/0.18 = $ 33,333

A new graduate may prefer a straight salary to a commission-based salary for the stability it gives. Many practices use a combination system with a base salary and a production-based bonus if you bring in more than a monthly production goal, but no penalty if you are below that monthly goal.
An 11 year old neutered male Doberman pinscher is presented with a 2 week history of limping on the left fore. The medial digit is swollen, the nail is deviated laterally. Ulceration and proliferation are present in the ventral nail bed.

Cytology of the mass is inconclusive. Chest radiographs are clear. Following amputation of the digit, histopathology indicates that the mass is a malignant melanoma.

What is the prognosis for this case?

A - Cannot say
B - Poor
C - Excellent
D - Fair
E - Good
B - Poor
The prognosis is poor. Melanoma of the digit is an aggressive, infiltrative tumor, with substantial metastatic potential and poorer prognosis. Median survival with resection is 12 months, with a 30% local recurrence rate. Melanomas are not thought to be responsive to radiotherapy, and the efficacy of chemotherapy for subungual melanomas is unclear.

Remember that a malignant melanoma can appear as swellings of the digit, often with loss of the nail and destruction of underlying bone, mimicking osteomyelitis. Radiographs and a biopsy are indicated for older dogs that present with a festering, swollen toe lesion. Click here to see a radiograph of oesteomyelitis in a dog's toe.

In contrast, the prognosis is good for dogs with digital squamous cell carcinoma (SCC). 95% of dogs with digital SCC survive 1 year after amputation and 75% survive 2 years after amputation. SCC have a low metastatic rate and most have not yet metastasized at the time of amputation and diagnosis. In addition to chest radiographs prior to surgery, local lymph node aspiration for cytology during surgery is important in order to help assess prognosis.
What feline condition may cause the lesion evident in this image?
C - Hypertrophic cardiomyopathy
This is an aortic thromboembolism, secondary to feline hypertrophic cardiomyopathy (HCM) the most common heart disease of cats.

Physical signs of aortic thromboembolism include hindlimb paresis or paralysis, cyanotic nail beds, toe pads and cold extremities, decreased or absent pulses, contracted and painful hindlimb muscles, relentless crying.

Don't confuse this presentation with the nonpainful plantigrade stance of diabetic neuropathy in cats, an uncommon sequella of diabete mellitus.

Often, cats with HCM are asymptomatic and the problem is discovered on physical exam, with auscultation of a systolic murmur, evident in 80% of cats with HCM. Physical signs in cats with clinical HCM may include tachypnea, dyspnea, anorexia, vomiting and lethargy
A 1 year old German Shepherd is presented with a 2-week history of lameness. Although the dog limps on the right foreleg as it enters the exam room, the owner reports that the dog was lame on the left hindleg last week.

T=99.8 F (37.7 C)..[N=99.5-102.5 F]
RR=24 brpm.......[N= 15-34]
HR=100 bpm........[N= 80-120]

On physical exam, the dog reacts painfully on palpation of the long bones of the right foreleg.

Which one of the following choices is the most likely diagnosis?


A - Multiple cartilaginous exostoses
B - Retained ulnar cartilage cores
C - Panosteitis
D - Hypertrophic osteopathy
E - Hypertrophic osteodystrophy
C - Panosteitis
The hallmark of panosteitis is an acute-onset shifting leg lameness with long bone pain in a young (5 mos-2 years), medium to large breed dog.

German Shepherds are reported to be at highest risk of panosteitis. Basset hounds may be over-represented.

Hypertrophic osteodystrophy (HOD) is characterized by bilateral metaphyseal pain, swelling in distal radius and ulna, fever, anorexia and depression. Typically a disease of young, growing large and giant breed dogs.

Hypertrophic osteopathy (HO) is a diffuse periosteal proliferative disease of long bones in dogs SECONDARY to neoplastic or infectious masses in the thoracic or abdominal cavity.

Multiple cartilaginous exostoses is characterized by non-painful ossified swellings on metaphyseal cortical surfaces of long bones, vertebrae, and ribs in young dogs and cats. Animals may have no signs at all. Diagnosis is confirmed by palpation and radiography. Click here to see a radiograph of cartilaginous exostoses

Retained ulnar cartilage cores are characterized by lameness and eventually, angular limb deformity in young, large breed dogs.
An 8-month old male German Shorthaired Pointer is presented with a history of intermittent hindlimb lameness which is exacerbated by exercise during hunting.

On physical exam the dog is painful on manipulation of the right stifle. Click here to see a radiograph of affected area.

What advice should the owner be given?

A - Don't breed this dog
B - Joint imbrication may prevent imminent cruciate ligament rupture
C - Need to test dog and owner for blastomycosis
D - Need arthroscopy to confirm the diagnosis
E - Good prognosis for return to function by 18 months of age
A - Don't breed this dog
Discourage breeding of dogs with osteochondrosis (OC, or OCD).

Common sites for OC are the shoulder (caudocentral humeral head), elbow (medial aspect of humeral condyle), stifle (femoral condyle, usually lateral), hock (ridge of the talus, usually medial).

OC typically presents as a lameness in a young (4-10 mo), male (3x more likely than female), fast-growing, large breed dog; bilateral in 51%.

Prognosis for return to function is good to excellent with shoulder OC. More likely to see degenerative joint disease in elbow, stifle, hock OC.
Which of the following choices describes the correct order of putting on surgical attire and scrubbing for surgical personnel?

A - Facemask, gown, hand scrub, gloves, hair cap
B - Hair cap, facemask, hand scrub, gown, gloves
C - Facemask, hair cap, gown, gloves, hand scrub
D - Gown, hand scrub, gloves, hair cap, facemask
E - Hand scrub, gown, gloves, hair cap, facemask
B - Hair cap, facemask, hand scrub, gown, gloves
The basic order is: Hair cap, facemask, hand scrub, gown, gloves. Most facilities have disposable shoe covers to wear, which are put on when you put on the hair cap and facemask.

Gloving is important, but is not a substitute for proper scrubbing. There are three gloving methods:
1. Closed gloving (your scrubbed hand is inside the gown as you handle the glove).
2. Open gloving (your scrubbed hand touches the inside of the glove as you put it on).
3. Assisted gloving (an assistant who is already gloved holds your glove open as you put your scrubbed hand in).
An 11 year old male neutered dog is presented with a 4 week history of worsening problems with urination. The dog appears to have abdominal pain and strains to urinate a small volume of reddish urine.

Urinalysis: USp.G=1.028, 15-20 WBC/hpf, RBC +++, protein +, bacterial rods +++

A pneumocystogram radiograph looks like this
Click here to see image

Which of the following is the most likely diagnosis?

A - Benign prostatic hypertrophy
B - Struvite urolithiasis
C - Renal calculi with secondary nephrosis
D - Amyloidosis
E - Transitional cell carcinoma
E - Transitional cell carcinoma
This is likely to be neoplasia, specifically, a transitional cell carcinoma seen here in the trigone of the bladder after pneumocystogram (air in bladder) and here after injection of contrast media.

Hematuria, pollakiuria, abdominal pain and bacterial cystitis in an older dog may also suggest urolithiasis, but if stones were visible on radiograph, they would be less likely to sit in the trigone. The most common form is struvite urolithiasis (generally radio-opaque), seen in 60% dogs, 90% cats.
Click here to see a radiograph of a cat with urolithiasis.

With renal calculi, look for classic "staghorns" in the kidneys on DV rads.

With prostatic hypertrophy look for prostate displacing the bladder cranially into the abdomen. The oval closest to the pelvis is the prostate, the larger oval cranial to it is the bladder.
A 7-year old dog weighing 24 lbs (10.9 kg) is presented after the owner caught the dog eating warfarin-containing rat poison the day before.

The dog has no overt clinical signs at presentation. Baseline coagulation parameters are normal [Prothrombin time (PT), Activated partial thromboplastin time (aPTT) and Proteins induced by vitamin K1 absence or antagonism (PIVKA)].

The dog is confined to limit exercise and monitored. At 72 hours PT and PIVKA tests are elevated.

Which one of the following choices is the most appropriate treatment step?

A - Injectable vitamin K1, EOD
B - Plasma transfusion
C - Blood transfusion
D - Oral vitamin K1, SID
E - Activated charcoal
D - Oral vitamin K1, SID
Oral vitamin K1. If PT or PIVKA tests elevate at 48 or 72 hours in a case-patient with suspected anticoagulant rodenticide toxicity, start oral vitamin K1 at 1.5-2.5 mg/kg q 12h or 3-5 mg/kg once daily.

Continue treatment for 14 to 30 days, depending on the specific anticoagulant. Warfarin is a first generation, shorter-acting anticoagulant, brodifacuom is a second-generation long-acting anticoagulant.

PT or PIVKA should be checked 48 hours after the last dose of vitamin K1. If PT or PIVKA is still elevated 48 hours after last dose (16 to 32 days postexposure), restart vitamin K1 treatment for 1 week, then recheck PT or PIVKA 48 hours after last dose. Once the PT or PIVKA is normal at 48 hours, you can stop vitamin K1 treatment.

Injectable vitamin K1 has no advantage over oral vitamin K1 and can cause anaphylaxis in some animals, even when injected subcutaneously. A blood or plasma transfusion is indicated for animals that present with overt clinical signs (hemorrhage. dyspneic, pale).
A ten year old neutered male cat is presented with an acute onset of vomiting and anorexia. On physical examination, the patient is dehydrated with a painful abdomen.

Bloodwork
ALB=2.2 g/dL.......[N=2.6-4.0], ALK PHOS=88 U/L..[N=3-65]
ALT=112 U/L........[N=8.2-57], AMYL=2483 U/L..[N=270-1,462]
BUN=42 mg/dL.....[N=10-30], K=3.3...[N=3.5-5.1]
CL=108 mEq/L......[N=109-122], WBC=22,200..[N=3800-19,500]
LYMPHS=1404/uL..[N=1000-4800], NEUTS=15538/uL..[N=0-3000]
Ultrasound: Mass effect on the region of the pancreas
Radiographs: Decreased serosal detail in the cranial abdomen

In addition to supportive care (IV fluids, anti-emetics) and pain control, which one of the following treatment options is indicated?

A - Prednisone
B - Trimethoprim-sulfamethoxazole
C - Pancreatic enzyme replacement therapy
D - Tylosin; Cisapride
E - Hypoallergenic diet
A - Prednisone
Prednisone is a viable treatment option for some patients and may also mitigate associated diseases such as cholangiohepatitis and inflammatory bowel disease.

The mainstay of pancreatitis therapy is supportive care, with IV fluids, pain control (meperidine, butorphenol, fentanyl, buprenorphine) and antiemetics. If vomiting can be controlled, judicious offering of low-fat food is indicated in cats.

Prednisone is contraindicated in feline diabetes mellitus and canine pancreatitis. Antibiotics are only indicated in cases where an underlying cause can be identified that requires their use.
A female veterinarian is pregnant and her physician tests her serologically for toxoplasmosis.

IgM is negative.
IgG is positive

What is the most appropriate interpretation?

A - Mother at risk, baby is safe
B - Both mother and baby are safe
C - Both mother and baby at risk
D - Need to re-check in 2 weeks for rising titers
E - Mother is safe, baby at risk
B - Both mother and baby are safe
Both mother and baby are safe. The toxoplasmosis organism causes birth defects in a developing fetus if a mother is infected for the first time in her life while pregnant (ie: IgM positive while pregnant).

Toxoplasmosis is not generally dangerous to immune-competent people and a positive IgG result suggests an old infection.

There are challenges to toxoplasmosis testing in pregnant women (false positives). If a pregnant woman is IgM positive, confirmatory tests must be done.

Click here for more on pregnancy and toxoplasmosis
A person calls to to say she adopted a friend's dog. The former owner is a client at your clinic.

The new owner requests a copy of the dog's medical record and radiographs.

Which one of the following choices is the most appropriate action to take?

A - Give caller a copy of medical record only
B - Give a summarized record with personal identifiers (vet, owner names) blocked out
C - After physical exam, start a new medical record documenting previous issues
D - Require original owner consent or court order to release information
E - Give caller a copy of medical record and radiographs
D - Require original owner consent or court order to release information
According to the AVMA's Principles of Veterinary Medical Ethics (2008 revision)

"Ethically, the information within veterinary medical records is considered privileged and confidential.

It must not be released except by court order or consent of the owner of the patient.

Veterinarians should secure a written release to document that request."
A 7-year old outdoor cat is presented with a month-long history of cough, dyspnea and weight loss. A heartworm antibody test is positive.

What is the most appropriate interpretation?

A - A modified Knott's test is indicated
B - Further diagnostics needed
C - Presumptive feline asthma
D - Cat has heartworm disease
E - Cat does not have heartworm disease
B - Further diagnostics needed
Further diagnostics needed. Diagnosis of heartworm disease (HW) in cats is difficult and requires an elevated index of suspicion and serial diagnostic tests. A positive antibody test in the cat only indicates EXPOSURE to heartworms, and further work up is indicated.

A negative antibody is useful to rule-OUT HW disease in cats, but unfortunately, 14% of cats with HW infection may be antibody negative.

A positive heartworm antigen test is diagnostic in cats, but a negative antigen doesn't say much because of high false negative antigen tests.

Bottom line-there is no single test for HW in cats, and you need a full workup. Further diagnostics may include echocardiography, thoracic radiographs, a CBC and panel.
A one-year-old intact male domestic short hair cat presents with dyspnea after vehicular trauma. On physical examination, the cat is open-mouth breathing with muffled heart sounds and borborygmi heard on pulmonary auscultation.

Which one of the following choices is the most likely diagnosis?

A - Pneumothorax
B - Cardiac tamponade
C - Posterior lung lobe torsion
D - Diaphragmatic hernia
E - Flail chest
D - Diaphragmatic hernia
Diaphragmatic hernia is most likely to cause dyspnea with gastrointestinal sounds auscultable in the chest.
Which one of the following choices would result in the most severe transfusion reaction in a cat?

A - Type AB cats receive Type A blood
B - Type B cats receive Type A blood
C - Type O cats receive Type A blood
D - Type O cats receive Type B blood
E - Type A cats receive Type B blood
B - Type B cats receive Type A blood
The most severe transfusion reactions tend to occur when Type B cats receive Type A blood.

The anti-B antibody is much stronger than the anti-A antibody. Cats have naturally occurring isoantibodies to RBC antigens; a mismatched transfusion can be rapidly lethal. They do not have type O blood.
The major active ingredient in most IV euthanasia solutions is:

A - Pentobarbital
B - Thiopental
C - Phenytoin
D - Potassium chloride
E - Phenobarbital
A - Pentobarbital
Pentobarbital is one of the most commonly used drugs in IV euthanasia solutions. For the most complete reference on veterinary euthanasia, see the 2000 Report of the AVMA panel on Euthanasia , JAVMA, Vol 218, No. 5, March 1, 2001.

The AVMA report states IV injection of a barbituric acid derivative is the PREFERRED METHOD for euthanasia of dogs, cats, other small animals, and horses.

Potassium chloride can be used in conjunction with general anesthesia.

Phenytoin and lidocaine are often added to pentobarbital-containing euthanasia solutions to increase cardiac depressant effects.

Thiopental is an ultra-short acting thiobarbiturate used for anesthesia induction and for short procedures.
Under what conditions is a very sensitive test used?

A - Lethal disease, Highly prevalent disease
B - Treatment does not affect prognosis, Non-infectious diseases
C - Common disease, infectious diseases
D - Rare disease, Early diagnosis improves prognosis
E - Highly prevalent disease, Treatment does not affect prognosis
D - Rare disease, Early diagnosis improves prognosis
You need a very sensitive test if: 1. Disease is rare (ie: BSE), or 2. Early Dx improves prognosis (ie: HIV in people), or 3. The disease is highly lethal or consequences of missing a case are severe. (ie: Rabies, Brucellosis, BSE, Screw-worm, FMD, EIA)

Remember that a HIGHLY SENSITIVE test will have very FEW false negatives. That means if a test is highly sensitive, you can TRUST a NEGATIVE TEST. This sounds contradictory, but it makes more sense if you review this sensitivity diagram.

Sensitivity=a/(a+c). "a" are true positives. "c" are false negatives. If sensitivity is HIGH then "c" (FALSE negs) must be small. Therefore, high sensitivity means you can really trust a NEGATIVE result to be correct.
How long after a booster rabies vaccination is a dog, cat or ferret considered to be currently vaccinated and protected against rabies?

A - After 24 hours
B - After 48 hours
C - Immediately
D - After 7 days
E - After 14 days
C - Immediately
Immediately. According to the Compendium for Rabies Control, a peak rabies virus antibody titer is reached 28 days after initial vaccination and immediately after booster vaccination.

Here are some thoughts on rabies:
When in doubt, it is never wrong to check with your local health department.

Basically all potential rabies exposures boil down to 2 questions:
1. Who is involved?
Animal-Animal exposure (less alarm bells)
Animal bites/exposes human (more alarm bells)

2. Was animal vaccinated/up to date on vaccination?
Up to date on vaccs (less alarm bells, shorter observation)
Vaccinated, but not up to date (Handle on case-by-case basis)
Un-vaccinated pet (more alarm bells, euthanize or long observation period)
Wild animal, esp. bats, raccoon, skunk (euthanize, send head to state lab)

When dealing with rabies questions, ask yourself if this seems like a HIGH-risk exposure (ie: wild raccoon bites a child)
or a LOWER risk exposure (ie: Up-to-date vaccinated dog messes with woodchuck but no bite wounds on dog).

For high risk lean towards euthanasia/testing or long quarantine. For low risk lean towards short observation period (10 days) and a rabies booster.
What condition would be expected to have a positive Ortolani sign?

A - Panosteitis
B - Cranial cruciate rupture
C - Coxofemoral luxation
D - Hip dysplasia
E - Osteochondrosis dissecans (shoulder)
D - Hip dysplasia
A positive Ortolani sign indicates joint laxity, typically associated with hip dysplasia. A click/pop heard or felt by one hand pressed over coxofemoal joint while other hand presses upward and abducts knee. Think LARGE, hindlimb-LAME dogs, especially German shepherds.

Follow these links to see radiographs of: early hip dysplasia,(no DJD yet), severe hip dysplasia (Note flattened, angular femoral head, poor congruence (parallel line) with acetabulum) and in contrast normal canine hips with deeply seated femoral heads and good congruence with acetabulae.

Do a "Thumb test" for coxofemoral luxation (dislocated hip)- place thumb in the groove between greater trochanter & ischial tuberosity, externally rotate femur: thumb is pushed OUT of groove with normal hip, but stays in groove with luxated hip or fractured femoral head.

A positive drawer sign indicates cranial cruciate rupture.

Panosteitis characterized by long bone pain on palpation and Hx of a shifting leg lameness in young, large dogs.
A 5 year old female spayed Cocker Spaniel is presented with a strange expression. Her right ear and lip appear to droop. There is ptosis O.D. (right eye) and the dog is drooling on the exam table.

What anatomic structure is damaged?

A - Right side inner ear
B - Left side inner ear
C - Facial nerve
D - Trigeminal nerve
E - Left side medulla, motor tract
C - Facial nerve
Think of facial nerve paralysis (CN 7) with a unilaterally droopy face.

Remember the facial nerve is motor to the muscles of facial expression (explaining the right side drooped ear, lip and eyelid) and innervates the lacrimal and salivary glands. Loss of innervations can lead to a dry eye, and possibly to exposure keratitis if animal losses ability to close eyelid from damage to facial nerve innervation of the orbicularis oculi muscle.

Idiopathic in 75% of canine cases (25% of cats). Can also see these signs with middle ear damage (from otitis media), from facial nerve trauma (ear surgery in dogs, or pressure from halter buckles in anesthetized horse), or neoplasia. Follow this link to see a horse with facial nerve damage: note the nose pulled to horse's left. (means facial nerve damaged on right).

Think more of a dropped jaw with trigeminal nerve neuropathy (CN 5-dogs, horses).
A stray dog is presented after being hit by a car.

The dog has hypotonic forelimbs and spastic paresis in the hinds. All four limbs have proprioceptive deficits and sensation loss-signs are worse in the forelimbs.

Where is the lesion?

A - Thoracolumbar T3-L3
B - Cannot say without cutaneous trunci reflex results
C - Lumbosacral L4-S3
D - Cervicothoracic: C6-T2
E - Cranial cervical: C1-C5
D - Cervicothoracic: C6-T2
Cervicothoracic: C6-T2. Weak, hypotonic (Lower motor neuron-LMN) forelimbs and spastic paresis (Upper motor neuron-UMN) hindlimbs are signs of a cervicothoracic (C6-T2) lesion. May see worse signs in fores then hinds.

NOTE: This is the OPPOSITE presentation as Schiff-Sherrington syndrome ie: severe spinal cord trauma T3-L3, with thoracic limb extensor rigidity (UMN) and hind limb flaccid paralysis (LMN). Lesion is caudal to T2, typically see animal soon (hours) after a bad trauma, like hit by car.

Can localize T3-L3 lesion by checking cutaneous trunci reflex -The lesion is usually 1-2 vertebrae cranial to the line of analgesia (where dog does not feel pinching skin).

With C1-C5 would expect UMN signs in all 4 limbs, usually worse in hinds.

With a T3-L3, would see UMN hind limb signs and normal forelimbs.
Which category of drugs are amrinone and milrinone?

A - Angiotensin-converting enzyme (ACE) inhibitors
B - Calcium channel blockers
C - Beta blockers
D - Phosphodiesterase (PDE) inhibitors
E - Negative inotropes
D - Phosphodiesterase (PDE) inhibitors
Milrinone and amrinone are phosphodiesterase (PDE) inhibitors, one of three types of positive inotropes. Positive inotropes increase the cardiac muscular contraction strength by making more intracellular calcium available for muscle proteins.

Examples of positive inotropes include
Beta adrenergic agonists (dopamine, dobutamine, isoproterenol and epinephrine),
Cardiac glycosides (digoxin, digitoxin) and
phosphodiesterase (PDE) inhibitors like milrinone and amrinone.
An 8-year old neutered male golden retriever is presented with a 2 month history of nonspecific lethargy and weight loss.

T=99.8 F (37.7 C)..[N=99.5-102.5 F]
RR=24 brpm.......[N= 15-34]
HR=64 bpm........[N= 80-120]

On physical exam, there is normal hydration and mild ascites.

Complete Blood Count
PCV=45%....[N= 37-55%], RBC=6.5 x 1012 g/L...[N=5.2-8.5 x 1012]
Normocytic, normochromic
WBC=12,350...[N=5400-15300],
Neuts=63%...[N=60-70%],Lymphs=24%...[N=12-30%],
Monos=5%.....[N=3-10%], Eos=8%...[N=2-10%]

Blood Chemistry
Na=148 mEq/L...[N=146-156], Cl=118 mEq/L...[N=109-122],
K=6.0 mEq/L...[N=3.8 -5.6]

LDH=200 u/L...[N=24-219], ALT=36 u/L....[N=8.2-57]
AST=14 u/L.....[N= 13-15], GGT=4.4 u/L...[N= 1.0-9.7]
Alk Phos=101 u/L...[N=1-114]
Glucose=120 mg/dL...[N= 79-126], Cholesterol=200 mg/dL..[N= 116-300]
BUN=29 mg/dL...[N=7.0-26], ..........Creatinine=1.6 mg/dL....[N=0.5-1.6]

Bilirubin (total)=0.4 mg/dL...[N=0.0-0.4 ]
Total protein=4.6 g/dL...[N=5.5-7.5],
(globulin=3.0 g/dL...[N=2.1-3.7 ], albumin=1.6 mg/dL...[N=2.6-4.0])

Urinalysis
USpG=1.031...[N=1.016-1.060], no WBC or RBC,protein +++

Which diagnosis is on top of the differential diagnosis list?

A - Glomerulonephritis
B - Hypoadrenocorticism
C - Renal disease
D - Pyelonephritis
E - Diabetes insipidus
A - Glomerulonephritis
Glomerulonephritis is a top rule out here for a middle-aged dog with low albumin, ascites and proteinuria without evidence of urinary infection (no RBC or WBC in urine sediment).

This is a type III immune reaction in which antigen-antibody complexes deposited on glomeruli or capillary walls of glomeruli, stimulate complement and cause damage via a neutrophilic inflammatory response.

Another big rule out for a canine protein-losing nephropathy is renal amyloidosis. Renal biopsy is the best way to distinguish between glomerulonephritis and amyloidosis
A 6 year old female spayed cocker spaniel is presented with a 2 day history of lethargy. Upon physical exam mucosal petechiae and ecchymoses and an ocular hemorrhage O.D. is noted

A coagulation profile shows the following:
Thrombocytes= 49,720..[N=200,000-900,000]
Buccal mucosal bleeding time (BMBT), increased
Activated partial thromboplastin time (aPTT), normal
Prothrombin time (PT), normal
Thrombin time (TT), normal

What is the diagnosis?


A - Hepatic insufficiency
B - Von Willebrand's disease
C - Disseminated intravascular coagulation (DIC)
D - Idiopathic thrombocytopenia
E - Anticoagulant rodenticide toxicity
D - Idiopathic thrombocytopenia
The history, plus a lab pattern of low platelets, increased bleeding time and normal aPTT, PT and TT tests suggests thrombocytopenia. Idiopathic thrombocytopenia (often immune-mediated) is the most common cause of spontaneous bleeding in dogs. Twice as common in females; cockers, poodles and old English sheepdogs are predilected, but can occur in any breed.

Of the common causes of coagulation disorders, only disseminated intravascular coagulation (DIC) also presents with thrombocytopenia.

Follow this link to see a table of the four most important coagulation disorder patterns
Which parasite has been associated with a hypoadrenocorticism-like syndrome and has been suggested as a cause for cecocolic intussusception in dogs?

A - Toxocara canis
B - Ancylostoma caninum
C - Spirocerca lupi
D - Physaloptera spp
E - Trichuris vulpis
E - Trichuris vulpis
Whipworms, (Trichuris spp) are typically found in the cecum and large intestine. Mainly in dogs, rare in cats. Trichuris suis in pigs can cause unthriftiness in younger animals.

If clinical, look for signs of large bowel diarrhea (frequent urgent defecation of loose watery feces, possibly with mucus or fresh blood). Can be associated with a hypoadrenocorticism-like syndrome (hyponatremia, hyperkalemia, azotemia, metabolic acidosis). Whipworm infection has been suggested as one cause of cecocolic intussusception.

Physaloptera spp (Stomach worms) may cause vomiting, anorexia, dark feces.

Spirocerca lupi makes nodules in the esophageal, gastric, or aortic walls. Typically asymptomatic.

Roundworms (Toxocara canis) may cause visceral and ocular larva migrans.

Hookworms (Ancylostoma spp) may cause cutaneous larva migrans.
During the necropsy of an 8 year-old mixed breed dog from the Southern United States, reactive granulomas in the esophagus containing bright red worms, 40 mm to 70 mm long are found.

What is the diagnosis?

A - Gastrophilus spp
B - Physaloptera spp
C - Haemonchus placei
D - Spirocerca lupi
E - Ollulanus tricuspis
D - Spirocerca lupi
A disease of dogs in the Southern U.S. and tropical climates, Spirocerca lupi (esophageal worms) make reactive granulomas of variable size in the esophageal, gastric or aortic walls. Spirocercosis may also lead to aneurysm in the thoracic aorta or an ossifying spondylitis of the posterior thoracic vertebrae.

Typically asymptomatic, but large granuloma can cause esophageal obstruction. Large granomas may become neoplastic (osteosarcoma, fibrosarcoma). Some dogs develop spondylitis or enlargement of the extremities characteristic of hypertrophic osteopathy.

All four of the other choices are gastric parasites.
Ollulanus tricuspis is an uncommon gastric parasite of cats.
Physaloptera spp is a stomach worm that may cause vomiting, anorexia, dark feces in dogs and cats.
Haemonchus spp, Ostertagia spp and Trichostrongylus spp are found in the abomasum of ruminants.
Gastrophilus spp are the larvae of horse bot flies, found in the stomach of horses.
In addition to treatment for the organism shown above, which one of the following diagnostic tests may be indicated to rule out a second disease in this outdoor dog?

A - Lower gastrointestinal barium series
B - Basal serum thyroid hormone concentration
C - Heartworm antigen
D - Serum trypsin-like immunoreactivity
E - Cobalamin and folate concentration
C - Heartworm antigen
Heartworm antigen. This is a whipworm egg (Trichuris spp, looks like an American football). The eggs are extremely tough, surviving in the environment for 4-5 years. This dog is probably becoming reinfected with whipworms in his own yard outside, where he can also become infected with heartworm , particularly in the Southern U.S. where mosquitoes can be active 8-12 months out of the year.

Rx whipworms with antihelmintics like fenbendazole, febantel, praziquantel, pyrantel pamoate. Milbemycin oxime is used as a preventive for chronic recurring cases of heartworm, but must check dog with a heartworm antigen test first.

Think of cobalamin and folate concentration tests for suspected small-intestinal bacterial overgrowth (SIBO), a contributor to malabsorption syndromes, which often complicates exocrine pancreatic insufficiency (EPI).

Think of a serum trypsin-like immunoreactivity test (TLI) as the test of choice for exocrine pancreatic insufficiency.
An 8-year old male neutered domestic shorthair cat is presented with a one-month history of progressive exercise intolerance, panting, anorexia, weight loss and vomiting.

On physical exam there is moderate cyanosis and a jugular pulse. On chest auscultation there is a systolic murmur loudest on the left side between the 5th and 6th intercostal space.

T=102.1 F (38.9 C)..[N=100-103.1]
HR=176 bpm...........[N=100-140]
RR=40 brpm...........[N=16-40]

A DV chest radiograph looks like the image below. What is the diagnosis?

Hrt DV im

A - Tricuspid insufficiency
B - Taurine deficiency
C - Hypertrophic cardiomyopathy
D - Aortic insufficiency
E - Congestive heart failure
C - Hypertrophic cardiomyopathy
This is the classic "Valentine heart" of feline Hypertrophic Cardiomyopathy (HCM).Note the very high RR and HR. Typically see HCM in cats 5-7 years old, more often in males.

Cause unknown. Look for thickened L. ventricle wall on echocardiography. Follow this link to see thickened L ventricle on necropsy

May see secondary pulmonary hypertension, edema, pleural effusion. DDX includes hyperthyroidism, systemic hypertension, acromegaly, congenital aortic stenosis.

Systolic murmur loudest on L betw 5th-6th suggests MITRAL valve insufficiency (left AV). Aortic insufficiency is DIASTOLIC. Tricuspid valve murmurs (right AV) are loudest on the RIGHT (See Blackwell's, p. 905, Tschauner p. 212 for excellent murmur DDX tables).

Taurine deficiency is associated with DILATED cardiomyopathy (DCM) in cats. Think more of LARGE BREED DOGS with DCM.

Technically, HCM is a form of congestive heart failure, but the "Valentine" radiograph points you to the much more specific diagnosis of HCM.
A 5 month old Persian kitten presents with a small intestinal linear foreign body. A resection and anastomosis are performed. What suture pattern is recommended for intestinal anastomosis?

A - Vertical mattress
B - Locking loop
C - Gambee
D - Horizontal mattress
E - Purse-string
C - Gambee
The simple interrupted Gambee suture pattern is commonly used for intestinal anastomosis.

The Gambee prevents eversion of the intestinal mucosa and wicking from the intestinal lumen to the peritoneal cavity.

Always test the incision site for leakage before closing the abdominal cavity.
A 7-week old male Yorkshire terrier is presented with a 2 week history of on and off vomiting and diarrhea that began around the time he was weaned.

The owners relate that he seems to "drink and pee a lot". They report pacing, disorientation, weakness, and "stumbling around".

Physical exam is unremarkable, but only one testicle has descended. As the puppy explores the room he appears ataxic, stumbles a few times, and bumps his head into the wall.

What is the clinical diagnosis?

A - Lead poisoning
B - Canine distemper
C - Diabetes insipidus
D - Portosystemic shunt
E - Congenital hiatal hernia
D - Portosystemic shunt
Signs of hepatic encephalopathy (ataxia, disorientation, vomiting, diarrhea) beginning after weaning combined with polyuria/polydipsia ("drink and pee alot") in a cryptorchid male Yorkshire terrier says Congenital Portosystemic Shunt.

Seen most in pure-breeds. Think SMALL Maltese, Yorkshire terrier, Min. Schnauzer. (But can see in Old English sheepdog, Irish Wolfhound)

Usually in YOUNG animals, especially after weaning. 50% of males are CRYPTORCHID.

Lead poisoning can cause vomiting, diarrhea and CNS signs (blind, hyperactive, seizures). Can see PU/PD in older animals but Hx here puts a shunt first on DDX.
A 10-year old female spayed Irish Setter is presented with a 2-day history of progressively worsening lethargy, weakness and inappetence. Physical exam shows pale mucous membranes, tachycardia, bounding pulses and discolored urine. A blood sample is shown below.

What are the key elements of acute treatment for this dog?

A - Vasodilators, positive inotropes, oxygen
B - Immunosuppression, anticoagulants, blood transfusion
C - Antibiotics, activated charcoal, high fat nutritional support
D - Vitamin K, hyper-immune plasma, antiserum
E - Cyclophosphamide, IV crystalloids
B - Immunosuppression, anticoagulants, blood transfusion
Immunosuppression, anticoagulants and blood transfusion. This is the clinical picture of Immune-mediated hemolytic anemia (IMHA).

The basis of acute treatment includes:
1. Immunosuppressive therapy (Prednisone 1-2 mg/kg PO, SC or IM, q12h; or Dexamethasone Na phosphate, 0.15-0.25 mg/kg IV q12h)

2. Anticoagulant therapy (heparin)

3. Packed RBC transfusion is indicated if anemia is accompanied by tachycardia, tachypnea, bounding pulses, weakness.

Chronic therapy is based on immunosuppression with prednisone, for example, on tapering doses for 3-6 months, as long as hematocrit is stable.

Be aware that thrombocytopenia, thromboembolism and disseminated intravascular coagulation (DIC) are three associated conditions to watch for in a dog with IMHA.
Which choice describes excessive growth of granulation tissue around a healing wound?

A - Ulceroproliferative faucitis
B - Hygroma
C - Proudflesh
D - Suspensory desmitis
E - Villonodular synovitis
C - Proudflesh
Proudflesh is excessive growth of cauliflower-like granulation tissue around a healing wound. Click here to see a link to case images of proud flesh and healthy granulation tissue on the leg of a horse.

A hygroma is inflammation of an acquired bursa that develops where normally there is no bursa due to trauma to the dorsum of the carpus.

Villonodular synovitis is an inflammation of the synovial membrane of the dorsoproximal aspect of the forelimb fetlock joints.

Ulceroproliferative faucitis is a progressively worsening gingivitis and stomatitis in cats. The glossopalatine arches (fauces) often have severely ulcerated, friable, inflamed, and proliferative lesions. Click here to see a cat with ulceroproliferative faucitis.
On a fecal examination of a 7 year old dog this organism is evident.

Click here to see image

Which one of the following drugs is the best treatment?

A - Diethyl carbamizine
B - Ivermectin
C - Metronidazole
D - Piperazine
E - Fenbendazole
E - Fenbendazole
Fenbendazole. This is a whipworm egg (Trichuris spp, looks like an American football). Rx with antihelmintics like fenbendazole (preferred treatment), febantel, praziquantel, pyrantel pamoate. Can use milbemycin oxime as a preventive for chronic recurring cases, but must check dog with a heartworm test first.

May also see whipworms in ruminants and whipworms in pigs.
What are ongoing losses in fluid therapy?

A - Percent dehydration multiplied by body weight
B - Vomit and diarrhea
C - The tears I shed when I can't make sense of fluid calculations
D - Fluids given minus extracellular volume estimate
E - Urine output
B - Vomit and diarrhea
Ongoing losses are typically vomiting, diarrhea or other losses into a third compartment (pleura, abdomen etc). These are sometimes called "contemporary" losses. A classic example of a disease with significant ongoing losses is a puppy with parvovirus who has both diarrhea and vomiting.

Sensible losses are easily measured, like the fluids the animal loses by urination.

Insensible losses are the fluids an animal loses that are hard to measure, through breathing and via the skin. In humans and animals that sweat (like horses) sweating is part of insensible losses.

Remember that all three types of loss must be accounted for (or at least estimated) when calculating fluids needed to rehydrate a dehydrated animal.
A cat is presented with bilateral conjunctivitis and rhinitis. A conjunctival scrape looks like the following image.

Click here to see image.

What is the diagnosis?

A - Ureaplasma noeti
B - Mycoplasma felis
C - Chlamydophila spp
D - Feline reovirus
E - Feline viral rhinotracheitis
C - Chlamydophila spp
An inclusion body inside of a cell in eye discharge suggests Chlamydophila spp (ie: Chlamydophila felis). Follow this link to see the original Merck image of a chlamydial inclusion body.

Genetic testing led to taxonomic reclassification in 1999, but many sources still refer to Chlamydophila felis infection as "Chlamydophila psittaci" or Chlamydiosis.

Although C. felis is a potential zoonotic disease, there are only a few reports of mild conjunctivitis in people from infected cats.

This is IN CONTRAST to the zoonotic potential of pet birds infected with Chlamydophila psittaci, which can apparently infect people more readily than the mammalian version. Single best ref on Psittacosis (what it is called when people get Chlamydophila), is the 2009 AVMA Compendium of measures to control Chlamydophila.
The Animal Welfare Act is enforced by which U.S. government agency?

A - National Institute of Health (NIH)
B - Centers for Disease Control and Prevention (CDC)
C - Institutional Animal Care and Use Committee (IACUC)
D - Department of Agriculture (USDA)
E - Food and Drug Administration (FDA)
D - Department of Agriculture (USDA)
The United States Department of Agriculture (USDA) enforces the Animal Welfare Act.

Specifically, it is the Animal and Plant Health Inspection Service (APHIS) within the USDA that is responsible.

The Animal Welfare act sets minimal standards for care of laboratory animals including dogs, cats and non-human primates. It regulates the pet trade, animal transportation and exhibition and licensure of animal dealers. Since 1976 it has prohibited most forms of commercial animal fighting.
A dog that was treated for vomiting with metoclopramide is now displaying involuntary muscle spasms and inappropriate aggression.

Which one of the following choices is most appropriate to help reverse the adverse effects?

A - Yohimbine
B - Ace-promazine
C - Diphenhydramine hydrochloride
D - Telazol (tiletamine-diazepam combination)
E - Ketamine
C - Diphenhydramine hydrochloride
Diphenhydramine hydrochloride. Metoclopramide crosses the blood-brain barrier, where dopamine antagonism at the medullary chemoreceptor trigger zone (CTZ) causes an antiemetic effect.

This dopamine antagonism can also cause adverse extrapyramidal signs, like involuntary muscle spasms, motor restlessness and inappropriate aggression. If recognized in time, extrapyramidal signs can be reversed by restoring the dopamine:acetylcholine balance with the anticholinergic action of an antihistamine like diphenhydramine hydrochloride.

The pyramidal and extrapyramidal systems are a complex series of upper motor neurons (UMN) that connect the cerebral cortex to distant body parts and influence muscular tone and control.

The pyramidal system controls skilled muscle movement.
The extrapyramidal system helps support the body against gravity (posture) and recruits spinal reflexes to initiate voluntary movement.
Which one of the following diseases is characterized by schistocytes on a complete blood count?<

A - Disseminated intravascular coagulation
B - Systemic lupus erythematosus
C - Methemoglobinemia
D - Acetaminophen toxicity
E - Cyanocobalamin deficiency
A - Disseminated intravascular coagulation
Disseminated intravascular coagulation. Schistocytes are produced by the mechanical fragmentation of erythrocytes on intravascular fibrin strands. They are most commonly associated with conditions that affect blood flow or clotting like disseminated intravascular coagulation(DIC), heartworm, hemangiosarcoma and glomerulonephritis.

Cobalamin deficiency causes a macrocytic anemia (pernicious anemia).

Systemic lupus erythematosus may cause anemia, thrombocytopenia and leukopenia or leukocytosis.

Think of methemoglobinemia, heinz bodies and hepatotoxicity with acetaminophen toxicity in cats.
Where should a feline leukemia (FeLV) vaccine be injected?

A - Below stifle, lateral right hind
B - Above stifle, lateral right hind
C - Above stifle, lateral left hind
D - Below stifle, lateral left hind
E - Cervical interscapular region
D - Below stifle, lateral left hind
Below stifle, lateral left hind. Feline leukemia virus (FeLV) and rabies vaccinations have been associated with sarcomas. You should always keep a record of where vaccinations were given.

Remember your L's and R's for feline vaccination:
For FeLV, vaccinate LOW and LATERAL on the LEFT hind.
For Rabies vaccinate low and lateral on the RIGHT hind.

Here is a direct quote from the AAFP Feline Vaccine Advisory Panel Report
"FeLV or FIV antigen (plus any other antigen except rabies) should be administered subcutaneously (SC) on the lateral side of the left hind limb below the stifle joint (vaccine-associated sarcomas arising in the proximal femoral area are difficult to completely excise; placement of vaccines in this area is strongly discouraged)."
What is the most common clinical sign exhibited by a horse with cystic calculi (bladder stones)?
E - Hematuria after exercise
Bladder stones in horses are usually single, large spiculated stones composed of calcium carbonate. The most common clinical sign exhibited by horses with cystic calculi is hematuria after exercise. Hematuria is most evident toward the end of a voided urine stream. Other signs may include stranguria, pollakiuria and urinary incontinence.

In adult male geldings, urethral obstruction may also be associated with cystitis. If there is urethral blockage by smaller uroliths, stranguria, pollakiuria, incontinence, restlessness, colic and stretched posture may be more prominent.

Click here to see an endoscopic view of a urolith in a stallion and a necropsy image showing a nephrolith in the kidney of a horse.
A three year old male neutered Weimaraner dog is presented with a two day history of worsening anorexia, lethargy, cough and exercise intolerance.

On physical exam, the mucous membranes are pale with a few petechiae.

T=99.8 F (37.7 C)..[N=99.5-102.5 F]
RR=24 brpm.....[N= 15-34]
HR=144 bpm....[N= 110-120]

A coagulation profile shows the following:

Thrombocytes= 343,500 per microliter..[N=200,000-900,000]
Buccal mucosal bleeding time (BMBT), normal
Activated partial thromboplastin time (aPTT), increased
Prothrombin time (PT), increased
Thrombin time (TT), normal
Fibrin degradation products (FDPs), normal

Which one of the following choices is the most appropriate diagnosis?

A - Neonatal isoerythrolysis
B - Idiopathic thrombocytopenia
C - Disseminated intravascular coagulation (DIC)
D - Anticoagulant rodenticide toxicity
E - Von Willebrand's disease
D - Anticoagulant rodenticide toxicity
Anticoagulant rodenticide toxicity (or liver disease) can demonstrate increased activated partial thromboplastin time (aPTT) and prothrombin time (PT).

Sometimes a mild to moderate thrombocytopenia may occur (50,000-150,000/μl). Proteins induced by vitamin K1 absence or antagonism (PIVKA) will be prolonged. The PIVKA test is more sensitive than PT/aPTT but is not as widely available. A threefold increase in PT or PIVKA is supportive of anticoagulant rodenticide toxicosis.

Often there is no history of exposure to a rodenticide. Clinically, vague initial clinical signs like anorexia, lethargy and exercise intolerance may be the first manifestation of illness. With progression, you may see an acute hemorrhagic presentation.

Follow this link to see a table of the four most important coagulation disorder patterns
A cat with a previous diagnosis of diabetes mellitus confirmed by persistent fasting hyperglycemia and persistent glycosuria is presented for a routine check-up. The owner relates that she ran out of injectable insulin two months ago, but the cat seemed to do fine without it, so she stopped giving insulin shots.

On physical exam, the cat appears healthy and a dipstick test shows a blood glucose level of 125 mg/dL (normal 61-132 mg/dL)

What is the most likely explanation?

A - Incorrect initial diagnosis
B - Transient diabetes mellitus
C - Type I diabetes mellitus
D - Insulin resistance
E - Concurrent diabetes insipidus
B - Transient diabetes mellitus
20% of cats may have transient or subclinical diabetes mellitus characterized by resolution of the clinical weeks to months after beginning insulin treatment. Clinical disease may or may not recur in the future.

Non-insulin-dependent diabetes mellitus (type II) occurs in about 30% of cats at the time of diabetes diagnosis. There is a a reduced population of pancreatic Beta cells.

Cats with non-insulin-dependent diabetes mellitus may respond to a treatment regimen of weight loss, diet, oral hypoglycemic drugs, and correction of concurrent insulin antagonistic disease; that is, they can respond without injectable insulin.

Persistent fasting hyperglycemia (blood glucose greater than 200 mg/dL) and persistent glycosuria are confirmatory for diabetes mellitus, so "incorrect diagnosis" is a wrong answer choice in this case.
A 12 year old neutered male cat is presented with a history vomiting, weight loss, increased drinking, polyphagia and recent urinary accidents in the house.

On physical exam, the patient is unthrifty and tachycardic with a moderate systolic heart murmur, loudest on the left.

T=102 F (38.8C)..[N=100-103.1F]
HR=172 bpm.......[N=130-140]
RR=38 bpm.........[N=16-40]

CBC
PCV=40 %.............[N=24-45%], WBC=14,810..[N=3800-19,500]

Blood chemistry
NA=157................[N=151-161], K=4.1..[N=3.5-5.1]
LDH=250...............[N=35-225], ALT=108..[N=8.3-53]
Total protein=6.2..[N=5.7-8.0], Glucose=140..[N=63-132]
Alk Phos=480.........[N=3-65], Cholesterol=110..[N=95-130]
BUN=42 mg/dL.......[N=10-30], Creatinine=1.9 mg/dL..[N=0.8-2.0 ]
Bilirubin (total)=0.2.[N=0.0-0.2]

Urinalysis
U Sp. G= 1.017........[N=1.020-1.040]
Glucose none, WBC none, RBCs occasionally.

Which one of the following tests is most likely to confirm the diagnosis?

A - Fasting blood glucose
B - Serum total T4
C - Echocardiogram
D - ACTH stimulation test
E - Hepatic biopsy
B - Serum total T4
Think of hyperthyroidism and a serum total T4 test for a middle-aged to older cat with clinical signs of weight loss, polyphagia, polyuria, polydipsia, and or poor grooming habits (ie: unthrifty).

Other signs include hyperexcitability and palpable enlargement of the thyroid gland. GI signs are common, including vomiting, diarrhea and increased fecal volume. Cardiovascular signs can include tachycardia, systolic murmurs, dyspnea, cardiomegaly, and congestive heart failure.

Clinical pathology findings may include a stress leukogram and mild erythrocytosis. Liver enzymes are commonly increased, particularly alkaline phosphatase. Urine specific gravity results vary.

The test of choice for hyperthyroidism is serum total T4 (TT4--measures protein-bound and free (unbound) T4), in conjunction with clinical signs.
Benzodiazepines act in upon which one of the following receptors?

A - Dopamine
B - Gamma amino butyric acid
C - N-methyl-D-aspartate (NMDA)
D - Alpha - adrenergic
E - Muscarinic type cholinergic
B - Gamma amino butyric acid
The gamma amino butyric acid receptor (GABA) is the site of action of benzodiazepine (BZ) tranquilizers, and many other drugs.

Barbiturates, inhalant anesthetics, and propofol all have binding sites on the GABA receptor. GABA is the primary inhibitory neurotransmitter in the brain of mammals.

Binding of a BZ enhances the binding of GABA to its receptor. This results in hyperpolarization of the cell and inhibition of neuronal activity. Sedation, muscle relaxation, and anti-seizure effects are seen with BZs.

Click here to see a GABA receptor image and informative blog.

Diazepam and midazolam are the BZs used most often in veterinary medicine. Zolazepam is found in combination with tiletamine in the general anesthetic Telazol®.

BZs are commonly used in combination with opioids as premedication prior to general anesthesia in older or compromised patients. Agitation can be seen when given as premedication to young healthy patients, especially cats.

Ketamine acts upon N-methyl-D-aspartate (NMDA) receptors in the spinal cord. The potent sedatives xylazine, medetomidine, romifidine, and detomidine, etc. act primarily at alpha-2 receptors.

Cholinergic receptors are normally activated by acetylcholine and are blocked by atropine and glycopyrrolate. Dopamine acts at dopamine receptors.
An obese 7-year-old Labrador Retriever presents for annual vaccinations.

The owners claim that they have restricted his diet and try to exercise him but he still keeps the weight on. There is alopecia on the dorsum of his tail and he has an unusual worried facial expression.

Which one of the following choices is the most likely diagnosis?

A - Hypoadrenocorticism
B - Hyperadrenocorticism
C - Sarcoptic mange
D - Hypothyroidism
E - Male pattern alopecia
D - Hypothyroidism
Tail alopecia and tragic facial expression are a classic signs of Hypothyroidism in dogs.

Other areas of bilateral alopecia that are common in hypothyroidism are the ventral and lateral trunk, caudal thighs, ventral neck and dorsum of the nose.

Hyperadrenocorticism commonly has truncal alopecia and also presents with obesity. It is more common in toy dog breeds.
A middle-aged dog was recently diagnosed with hyperadrenocortism. The owner has questions regarding skin lesions on this animal.

There are erythematous papules and raised firm lesions. A single skin scraping is negative for mites, but there is gritty material in the scraping.

Which one of the following choices is the most likely diagnosis?

A - Flea allergy dermatitis
B - Superficial pyoderma
C - Calcinosis cutis
D - Squamous cell carcinoma
E - Demodecosis
C - Calcinosis cutis
Calcinosis cutis. This commonly occurs in dogs with Hyperadrenocorticism. Often the skin calcification is visible on radiographs.

Secondary demodecosis can occur in dogs with hyperadrenocorticism, but the lesions are characterized by focal alopecia, erythema and comedones. A skin scraping or skin biopsy can differentiate the two conditions.
Which one of the following choices is the most common etiology of canine cholangiohepatitis?

A - Toxicity
B - Neoplastic biliary obstruction
C - Liver fluke migration
D - Ascending infection
E - Idiopathic
D - Ascending infection
Enteric bacteria migrate up the bile duct from the intestines and create an infection in the liver and biliary tract in most cases of canine cholangiohepatitis.

Feline cholangiohepatitis is more common than the canine form and has three main etiologies.
1. Acute neutrophilic (suppurative)
2. Chronic (lymphoplasmacytic or mixed)
3. Lymphocytic (nonsuppurative)
A female veterinarian is pregnant and her physician tests her serologically for toxoplasmosis.

IgM is negative.
IgG is positive

What is the most appropriate interpretation?

A - Both mother and baby are safe
B - Need to re-check in 2 weeks for rising titers
C - Mother at risk, baby is safe
D - Mother is safe, baby at risk
E - Both mother and baby at risk
A - Both mother and baby are safe
Both mother and baby are safe. The toxoplasmosis organism causes birth defects in a developing fetus if a mother is infected for the first time in her life while pregnant (ie: IgM positive while pregnant).

Toxoplasmosis is not generally dangerous to immune-competent people and a positive IgG result suggests an old infection.

There are challenges to toxoplasmosis testing in pregnant women (false positives). If a pregnant woman is IgM positive, confirmatory tests must be done.

Click here for more on pregnancy and toxoplasmosis
Which group is most at risk of developing the lesion evident in this image?

A - Older, small-breed dogs; Cavalier King Charles Spaniel
B - Sheep or goats pastured above 2000 meters; Saanens
C - Cattle without reticular magnets; Charolais
D - Obese cats, any breed; Burmese cats
E - Young horses ingesting Perilla mint; Standardbreds
A - Older, small-breed dogs; Cavalier King Charles Spaniel
This is endocardiosis (degenerative valve disease). Note the nodular thickening of mitral valve margins. Degenerative valve disease is the most common cardiac disease of dogs, accounting for about 75% of all canine cardiovascular disease.

Roughly 60% of affected dogs have myxomatous degeneration of the mitral valve. Older, small-breed dogs have a higher incidence and Cavalier King Charles Spaniels are prone.

Don't confuse endocardiosis, a degenerative disease with infective endocarditis which is due to bacterial infection of the cardiac valves and endocardial muscle.
An immunochromatographic test kit for detection of fecal canine parvoviruses (CPV) antigen is being tested in a local cat shelter where as many as 10% of the cats there may have panleukopenia secondary to infection with the canine parvovirus.

Here are simulated test results, compared to a gold standard test for CPV.

.....................CPV pos.......CPV neg.............Total

Test kit positive..........128..............734...........862

Test kit negative..........63............1575...........1638

Total.........................191............2309...........2500

What is the sensitivity of this test kit?

A - 128/734
B - 734/862
C - 1575/2309
D - 1575/1638
E - 128/191
E - 128/191
Sensitivity=128/191 (67%) a/(a+c)
This is a classic example of a 2x2 table in epidemiology, used to compare a new test (the immunochromatographic test kit) to a gold standard test (the CPV test). Draw a 2x2 table, and label the boxes a,b,c,d. Sensitivity = a/(a+c). Click here to see a Basic 2X2 table.

Feline panleukopenia virus(FPV) is closely related to type 2 canine parvoviruses(CPV-2, CPV-2a, CPV-2b). CPV-2a and CPV-2b have been shown to cause a panleukopenia-like illness in domestic cats. Click here for a PDF summary on Canine and Feline Parvovirus in Animal Shelters (may take a half minute to load) by Dr. Cynda Crawford, Maddie's Shelter Medicine Program, Univ. Florida College Vet Med.
Carprofen (Rimadyl ®) is a nonsteroidal anti-inflammatory (NSAID) commonly-used in dogs with arthritis. What is the most important side effect about which to be concerned?

A - Secretory diarrhea
B - Hypersensitivity
C - Seizures
D - Hepatopathy
E - Protein-losing nephropathy
D - Hepatopathy
There is a reported incidence of hepatopathy in 0.05% of dogs treated with carprofen (Rimadyl ®). Geriatric dogs, or dogs with pre-existing chronic diseases like inflammatory bowel disease (IBD), renal or hepatic insufficiency may be at a greater risk of toxic side effects. Carprofen is contraindicated in animals with bleeding disorders, like Von Willebrand's disease.

GI effects like gastric upset and gastric ulcers are LESS common with carprofen than with other NSAIDS, but still can occur.
What is the average length of estrus in the cat?

A - 4-5 days
B - 9-10 days
C - 6-7 days
D - 2-3 days
E - 21 days
C - 6-7 days
Estrus in the cat generally lasts 6-7 days (range 1-10 days).

Cats are seasonally polyestrous and induced ovulators. The length of feline estrus is affected by whether a male is present. If a male is present, estrus typically lasts 1-4 days. Without a male, estrus lasts 7-10 days and recurs in 2-3 weeks.

UNlike dogs, the feline estrus cycle is controlled by day length. In North America, cats go through an anestrus period in December and January when day length is less than 12 hours.

Click the following link for a table of reproductive cycle features, most species.
A 12 year old neutered female black Scottish terrier is presented with a 3 week history of limping on the right fore. The lateral digit is swollen and the nail is deviated ventrally, with ulceration of the nail bed.

A lytic bone lesion of the 3rd phalanx is visible on radiograph and cytology of the mass suggests neoplasia. Chest radiographs are clear. Following amputation of the digit, histopathology indicates that the mass is a subungual melanoma.

What message should be communicated to the owner?

A - Radiotherapy is indicated
B - Best outcome with radiotherapy and chemotherapy
C - Chemotherapy is indicated
D - 95% chance she will survive 1 year
E - 50% survive 1 year, 30% local recurrence
E - 50% survive 1 year, 30% local recurrence
The prognosis is poor. Melanoma of the digit is an aggressive, infiltrative tumor, with substantial metastatic potential and poorer prognosis. Median survival with resection is 12 months, with a 30% local recurrence rate. Melanomas are not thought to be responsive to radiotherapy, and the efficacy of chemotherapy for subungual melanomas is unclear.

In contrast, the prognosis is good for dogs with digital squamous cell carcinoma (SCC). 95% of dogs with digital SCC survive 1 year after amputation and 75% survive 2 years after amputation. SCC have a low metastatic rate and most have not yet metastasized at the time of amputation and diagnosis. In addition to chest radiographs prior to surgery, local lymph node aspiration for cytology during surgery is important in order to help assess prognosis.
A seven-month-old Jack Russell Terrier presents with right pelvic limb lameness. Based on the radiograph, which one of the following choices is the most likely diagnosis?

A - Salter-Harris fracture
B - Panosteitis
C - Osteochondrosis dessicans
D - M
A seven-month-old Jack Russell Terrier presents with right pelvic limb lameness. Based on the radiograph, which one of the following choices is the most likely diagnosis?

A - Salter-Harris fracture
B - Panosteitis
C - Osteochondrosis dessicans
D - Medial patellar luxation
E - Normal radiograph for age and breed
A - Salter-Harris fracture
A - Salter-Harris fracture
Salter-Harris fracture, proximal tibia.

In immature animals, weakness of the physis predisposes it to injury. Salter-Harris classification is used to characterize the fracture relative to the physis and joint.
Type 1 is displacement of the epiphysis
Type 2 is fracture of the metaphysis and physis
Type 3 is fracture through the epiphysis and physis
Type 4 is fracture through the physis, metaphysis, and epiphysis
Type 5 is compression of the physis.

Osteochondrosis dessicans is a condition of young, usually large breeds, and is caused by an abnormal endochondral ossification of epiphyseal cartilage. It is characterized radiographically by flatting of the joint surface, subchondral bone lucency, or sclerosis.
A 12-year-old West Highland White Terrier disappeared from its home for six hours and returned lame on his left pelvic limb.

Based on the pelvic radiograph made during the same day, which one of the following choices is the best treatment?

A - NSAID
A 12-year-old West Highland White Terrier disappeared from its home for six hours and returned lame on his left pelvic limb.

Based on the pelvic radiograph made during the same day, which one of the following choices is the best treatment?

A - NSAIDs and rest
B - Femoral head osteotomy and acetaminophen
C - Decompression and Kirschner-Lemur apparatus
D - Tibial tubercle transposition and Robert-Jones bandage
E - Closed reduction and Ehmer sling
E - Closed reduction and Ehmer sling
E - Closed reduction and Ehmer sling
Closed reduction and Ehmer sling.

Traumatic coxofemoral luxations comprise 90% of all luxations in small animals.

Closed reduction can be attempted when the luxation duration is less than 48 hours and there are no other hip injuries.

Otherwise femoral head osteotomy (FHO), total hip replacement, or Triple pelvic osteotomy (TPO) will be indicated.

http://www.merckmanuals.com/vet/musculoskeletal_system/arthropathies_and_related_disorders_in_small_animals/joint_trauma_in_small_animals.html
A 12-year-old neutered male mixed-breed cat presents with weight loss, polyphagia, polydipsia, polyuria, and unkempt haircoat. The cat is thin and has tachycardia.

Which one of the following tests is most likely to confirm the presumptive diagnosis?
A 12-year-old neutered male mixed-breed cat presents with weight loss, polyphagia, polydipsia, polyuria, and unkempt haircoat. The cat is thin and has tachycardia.

Which one of the following tests is most likely to confirm the presumptive diagnosis?

A - Urinalysis
B - Abdominal ultrasonography
C - Serum T4
D - Fecal examination
E - Abdominal radiographs
C - Serum T4
Serum T4. The signalment and clinical signs are highly compatible with hyperthyroidism.

Canned food diet, ectoparasiticide exposure, and mixed breed origin are probable risk factors for Hyperthyroidism.

The three treatment options are antithyroid medication, radioactive iodine therapy, and surgical thyroidectomy.
The following cytology is from a bronchoalveolar lavage in a dog.

Which one of the following choices is the most likely diagnosis?

A - Fungal bronchopneumonia
B - Bacterial contamination
C - Eosinophilic pneumonitis
D - Bacterial bronchopneumonia
The following cytology is from a bronchoalveolar lavage in a dog.

Which one of the following choices is the most likely diagnosis?

A - Fungal bronchopneumonia
B - Bacterial contamination
C - Eosinophilic pneumonitis
D - Bacterial bronchopneumonia
E - Actinomyces pneumonia
B - Bacterial contamination
Bacterial contamination.

Simonsiella are bacteria that normally inhabit the pharynx and have a large, ladder-like appearance. Their presence indicates contamination from the oropharynx.

Bacteria, if present within neutrophils or macrophages, would be a significant finding.
A five-year-old mixed breed presents with acute swelling of the left pinna that is determined to be an aural hematoma.

Which one of the following choices is the best treatment?

A - Pinnectomy
B - None of these
C - Incisional drainage
D - Bulla os
A five-year-old mixed breed presents with acute swelling of the left pinna that is determined to be an aural hematoma.

Which one of the following choices is the best treatment?

A - Pinnectomy
B - None of these
C - Incisional drainage
D - Bulla osteotomy
E - Fine-needle aspiration
C - Incisional drainage
This is an aural hematoma, a commonly seen condition in practice. Following incisional drainage, mattress sutures are applied to prevent deformation and the ear is bandaged to the head.

It is important to determine the underlying cause of aural hematomas with a thorough aural exam, cytology, thyroid profile, food trial, or allergy skin testing.
A fourteen-year-old neutered male Lab presents with a sudden onset of a left head tilt and horizontal nystagmus with the fast phase to the right.

He is barely ambulatory with ataxia but has normal conscious proprioception and normal stride length. The
A fourteen-year-old neutered male Lab presents with a sudden onset of a left head tilt and horizontal nystagmus with the fast phase to the right.

He is barely ambulatory with ataxia but has normal conscious proprioception and normal stride length. The rest of his physical and neurologic exam is normal.

Which one of the following choices is the most likely location of the lesion?

A - Left peripheral vestibular
B - Right cerebrum
C - Left cerebrum
D - Right brainstem
E - Right rostral cerebellar peduncle
A - Left peripheral vestibular
Peripheral vestibular disease in a geriatric dog has a high likelihood of being idiopathic geriatric vestibular syndrome – a self-limiting syndrome.

Otitis Media and Interna or hypothyroidism would be other possibilities.
A five-year-old Boxer dog presents for routine vaccinations. The owner points out a small, smooth mass on the right ear.

Fine needle aspiration cytology is shown below. Which one of the following choices is the most likely diagnosis? 

A - Pyogranulo
A five-year-old Boxer dog presents for routine vaccinations. The owner points out a small, smooth mass on the right ear.

Fine needle aspiration cytology is shown below. Which one of the following choices is the most likely diagnosis?

A - Pyogranulomatous inflammation
B - Bacterial inflammation
C - Transmissible venereal tumor
D - Lymphoma
E - Mast cell tumor
E - Mast cell tumor
This cytology slide shows mast cells full of purple histamine granules, suggesting a mast cell tumor. Follow this link to see another slide of mast cell cytology.

Grossly, appearances are highly variable and mast cell tumors can be mistaken for skin tags or lipomas.

Skin and subcutaneous masses should always be examined cytologically. These tumors can range from low grade to highly aggressive with local recurrence or lymph node metastasis.

Transmissible venereal tumors are often papillary or nodular in appearance. Cytologically they are a round cell tumor with large, central nucleoli.
A twelve-year-old female spayed miniature schnauzer presents with a history of seizure-like episodes.

Physical exam reveals an irregular heart beat. CBC and panel are unremarkable except for a mild triglyceridemia. ECG is shown below.

Which one of t
A twelve-year-old female spayed miniature schnauzer presents with a history of seizure-like episodes.

Physical exam reveals an irregular heart beat. CBC and panel are unremarkable except for a mild triglyceridemia. ECG is shown below.

Which one of the following choices is the most likely diagnosis?

A - Sick sinus syndrome
B - First degree AV block
C - Ventricular tachycardia
D - Atrial fibrillation
E - All of these
A - Sick sinus syndrome
Sick sinus syndrome.

The "seizure-like" episodes, after questioning the owner further, were actually syncopal episodes. Syncope lacks muscle activity and post-ictal behavior.

Older female Miniature Schnauzers tend to be overrepresented with sick sinus syndrome.

The ECG here shows sinus arrest with bradycardia and tachycardia.

First degree AV block is characterized by an increased PR interval.

Second degree AV block consists of occasional P waves not followed by QRS complexes.
Which one of the following choices is the most likely finding consistent with myocardial hypoxia in the ECG below? 

A - Increased T amplitude
B - Alternating bradycardia and tachycardia
C - Variable complex intervals
D - ST segment depression
E - N
Which one of the following choices is the most likely finding consistent with myocardial hypoxia in the ECG below?

A - Increased T amplitude
B - Alternating bradycardia and tachycardia
C - Variable complex intervals
D - ST segment depression
E - Narrow QRS complex
D - ST segment depression
ST segment depression or elevation is consistent with myocardial hypoxia.

Tall T waves are commonly normal in cats and dogs, however, if the onset of tall waves is noted during ECG monitoring over time it could indicate hypoxia or movement artifact.

Alternating bradycardia and tachycardia is seen with sick sinus syndrome (SSS). In SSS, the sinoatrial node is unable to generate an impulse. Older female miniature schnauzers are predisposed. Look for signs of fainting, weakness, confusion. Rx is a pacemaker.
What are potential complications to surgical thyroidectomy in a hyperthyroid cat?

A - Laryngeal paralysis
B - May miss ectopic thyroid tissue
C - Horner's syndrome
D - All of these
E - Hypocalcemia
What are potential complications to surgical thyroidectomy in a hyperthyroid cat?

A - Laryngeal paralysis
B - May miss ectopic thyroid tissue
C - Horner's syndrome
D - All of these
E - Hypocalcemia
D - All of these
All of these.

A unilateral thyroidectomy could allow for recurrent Hyperthyroidism, by way of hyperplasia or adenoma, of the contralateral thyroid gland.

The cat should be treated medically for several weeks before surgery.
A fourteen-year-old cat presents with a protruded nictitating membrane and miotic pupil on the right. There is an absent right palpebral reflex and a right head tilt. The physical, ophthalmologic, and neurological exams are normal. 

here is the lesion?
A fourteen-year-old cat presents with a protruded nictitating membrane and miotic pupil on the right. There is an absent right palpebral reflex and a right head tilt. The physical, ophthalmologic, and neurological exams are normal.

here is the lesion?

A - Right brachial plexus
B - Left cavernous sinus
C - Right medulla oblongata
D - Left brachial plexus
E - Right middle/inner ear
E - Right middle/inner ear
A lesion of the right middle/inner ear could cause ipsilateral Horner's syndrome (miosis, ptosis, enophthalmos), facial nerve paralysis, and vestibulopathy.

Otitis Media and Interna is the most common cause of disease in this area, but neoplasia can also occur in the middle/inner ear.

A brachial plexus avulsion can also cause an ipsilateral Horner's syndrome, but not facial nerve paralysis or vestibulopathy.
A dog that was treated for vomiting with metoclopramide is now displaying involuntary muscle spasms and inappropriate aggression.

Which one of the following choices is most appropriate to help reverse the adverse effects?

A - Diphenhydramine hydrochloride
B - Acepromazine
C - Telazol (tiletamine-diazepam combination)
D - Yohimbine
E - Ketamine
A - Diphenhydramine hydrochloride
Diphenhydramine hydrochloride. Metoclopramide crosses the blood-brain barrier, where dopamine antagonism at the medullary chemoreceptor trigger zone (CTZ) causes an antiemetic effect.

This dopamine antagonism can also cause adverse extrapyramidal signs, like involuntary muscle spasms, motor restlessness and inappropriate aggression. If recognized in time, extrapyramidal signs can be reversed by restoring the dopamine:acetylcholine balance with the anticholinergic action of an antihistamine like diphenhydramine hydrochloride.

The pyramidal and extrapyramidal systems are a complex series of upper motor neurons (UMN) that connect the cerebral cortex to distant body parts and influence muscular tone and control.

The pyramidal system controls skilled muscle movement.
The extrapyramidal system helps support the body against gravity (posture) and recruits spinal reflexes to initiate voluntary movement.
A 3 year old male cat is positive for feline leukemia virus (FeLV) by both ELISA and IFA tests. 

A complete blood count (CBC) shows 
PCV=19%.................[N=24-45%] with polychromasia, reticulocytosis, anisocytosis
WBC=3,600...............[N=3800-
A 3 year old male cat is positive for feline leukemia virus (FeLV) by both ELISA and IFA tests.

A complete blood count (CBC) shows
PCV=19%.................[N=24-45%] with polychromasia, reticulocytosis, anisocytosis
WBC=3,600...............[N=3800-19,500] with neutropenia, lymphopenia
Thrombocytes=300,000/microliter..[N=300,000-700,000]

In addition to feline leukemia, what other infection is suspected in this cat?

A - Cytauxzoon variabilis
B - Toxoplasma gondii
C - Mycoplasma haemofelis
D - Hemobartonella bigemina
E - Chlamydophila felis
C - Mycoplasma haemofelis
When you see regenerative anemia (polychromasia, reticulocytosis, anisocytosis) in a FeLV-positive cat, suspect coinfection with Mycoplasma haemofelis (or Mycoplasma haemominutum). Typically, the anemia of feline leukemia virus (FeLV) alone is NON-regenerative.

Mycoplasma haemofelis (formerly called Hemobartonella felis) causes feline infectious anemia, and is treated with tetracyclines.

Click here to see regenerative anemia on a blood smear.

In the SE USA, Cytauxzoon felis must be differentiated from Mycoplasma felis in cats with regenerative anemias.

Think of Toxoplasma gondii (with neurologic and ocular manifestations) more in association with feline immunodeficiency virus (FIV).
A 6 year old female spayed cocker spaniel is presented with a 2 day history of lethargy. Upon physical exam mucosal petechiae and ecchymoses and an ocular hemorrhage O.D. is noted

A coagulation profile shows the following:
Thrombocytes= 49,720..[N=200,000-900,000]
Buccal mucosal bleeding time (BMBT), increased
Activated partial thromboplastin time (aPTT), normal
Prothrombin time (PT), normal
Thrombin time (TT), normal

What is the diagnosis?

A - Hepatic insufficiency
B - Anticoagulant rodenticide toxicity
C - Disseminated intravascular coagulation (DIC)
D - Von Willebrand's disease
E - Idiopathic thrombocytopenia
E - Idiopathic thrombocytopenia
The history, plus a lab pattern of low platelets, increased bleeding time and normal aPTT, PT and TT tests suggests thrombocytopenia. Idiopathic thrombocytopenia (often immune-mediated) is the most common cause of spontaneous bleeding in dogs. Twice as co
The history, plus a lab pattern of low platelets, increased bleeding time and normal aPTT, PT and TT tests suggests thrombocytopenia. Idiopathic thrombocytopenia (often immune-mediated) is the most common cause of spontaneous bleeding in dogs. Twice as common in females; cockers, poodles and old English sheepdogs are predilected, but can occur in any breed.

Of the common causes of coagulation disorders, only disseminated intravascular coagulation (DIC) also presents with thrombocytopenia.
A 7-year old male German shepherd presents with a history of weakness in the hind limbs, urinary incontinence and recent obsessive chewing around his tail area. Dorsiflexion of the tail over the back and extension of the hind limbs elicits a painful response.

There is moderate hindlimb ataxia. He does not withdraw each hind leg when a toe is pinched, but bears weight on the hindlimbs. Patellar reflexes are normal.

What is the clinical diagnosis?

A - Hip dysplasia
B - Wobbler syndrome
C - Radiculoneuritis
D - Cauda equina syndrome
E - Diskospondylitis
D - Cauda equina syndrome
This is a common presentation of Cauda equina syndrome. Look for PAIN in the lumbosacral area (elicited by tail raise, hindlimb extension), LMN hindlimbs, especially Sciatic nerve damage at L7-S1 (lack withdrawal), +/- urinary/fecal incontinence, +/- SELF-MUTILATION of tail, perineum, pelvic limb.

Lesion due to compression of cauda equina at L7-S1 (lumbosacral stenosis). Can be congenital (abn development dorsal arch L7-S1, small dogs, Border Collies) or acquired (degenerative changes, big dogs, especially German Shepard, Rottweiler, Boxer).

Wobbler syndrome is a cervical spinal cord disease (also called cervical vertebral instability/ caudal cervical spondylomyelopathy). In adult form it is an intervertebral disc disease, usually seen at C5-C6 or C6-C7 in Dobies> 5 yrs, Great Danes> 2 years.

Diskospondylitis is a good second choice on your DDX of a large middle aged dog presenting with lumbosacral pain. Due to bacterial/fungal infection of intervertebral disk and adjacent vertebral bodies. Look for systemic signs like fever (1/3 of patients), weight loss, anorexia. Follow this link to see a Merck image of diskospondylitis.