BCSE Small Animal Internal Medicine 2 — Questions and Answers
Question 1: A 7-year-old dog presents with polyuria, polydipsia, and a urine specific gravity of 1.008. Serum chemistry reveals hypernatremia and hyperosmolality. Which test best differentiates central from nephrogenic diabetes insipidus?
- ACTH stimulation test
- Modified water deprivation test followed by desmopressin administration (Correct answer)
- Urine cortisol:creatinine ratio
- Low-dose dexamethasone suppression test
Correct answer: Modified water deprivation test followed by desmopressin administration
The modified water deprivation test followed by desmopressin (ADH) administration distinguishes central DI (urine concentrates after desmopressin) from nephrogenic DI (no response).
Question 2: A cat presents with acute vomiting, icterus, and marked elevation in serum lipase. Abdominal ultrasound reveals a hypoechoic pancreas with surrounding hyperechoic mesentery. Which supportive therapy is most important initially?
- Oral pancreatic enzyme supplementation
- Aggressive IV fluid resuscitation and analgesia (Correct answer)
- Immediate surgical debridement
- Corticosteroid administration
Correct answer: Aggressive IV fluid resuscitation and analgesia
Aggressive IV fluid therapy corrects hypovolemia and improves pancreatic microcirculation, and analgesia is essential in feline pancreatitis management.
Question 3: A 9-year-old dog has a 3-month history of weight loss, small-bowel diarrhea, and hypoalbuminemia. Endoscopic biopsies show villous blunting and lymphangiectasia. The most appropriate initial dietary recommendation is:
- High-protein, high-fat diet
- Ultra-low-fat diet with medium-chain triglycerides (Correct answer)
- Raw meat diet
- High-fiber prescription diet
Correct answer: Ultra-low-fat diet with medium-chain triglycerides
Intestinal lymphangiectasia is managed with an ultra-low-fat diet and medium-chain triglycerides (MCTs), which bypass lacteals and reduce lymphatic hypertension.
Question 4: Which electrocardiographic finding is most consistent with hyperkalemia in a dog presenting with weakness and bradycardia?
- Prolonged QT interval
- Tall, peaked T waves and absent P waves (Correct answer)
- ST segment depression
- Right bundle branch block pattern
Correct answer: Tall, peaked T waves and absent P waves
Hyperkalemia causes tall peaked T waves, widened QRS, and eventually loss of P waves as atrial standstill develops.
Question 5: A 6-year-old male dog presents with recurrent urinary tract infections, struvite crystalluria, and radiodense bladder stones. What is the most likely underlying predisposing condition?
- Calcium oxalate nephrolithiasis
- Urease-producing bacterial infection (Correct answer)
- Hypercalcemia
- Primary hyperaldosteronism
Correct answer: Urease-producing bacterial infection
Urease-producing bacteria (e.g., Staphylococcus, Proteus) hydrolyze urea to ammonia, raising urine pH and promoting struvite crystal formation.
Question 6: A 10-year-old cat with chronic kidney disease stage 3 (IRIS) is started on phosphate restriction. Serum phosphorus remains elevated. Which phosphate binder is preferred in cats due to palatability and safety?
- Aluminum hydroxide
- Calcium carbonate (Correct answer)
- Lanthanum carbonate
- Sevelamer hydrochloride
Correct answer: Calcium carbonate
Calcium carbonate is commonly used in cats as a phosphate binder; it is palatable and effective, though dose titration is needed to avoid hypercalcemia.
Question 7: A dog presents with acute onset of hemorrhagic diarrhea, hematocrit of 58%, and normal total protein. Which condition is most consistent with these findings?
- Parvoviral enteritis
- Acute hemorrhagic diarrhea syndrome (AHDS) (Correct answer)
- Exocrine pancreatic insufficiency
- Inflammatory bowel disease
Correct answer: Acute hemorrhagic diarrhea syndrome (AHDS)
AHDS (formerly HGE) classically presents with acute bloody diarrhea, markedly elevated PCV with normal or low total protein due to fluid shifts.
BCSE Small Animal Internal Medicine 2
A 7-year-old dog presents with polyuria, polydipsia, and a urine specific gravity of 1.008.
Serum chemistry reveals hypernatremia and hyperosmolality.
Which test best differentiates central from nephrogenic diabetes insipidus?