BCSE Small Animal Internal Medicine 4 — Questions and Answers
Question 1: A 3-year-old Labrador Retriever is presented with exercise intolerance and a grade IV/VI holosystolic murmur loudest at the left apex. Echocardiography confirms mitral valve regurgitation with a dilated left ventricle. What is the current recommendation regarding ACE inhibitor therapy at this stage?
- Start enalapril immediately to slow progression
- Delay ACE inhibitors until congestive heart failure signs appear (Correct answer)
- Begin pimobendan as the sole therapy
- Initiate digoxin for rate control
Correct answer: Delay ACE inhibitors until congestive heart failure signs appear
Based on current cardiology guidelines (EPIC/QUEST trials), ACE inhibitors are not started in asymptomatic preclinical MVD unless pimobendan criteria are met.
Question 2: Which urine sediment finding is pathognomonic for ethylene glycol toxicosis in a dog?
- Struvite crystals
- Calcium oxalate monohydrate (hippurate) crystals (Correct answer)
- Calcium phosphate crystals
- Amorphous urate crystals
Correct answer: Calcium oxalate monohydrate (hippurate) crystals
Calcium oxalate monohydrate crystals (prism- or hippurate-shaped) appear in the urine within 3–6 hours of ethylene glycol ingestion.
Question 3: A 6-year-old intact female Golden Retriever presents with PU/PD, a pendulous abdomen, and bilaterally symmetrical alopecia. Serum chemistry shows elevated ALP. Which single test has the highest sensitivity for diagnosing hyperadrenocorticism in this dog?
- Low-dose dexamethasone suppression test (LDDST)
- Urine cortisol:creatinine ratio (UCCR) (Correct answer)
- ACTH stimulation test
- High-dose dexamethasone suppression test (HDDST)
Correct answer: Urine cortisol:creatinine ratio (UCCR)
The urine cortisol:creatinine ratio has the highest sensitivity (~99%) for Cushing's disease, making it an excellent screening test, though it lacks specificity.
Question 4: A cat presents with acute hindlimb paralysis, cold distal limbs, absent femoral pulses, and vocalizing in pain. What is the most likely diagnosis?
- Intervertebral disc disease
- Aortic thromboembolism (Correct answer)
- Hypokalemic myopathy
- Fibrocartilagenous embolism
Correct answer: Aortic thromboembolism
Aortic thromboembolism (saddle thrombus) in cats causes peracute hindlimb paresis with absent femoral pulses, cold limbs, and severe pain.
Question 5: A dog is diagnosed with immune-mediated thrombocytopenia (IMT). After confirming the platelet count is 8,000/µL with spontaneous bleeding, which is the most appropriate initial treatment?
- Azathioprine monotherapy
- Prednisone at immunosuppressive doses (Correct answer)
- Vincristine alone
- Mycophenolate mofetil
Correct answer: Prednisone at immunosuppressive doses
Prednisone at immunosuppressive doses (1–2 mg/kg/day) is the first-line treatment for IMT and rapidly reduces platelet destruction.
Question 6: A 2-year-old Cocker Spaniel has chronic bilateral otitis externa with secondary Malassezia overgrowth. Dermatology suspects an underlying etiology. Which is the most likely primary cause?
- Hypothyroidism
- Atopic dermatitis (Correct answer)
- Food allergy
- Sarcoptic mange
Correct answer: Atopic dermatitis
Atopic dermatitis is the most common primary cause of recurrent Malassezia otitis in dogs, with Cocker Spaniels being a predisposed breed.
Question 7: On thoracic radiographs, an alveolar pattern with an air bronchogram and cranioventral distribution in a febrile dog with cough is most consistent with:
- Cardiogenic pulmonary edema
- Aspiration or bacterial bronchopneumonia (Correct answer)
- Pulmonary contusions
- Primary lung neoplasia
Correct answer: Aspiration or bacterial bronchopneumonia
Bacterial or aspiration pneumonia characteristically produces a cranioventral alveolar pattern with air bronchograms due to gravity-dependent distribution.
BCSE Small Animal Internal Medicine 4
A 3-year-old Labrador Retriever is presented with exercise intolerance and a grade IV/VI holosystolic murmur loudest at the left apex.
Echocardiography confirms mitral valve regurgitation with a dilated left ventricle.
What is the current recommendation regarding ACE inhibitor therapy at this stage?