BCSE Small Animal Internal Medicine 5 — Questions and Answers
Question 1: A 9-year-old cat presents with progressive weight loss, polyphagia, and a palpable ventral neck mass. T4 is markedly elevated. After confirming hyperthyroidism, which treatment option provides the best chance of permanent cure?
- Oral methimazole for life
- Radioactive iodine (I-131) therapy (Correct answer)
- Bilateral thyroidectomy
- Dietary iodine restriction alone
Correct answer: Radioactive iodine (I-131) therapy
Radioactive iodine (I-131) is considered the gold standard curative treatment for feline hyperthyroidism with >95% cure rate and minimal complications.
Question 2: A 4-year-old dog with recurrent epistaxis and petechiae has a prolonged buccal mucosal bleeding time but normal PT and aPTT. Which condition is most likely?
- Hemophilia A
- Von Willebrand disease (Correct answer)
- Vitamin K deficiency
- Factor X deficiency
Correct answer: Von Willebrand disease
Von Willebrand disease prolongs the buccal mucosal bleeding time (a primary hemostasis test) while leaving PT and aPTT normal because secondary coagulation is intact.
Question 3: A 10-year-old dog has a 2-week history of weight loss, polyphagia, and diarrhea. Serum TLI is below the reference range. What is the most appropriate treatment?
- Oral corticosteroids
- Pancreatic enzyme powder supplementation with meals (Correct answer)
- B12 supplementation alone
- Low-fat prescription diet only
Correct answer: Pancreatic enzyme powder supplementation with meals
Exocrine pancreatic insufficiency (EPI) is treated primarily with pancreatic enzyme (powder) supplementation mixed into each meal.
Question 4: A 6-month-old dog presents with small-stature, hepatic encephalopathy, and low BUN. A post-prandial bile acid test shows markedly elevated 2-hour values. What is the most likely diagnosis?
- Copper storage hepatopathy
- Congenital portosystemic shunt (Correct answer)
- Glycogen storage disease
- Microvascular dysplasia
Correct answer: Congenital portosystemic shunt
A congenital portosystemic shunt causes decreased hepatic perfusion, low BUN and albumin, and dramatically elevated post-prandial bile acids in young dogs.
Question 5: A cat presents with acute blindness and dilated, unresponsive pupils. Fundic examination reveals bilateral retinal detachment. Blood pressure is 240 mmHg. What is the most appropriate immediate treatment?
- IV mannitol for cerebral edema
- Amlodipine besylate to reduce blood pressure (Correct answer)
- Dexamethasone for neuro-ocular inflammation
- Laser photocoagulation
Correct answer: Amlodipine besylate to reduce blood pressure
Amlodipine is the drug of choice for systemic hypertension in cats and can allow retinal reattachment if treated promptly.
Question 6: A 5-year-old Shar-Pei dog presents with recurrent bouts of fever lasting 24–36 hours and joint swelling. Between episodes the dog appears normal. Genetic testing confirms a MEFV gene variant. What is the most likely diagnosis?
- Systemic lupus erythematosus
- Shar-Pei autoinflammatory disease (SPAID) / Shar-Pei fever (Correct answer)
- Lyme nephritis
- Rheumatoid arthritis
Correct answer: Shar-Pei autoinflammatory disease (SPAID) / Shar-Pei fever
Shar-Pei autoinflammatory disease (SPAID) causes episodic fever and swollen hocks due to an autoinflammatory process linked to hyaluronan accumulation.
Question 7: Which statement best describes the mechanism by which lactulose benefits dogs with hepatic encephalopathy?
- It directly inactivates ammonia in the portal bloodstream
- It acidifies colonic contents, trapping ammonia as ammonium and accelerating transit to reduce ammonia absorption (Correct answer)
- It increases urea cycle enzyme activity in the liver
- It chelates copper in the colon, reducing hepatotoxicity
Correct answer: It acidifies colonic contents, trapping ammonia as ammonium and accelerating transit to reduce ammonia absorption
Lactulose is metabolized by colonic bacteria to short-chain organic acids, acidifying the colon and converting ammonia (NH3) to ammonium (NH4+), which is not absorbed.
BCSE Small Animal Internal Medicine 5
A 9-year-old cat presents with progressive weight loss, polyphagia, and a palpable ventral neck mass.
T4 is markedly elevated.
After confirming hyperthyroidism, which treatment option provides the best chance of permanent cure?