DVM Doctor of Veterinary Medicine Small Animal Internal Medicine Questions and Answers — Questions and Answers
Question 1: A 10-year-old male neutered Domestic Shorthair cat is presented with a 2-month history of weight loss despite a ravenous appetite. Physical examination reveals a thin body condition, a heart rate of 240 bpm, and a palpable nodule in the cervical region. Which of the following is the most likely diagnosis?
- Hyperthyroidism (Correct answer)
- Chronic Kidney Disease
- Diabetes Mellitus
- Lymphoma
Correct answer: Hyperthyroidism
The combination of weight loss with polyphagia, tachycardia, and a palpable thyroid nodule (goiter) are classic clinical signs for feline hyperthyroidism. While the other conditions can cause weight loss, the presence of a ravenous appetite and tachycardia strongly points towards hyperthyroidism.
Question 2: A 7-year-old female spayed Golden Retriever is presented for evaluation of polyuria, polydipsia, polyphagia, and a pot-bellied appearance. An ACTH stimulation test is performed. Which of the following results would be most consistent with a diagnosis of hyperadrenocorticism (Cushing's disease)?
- Normal pre-ACTH cortisol, markedly elevated post-ACTH cortisol (Correct answer)
- Low pre-ACTH cortisol, low post-ACTH cortisol
- High pre-ACTH cortisol, normal post-ACTH cortisol
- Normal pre-ACTH cortisol, low post-ACTH cortisol
Correct answer: Normal pre-ACTH cortisol, markedly elevated post-ACTH cortisol
In a dog with hyperadrenocorticism, the adrenal glands have an exaggerated response to ACTH administration. This results in a post-stimulation cortisol level that is significantly above the normal reference range. A low pre- and post-ACTH cortisol is indicative of hypoadrenocorticism (Addison's disease).
Question 3: Which of the following is the gold standard for the diagnosis of Exocrine Pancreatic Insufficiency (EPI) in dogs?
- Serum Amylase and Lipase levels
- Abdominal Ultrasound
- Fecal Elastase Test
- Serum Trypsin-Like Immunoreactivity (TLI) Test (Correct answer)
Correct answer: Serum Trypsin-Like Immunoreactivity (TLI) Test
The serum Trypsin-Like Immunoreactivity (TLI) test is the diagnostic test of choice for Exocrine Pancreatic Insufficiency. TLI is highly specific for pancreatic acinar function, and a significantly low level is diagnostic for EPI. While other tests may show abnormalities, they are not as sensitive or specific for diagnosing EPI.
Question 4: A 4-year-old male neutered Standard Poodle presents in a state of collapse. Bloodwork reveals a Na:K ratio of 21:1, azotemia, and hypoglycemia. Which of the following is the most likely diagnosis?
- Acute renal failure
- Diabetic ketoacidosis
- Hypoadrenocorticism (Addison's disease) (Correct answer)
- Severe gastrointestinal disease
Correct answer: Hypoadrenocorticism (Addison's disease)
The classic electrolyte abnormalities for hypoadrenocorticism are hyponatremia and hyperkalemia, which result in a low sodium-to-potassium (Na:K) ratio, typically below 27:1. The combination of these electrolyte changes with collapse, azotemia, and hypoglycemia in a predisposed breed makes Addison's disease the top differential.
Question 5: The definitive diagnosis of diabetes mellitus in a dog requires the presence of which of the following findings?
- Elevated fructosamine and glycosuria
- Persistent fasting hyperglycemia and glycosuria (Correct answer)
- Weight loss and polyuria
- Ketonuria and hyperglycemia
Correct answer: Persistent fasting hyperglycemia and glycosuria
The cornerstone for diagnosing diabetes mellitus is the demonstration of persistent hyperglycemia in a fasted animal, combined with the presence of glucose in the urine (glycosuria). Clinical signs like weight loss and polyuria support the diagnosis but are not definitive on their own. Fructosamine indicates glucose levels over the prior 2-3 weeks but isn't the primary diagnostic criterion. Ketonuria can be present but is not required for the initial diagnosis.
Question 6: Which of the following is NOT a common cause or contributing factor for the development of chronic kidney disease (CKD) in cats?
- Polycystic kidney disease (PKD)
- Pyelonephritis
- High-protein diet in a healthy adult cat (Correct answer)
- Hypertension
Correct answer: High-protein diet in a healthy adult cat
While therapeutic renal diets for cats with established CKD are protein-restricted, a high-protein diet in a healthy cat with normal kidney function has not been shown to cause CKD. Common causes and contributors include genetic conditions like Polycystic Kidney Disease, bacterial kidney infections (pyelonephritis), and high blood pressure (hypertension), which can damage the kidneys over time.
DVM Doctor of Veterinary Medicine Small Animal Internal Medicine Questions and Answers
A 10-year-old male neutered Domestic Shorthair cat is presented with a 2-month history of weight loss despite a ravenous appetite.
Physical examination reveals a thin body condition, a heart rate of 240 bpm, and a palpable nodule in the cervical region.
Which of the following is the most likely diagnosis?