ICVA - International Council for Veterinary Assessment Canine Internal Medicine Questions and Answers 1 — Questions and Answers
Question 1: A 7-year-old, male neutered Miniature Schnauzer is presented with a 3-day history of vomiting, anorexia, and lethargy. On physical examination, he displays cranial abdominal pain. Laboratory results show neutrophilia, elevated amylase, and lipase. Which of the following is the most likely diagnosis?
- Acute pancreatitis (Correct answer)
- Gastroenteritis
- Intestinal foreign body
- Diabetic ketoacidosis
Correct answer: Acute pancreatitis
The signalment (Miniature Schnauzer), clinical signs (vomiting, anorexia, cranial abdominal pain), and laboratory findings (neutrophilia, elevated amylase and lipase) are all highly suggestive of acute pancreatitis. While other conditions can cause similar signs, the combination of findings makes pancreatitis the most probable diagnosis.
Question 2: Which of the following is the most appropriate initial treatment for a dog diagnosed with primary immune-mediated hemolytic anemia (IMHA) presenting with severe anemia (PCV 12%) and autoagglutination?
- Whole blood transfusion and broad-spectrum antibiotics
- Intravenous fluid therapy and gastroprotectants
- Immunosuppressive doses of corticosteroids and potentially a blood transfusion (Correct answer)
- A low dose of aspirin and oxygen therapy
Correct answer: Immunosuppressive doses of corticosteroids and potentially a blood transfusion
The cornerstone of treatment for primary IMHA is immunosuppression to stop the destruction of red blood cells. Corticosteroids at immunosuppressive doses are the first-line therapy. Given the severe anemia (PCV 12%), a packed red blood cell or whole blood transfusion is often necessary to stabilize the patient and provide oxygen-carrying capacity while waiting for the immunosuppressive drugs to take effect.
Question 3: A 9-year-old spayed female Golden Retriever is diagnosed with chronic kidney disease (CKD). Her initial bloodwork shows: Creatinine 2.8 mg/dL, SDMA 25 µg/dL, and a urine protein:creatinine (UPC) ratio of 0.8. Her systolic blood pressure is 155 mmHg. According to the International Renal Interest Society (IRIS) staging system, what is the correct stage and substage for this patient?
- IRIS Stage 2, Normotensive, Non-proteinuric
- IRIS Stage 4, Hypertensive, Proteinuric
- IRIS Stage 3, Borderline Hypertensive, Proteinuric (Correct answer)
- IRIS Stage 3, Normotensive, Non-proteinuric
Correct answer: IRIS Stage 3, Borderline Hypertensive, Proteinuric
Based on the IRIS guidelines, a creatinine of 2.8 mg/dL in a dog places it in Stage 3 (2.1-5.0 mg/dL). A UPC ratio of >0.5 makes the dog proteinuric. A systolic blood pressure of 155 mmHg falls into the borderline hypertensive (prehypertensive) category (150-159 mmHg). Therefore, the correct classification is IRIS Stage 3, Borderline Hypertensive, Proteinuric.
Question 4: Which diagnostic test is considered to have the highest sensitivity for diagnosing naturally occurring hyperadrenocorticism (Cushing's disease) in dogs, although it may have lower specificity?
- Urinary Cortisol:Creatinine Ratio (UCCR)
- Low-Dose Dexamethasone Suppression Test (LDDST) (Correct answer)
- ACTH Stimulation Test
- High-Dose Dexamethasone Suppression Test (HDDST)
Correct answer: Low-Dose Dexamethasone Suppression Test (LDDST)
The Low-Dose Dexamethasone Suppression Test (LDDST) is widely regarded as the most sensitive screening test for spontaneous hyperadrenocorticism, diagnosing 90-95% of cases. Its drawback is lower specificity, as other non-adrenal illnesses can cause false-positive results. The ACTH stimulation test is less sensitive but more specific, and the UCCR is a screening test that, if negative, makes Cushing's unlikely but if positive requires further testing.
Question 5: A 10-year-old mixed-breed dog presents with polyuria, polydipsia, polyphagia, and weight loss. A blood glucose measurement is 450 mg/dL and the urinalysis reveals glucosuria and ketonuria. What is the most definitive diagnosis?
- Chronic kidney disease
- Hyperadrenocorticism
- Hypothyroidism
- Diabetes mellitus (Correct answer)
Correct answer: Diabetes mellitus
The combination of classic clinical signs (polyuria, polydipsia, polyphagia, weight loss) along with persistent hyperglycemia (elevated blood glucose) and glucosuria (glucose in the urine) is diagnostic for diabetes mellitus in dogs. The presence of ketones indicates a more complicated state, often diabetic ketoacidosis, but the underlying disease is diabetes mellitus.
Question 6: Which of the following is NOT a typical clinical or laboratory finding in a dog with Canine Distemper Virus infection?
- Severe, hemorrhagic gastroenteritis (Correct answer)
- Hyperkeratosis of the nose and footpads
- Neurological signs such as seizures or myoclonus
- Respiratory signs including mucopurulent oculonasal discharge
Correct answer: Severe, hemorrhagic gastroenteritis
While gastrointestinal signs like vomiting and diarrhea can occur with Canine Distemper Virus, severe hemorrhagic gastroenteritis is the hallmark sign of Canine Parvovirus infection. Distemper is classically associated with respiratory, neurological, and dermatological (hyperkeratosis or 'hard pad disease') signs.
ICVA - International Council for Veterinary Assessment Canine Internal Medicine Questions and Answers 1
A 7-year-old, male neutered Miniature Schnauzer is presented with a 3-day history of vomiting, anorexia, and lethargy.
On physical examination, he displays cranial abdominal pain.
Laboratory results show neutrophilia, elevated amylase, and lipase.
Which of the following is the most likely diagnosis?