A 4-year old female spayed mixed Chihuahua presented to the emergency service at
approximately 5am this morning after presumptively being attacked by a coyote. The
patient has a flail chest and it is questionable if there is direct communication between
the thoracic cavity and the environment (it was difficult to examine the dog due to her
fractious nature). Exploration of the wound was performed, and once anesthetized, it
was apparent she had a pneumothorax. The patient must be ventilated, as there is no
vacuum present in the chest for lung expansion to occur. What pressure should the
anesthetist not exceed if manually bagging the patient during anesthesia?
20cm H2O
12cm H2O
24cm H2O
8cm H2O
Give this one a try later!
Pressures above 20cm H20 may result in barotrauma. In an otherwise
healthy patient it is not recommended to exceed this pressure. In patients
with chronic atelectasis, anesthetists will be much more apprehensive
about over ventilating or ventilating the lungs too quickly, as acute
, expansion can trigger re-expansion pulmonary edema, which may then
lead to acute respiratory distress syndrome and death.
A 4-year old male Manx cat presents to you because the owners found an empty,
opened pill vial in the bathroom and the cat vomited. On physical exam, you note
ptyalism and facial edema. The cat's mucous membranes are pale and slightly icteric.
You perform a blood smear and detect Heinz bodies in erythrocytes. The cat's
packed cell volume (PCV) is 26% (30-45%). The owners provide you a list of the
medications in the medicine cabinet which are acetaminophen (Tylenol), finasteride
(Propecia), enalapril (Vasotec), and omeprazole (Prilosec). What treatments should
you institute for this cat?
Prednisone and amoxicillin
Acetylcysteine and S-adenosylmethionine
Emesis and methylene blue
Activated charcoal and whole blood transfusion
Give this one a try later!
Acetylcysteine and S-adenosylmethionine. Acetaminophen toxicity in cats
usually occurs when owners administer the drug, unaware of its significant
potential toxicity in cats. In this case, the cat's clinical signs are most
consistent with acetaminophen toxicity based on the Heinz body anemia
that is present. Cats can die from oxidative damage and
methemoglobinemia within 1-2 days of ingestion. It may also be associated
with hepatotoxicity in cats, although this is seen more frequently in
dogs.Recall that cats are particularly sensitive to acetaminophen because
they have decreased glucuronyl transferase activity which conjugates
acetaminophen to glucuronic acid for excretion. As a result, 50-60 mg (a
single tablet) may be fatal for a 4-5 kg cat.Treatment should consist of toxin
removal if possible by inducing emesis in some cases. As the cat in this case
is already vomiting, this may not be necessary. Activated charcoal is
controversial and should only be given if ingestion occurred within hours
and should be administered very carefully in cats due to the risk of
aspiration.The specific antidote is acetylcysteine which binds to some of
the reactive metabolites of acetaminophen and increases the availability
and synthesis of glutathione. Other treatments may include S-
Adenosylmethionine (SAMe) which has hepatoprotective and antioxidant
properties. Cimetidine can be given to inhibit the p450 oxidase in the liver
, and limit formation of toxic metabolites. Ascorbic acid can also be used as
an adjunct treatment to bind toxic metabolites. In cats with signs of
hypoxemia from severe hemolytic anemia (PCV <20%), a transfusion and
further supportive care may be warranted.
Your client is pregnant and is worried about acquiring toxoplasmosis from her cat.
What do you advise?
Submit toxoplasmosis titers from the cat. A positive cat infected with toxoplasmosis
can shed multiple times in its lifetime and pose a zoonotic risk .
Toxoplasmosis titer should be performed on the owner by a human physician. A
positive titer indicates antibodies to the organism that will prevent infection in the first
trimester. A negative titer indicates she should remove her cats from her environment.
Have a housemate empty the litter box daily as a simple precaution to prevent
infection as it takes 1-3 days for passed oocysts in the stool to sporulate into an
infective form.
Submit toxoplasmosis titers from the cat. A IgG titer of 1:64 or greater suggests recent
or active infection that could pose a danger.
Give this one a try later!
Have a housemate empty the litter box daily as a simple precaution to
prevent infection as it takes 1-3 days for passed oocysts in the stool to
sporulate into an infective form.
Toxoplasmosis gondii is a protozoal organism. The cat is the definitive host;
the entire life cycle of the organism can be completed within this host.
Most cats become infected when they consume an exposed rodent with
bradyzoites encysted in their tissues. Only recently infected cats generally
shed oocysts in their stool, and cats typically only shed these oocysts for 1-
2 weeks. Most cats will only have one shedding episode in their lifetime.A
IgM (not IgG) titer of 1:64 or greater suggests recent or active infection and
that cat is at risk of shedding oocysts in their stools. Oocysts are not
infective until they sporulate. This process takes > 24 hours, so emptying the
litter box daily is advised, preferably by someone who is not pregnant.If an
owner has owned cats for a long while, it is possible that they may have
previously been exposed and therefore have mounted an immune
response to the organism. If so, it may be advisable to test for Toxoplasma
, antibody titers in the owner. A sufficient antibody titer will mean the client is
protected from infection during the first trimester.
A 1.5-year-old spayed female cat presents with a 7-day history of vocalizing, rolling,
and allowing a male neutered cat in the household to mount her. The cat has gone
through one similar episode 1 month ago. She otherwise has been behaving normally
and has no other health problems. You performed an ovariohysterectomy on the cat
at 3 months of age. You perform vaginal cytology which shows some cornified
epithelial cells but is inconclusive. You measure serum lutenizing hormone of 0.2
ng/ml (normal for an ovariectomized female is >1 ng/ml). Which of the following is the
most appropriate course of action?
Measure serum estrogen and progesterone levels
Measure serum testosterone levels
Exploratory laparotomy to remove the ovarian remnant
Order MRI of the brain to rule out a pituitary tumor
Give this one a try later!
approximately 5am this morning after presumptively being attacked by a coyote. The
patient has a flail chest and it is questionable if there is direct communication between
the thoracic cavity and the environment (it was difficult to examine the dog due to her
fractious nature). Exploration of the wound was performed, and once anesthetized, it
was apparent she had a pneumothorax. The patient must be ventilated, as there is no
vacuum present in the chest for lung expansion to occur. What pressure should the
anesthetist not exceed if manually bagging the patient during anesthesia?
20cm H2O
12cm H2O
24cm H2O
8cm H2O
Give this one a try later!
Pressures above 20cm H20 may result in barotrauma. In an otherwise
healthy patient it is not recommended to exceed this pressure. In patients
with chronic atelectasis, anesthetists will be much more apprehensive
about over ventilating or ventilating the lungs too quickly, as acute
, expansion can trigger re-expansion pulmonary edema, which may then
lead to acute respiratory distress syndrome and death.
A 4-year old male Manx cat presents to you because the owners found an empty,
opened pill vial in the bathroom and the cat vomited. On physical exam, you note
ptyalism and facial edema. The cat's mucous membranes are pale and slightly icteric.
You perform a blood smear and detect Heinz bodies in erythrocytes. The cat's
packed cell volume (PCV) is 26% (30-45%). The owners provide you a list of the
medications in the medicine cabinet which are acetaminophen (Tylenol), finasteride
(Propecia), enalapril (Vasotec), and omeprazole (Prilosec). What treatments should
you institute for this cat?
Prednisone and amoxicillin
Acetylcysteine and S-adenosylmethionine
Emesis and methylene blue
Activated charcoal and whole blood transfusion
Give this one a try later!
Acetylcysteine and S-adenosylmethionine. Acetaminophen toxicity in cats
usually occurs when owners administer the drug, unaware of its significant
potential toxicity in cats. In this case, the cat's clinical signs are most
consistent with acetaminophen toxicity based on the Heinz body anemia
that is present. Cats can die from oxidative damage and
methemoglobinemia within 1-2 days of ingestion. It may also be associated
with hepatotoxicity in cats, although this is seen more frequently in
dogs.Recall that cats are particularly sensitive to acetaminophen because
they have decreased glucuronyl transferase activity which conjugates
acetaminophen to glucuronic acid for excretion. As a result, 50-60 mg (a
single tablet) may be fatal for a 4-5 kg cat.Treatment should consist of toxin
removal if possible by inducing emesis in some cases. As the cat in this case
is already vomiting, this may not be necessary. Activated charcoal is
controversial and should only be given if ingestion occurred within hours
and should be administered very carefully in cats due to the risk of
aspiration.The specific antidote is acetylcysteine which binds to some of
the reactive metabolites of acetaminophen and increases the availability
and synthesis of glutathione. Other treatments may include S-
Adenosylmethionine (SAMe) which has hepatoprotective and antioxidant
properties. Cimetidine can be given to inhibit the p450 oxidase in the liver
, and limit formation of toxic metabolites. Ascorbic acid can also be used as
an adjunct treatment to bind toxic metabolites. In cats with signs of
hypoxemia from severe hemolytic anemia (PCV <20%), a transfusion and
further supportive care may be warranted.
Your client is pregnant and is worried about acquiring toxoplasmosis from her cat.
What do you advise?
Submit toxoplasmosis titers from the cat. A positive cat infected with toxoplasmosis
can shed multiple times in its lifetime and pose a zoonotic risk .
Toxoplasmosis titer should be performed on the owner by a human physician. A
positive titer indicates antibodies to the organism that will prevent infection in the first
trimester. A negative titer indicates she should remove her cats from her environment.
Have a housemate empty the litter box daily as a simple precaution to prevent
infection as it takes 1-3 days for passed oocysts in the stool to sporulate into an
infective form.
Submit toxoplasmosis titers from the cat. A IgG titer of 1:64 or greater suggests recent
or active infection that could pose a danger.
Give this one a try later!
Have a housemate empty the litter box daily as a simple precaution to
prevent infection as it takes 1-3 days for passed oocysts in the stool to
sporulate into an infective form.
Toxoplasmosis gondii is a protozoal organism. The cat is the definitive host;
the entire life cycle of the organism can be completed within this host.
Most cats become infected when they consume an exposed rodent with
bradyzoites encysted in their tissues. Only recently infected cats generally
shed oocysts in their stool, and cats typically only shed these oocysts for 1-
2 weeks. Most cats will only have one shedding episode in their lifetime.A
IgM (not IgG) titer of 1:64 or greater suggests recent or active infection and
that cat is at risk of shedding oocysts in their stools. Oocysts are not
infective until they sporulate. This process takes > 24 hours, so emptying the
litter box daily is advised, preferably by someone who is not pregnant.If an
owner has owned cats for a long while, it is possible that they may have
previously been exposed and therefore have mounted an immune
response to the organism. If so, it may be advisable to test for Toxoplasma
, antibody titers in the owner. A sufficient antibody titer will mean the client is
protected from infection during the first trimester.
A 1.5-year-old spayed female cat presents with a 7-day history of vocalizing, rolling,
and allowing a male neutered cat in the household to mount her. The cat has gone
through one similar episode 1 month ago. She otherwise has been behaving normally
and has no other health problems. You performed an ovariohysterectomy on the cat
at 3 months of age. You perform vaginal cytology which shows some cornified
epithelial cells but is inconclusive. You measure serum lutenizing hormone of 0.2
ng/ml (normal for an ovariectomized female is >1 ng/ml). Which of the following is the
most appropriate course of action?
Measure serum estrogen and progesterone levels
Measure serum testosterone levels
Exploratory laparotomy to remove the ovarian remnant
Order MRI of the brain to rule out a pituitary tumor
Give this one a try later!
