Cardiology
What are the Differentials for a Right Apical Systolic Murmur?
Dysplasia (congenital), Myxomatous Degeneration, Endocarditis, and PHT
(Review Differentials for all locations)
A small dog presents with tachypnea, dyspnea, and a left apical murmur. What 2 diagnostics will help increase or decrease suspicion of CHF(hint - these are test a normal vet can do)?
Thoracic Rads - VHS over 11.5, VLAS over 3, interstitial/alveolar pattern
POCUS - B line, LA:Ao over 2
(In cats only, could do a SNAP Pro-BNP test)
Name 3 things that differentiate vomiting and regurgitation!!
Vomiting: Abdominal effort, prodromal nausea, usually digested food, and no swallowing pain
Regurgitation: Passive event, no prodromal nausea, Undigested food, usually alkaline, and can have swallowing pain
(note - recall the 3 most common causes of esophageal disease)
What are the 4 parts of the Derm Database
Trichogram, Skin scrape, cytology (impression), and fungal eval (wodds lamp, KOH trichogram, or fungal culture)
(optional - fecal float, fungal or bacterial cultures, bloodwork, skin biopsy)
A 2 year old dog presents for new onset of mild pruritus (biting feet, scooting bum, scratching ears). A derm database was done and there are no signs of secondary secondary infection or mites. The client has limited money and wants fast relief. What is the best Tx option for the suspected Disease?
Prednisone 1mg/kg once daily for 7 days, then EOD (taper to maintenance dose of 0.5-1mg/kg)
(recall other Tx options)
What arrhythmia is characterized by an irregularly irregular rhythm?
A Fib
A 3 month old Frenchie is noted to have a grade 2 left basilar, systolic murmur on routine exam. At her next exam 3 weeks later it has progressed to a grade 4. What is the top differential
Top differential - Pulmonic stenosis - Confirm with Echo (Atenolol or Surgery is a Tx option)
If it were a large breed - Subaortic stenosis more likely (Surgery is NOT an option)
(note: review VSD, PDA)
An animal presents for weight loss and an increased appetitive. They have chronic watery diarrhea and steatorrhea. What is the best Tx for the suspected Disease? What is the number one cause of this disease in dogs versus cats?
Tx: Powdered pancreatic enzyme replacement, highly digestible diet (need high fat for calories), and COBALMIN (often low - prognostic indicator), probiotics.
Should respond in days, if No response can be due to dysbiosis - Tylosin Tx
Causes: chronic pancreatitis in cats, and Acinar Atrophy in young dogs
Which species of Demodex dwells on the surface, not in the follicle and is contagious?
D. gatoi
D. Canis, D. injai, and D. cati are all follicular
A dog presents with severe pruritus, and alopecia/erythema of the lumbar region and hind limbs. No other abnormalities are noted on exam. What is the best Tx?
Flea control products, steroids at 1mg/kg (anti-inflamm dose), and Tx secondary infections if present.
(Note - long term control, house, other pets, ect)
What is the Chronic (at home) Tx for Stage C CHF in a dog?
"Dogs Are For Special People"
Dietary Na reduction, ACE inhibitor, Furosemide, Spironolactone, and Pimobendan
(Review cats Tx and stage D)
A small dog presents for a cough, progressing over the past few month. Radiographs are taken and the VHS in 12.9 and VLAS in 3.7. There is no intersitial or alveolar pattern, and no dilation of pulmonary veins. What Tx should be started?
Start B2 therapies (cardiomegaly causing compression of the mainstem bronchi) - Pimobendan and an ACE inhibitor
A dog with chronic NSAID use presents for hematemesis, lethargy, abdominal pain, and melena. What medications can Tx the suspected Disease?
PPIs, Sucralfate, and Misoprostil
Can do endoscopy to find the cause
What 3 derm conditions cause SEVERE pruritus?
Sarcoptic mange, Malassezia, and Flea bite ALLERGY (he also mentions familial seborrhea often as a fourth)
A dog with a history of atopy, on daily apoquel, presents for reoccurance on clinical signs. He is severly pruritic and has areas of alopecia, erythema, and litchenified/hyperpigmented skin on the groin and feet. What is the best Tx option, for the MOST LIKELY cause of the reoccurance of signs?
Shampoo 1-2x a week with chlorhex/ketoconazole or selenium disulfide product and Daily use of wipes/spot treatment
Systemic antifungals only indicated if owner cant do topicals or if very severe.
What are the 3 Radiographic Hallmarks of Left CHF in dogs?
Left Cardiomegaly, Interstitial or Alveolar Pattern, and pulmonary venous distension
(also know hallmarks for Rt CHF)
A 14 year old cat presents for acute dyspnea. She also has a 6 month history of increased appetite and weight loss. On rads, there is cardiomegaly, scalloping and loss of vascular detail. SNAP Pro BNP is positive. No murmur is heard. How should you begin Tx for the suspected disease acutely in hospital and what additional test should be run?
Tx: FOPS - Furosemide, Oxygen, Pimobendan, and Sedation (torb)
Test: T4 and BP ALWAYS ran, secondary HCM likely in older cats. Can refer to cardiologist for Echo and definitive Dx (LV concentric hypertrophy and diastolic dysfunction)
For small animals, name the primary liver leakage enzyme, the inducible enzyme (from bile epithelium), and 3 of the 4 chemistry values that indicate decreased liver function
Leakage: ALT
Inducible: ALP
Decreased function: albumin, cholesterol, BUN, glucose
What are the 2 most common primary facotrs causing pyoderma in dogs?
1. Atopy (allergies)
2. Endocrine (Hypothyroid, then Cushings)
(note - patchy alopecia is folliculitis and draining tracts are furunculosis)
A 7 month old dog presents for multiple areas of alopecia, open serosanguinous draining tracts, erythema, crusts, lethargy and has become progressively pruritic. Which Treatment is best in the long term, to control the primary disease?
Isoxazolines!! (or other Demodex Tx - recall Tx options) Know that steroids are typically contraindicated
Do also need to use antibiotics to treat the secondary bacterial pyoderma - best thing to control the itch fast
(note - what if this was local demodex)
Name the Stage and Treatment of heart disease for a heart with a VHS of 11.8 and no other radiographic abnormalities.
Stage: B2
Tx: Pimobendan and ACE inhibitor
(review Cats, and VLAS cut offs)
A Labrador presents to a cardiologist with a history of exercise intolerance and collapse. On exam, there is an irregularly irregular rhythm, weak pulses, and no murmur or crackles heard. An Echo is performed and there is LV dilation and LV systolic dysfunction. There are no signs of CHF. What is the number one secondary cause of the suspected disease and how should this be treated?
Secondary cause: Grain Free Diets
Tx: Diltiazem or Digoxin (Atenolol not recommended for DCM), Pimobendan and ACE inhibitor (for stage B2), Switch diet!
(recall - what would be a top differential for a Boxer with collapse and an arrhythmia, review drugs for Ventricular arrhythmias)
What are the 6 sequential diagnostics for Chronic Diarrhea?
1. Fecal exam - parasites, bacterial
2. CBC, Chem, UA - rule out systemic causes
3. If small intestinal - Consider PLI, TLI, foalte, and cobalamin
4. Ultrasound to locate lesion - can biopsy reach it? obvious disease or obstruction?
5. Elimination diet
6. Biopsy - LAST
(note- review causes of diarrhea)
What are the big three Dermatophytes that affect small animals?
Bonus 100 points - What is the gold standard Diagnostic?
Microsporum canis (zoonotic, from other animals), Nannizzia gypseum (soil), and Trichophyton mentagrophytes (woodland creatures)
Bonus: Fungal culture (Trichogram is the in-clinic, RAPID test)
A 7 year old dog presents for mild, non-seasonal pruritus that is NOT responsive to steroids. There are no sign of infection or mites. What is the next best test for this dog?
Diet elimination trial for 8-12 weeks (homemade novel protein is gold standard, hydrolyzed, ultamino - NO venison, beef, chicken)
Avoid OTC brands
(Cats - pruritus is usually on the face)