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53 Cards in this Set

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What should the target non-structural carbohydrates be in a horse with equine metabolic syndrome?
<10%
T or F:
Hypothyroidism is an emerging concern as horses live longer.
False!
Hypothyroidism in adult horses does not exist!
What is the constellation of clinical signs comprising equine metabolic syndrome?
Insulin resistance
Obesity and/or regional adiposity
History of laminitis
Where does fat deposit in EMS horses?
Neck, top line, behind shoulder, over tail head, sheath (geldings)
Which horse breed is classic for EMS?
Morgan horses
Choose PPID or EMS for the following:
- supraorbital fat increase
- epaxial muscle wasting
- 6-20 yrs
- fat horse
- overnight dex suppression test suppresses to <1ug/dl
- Morgan horses
PPID - supraorbital fat increase
PPID - epaxial muscle wasting
EMS - 6-20 yrs
EMS - fat horse
EMS - overnight dex suppression test suppresses to <1ug/dl
EMS - Morgan horses
Choose PPID or EMS for the following:
- no breed predisposition
- overnight dex suppression test suppresses to 3ug/dl
- normal to increased insulin levels
- PU/PD
- 18 yo horse
PPID - no breed predisposition
PPID - overnight dex suppression test suppresses to 3ug/dl
EMS (also PPID) - normal to increased insulin levels
PPID - PU/PD
PPID or EMS - 18 yo horse
Choose PPID or EMS for the following:
- 15-23 yrs
- hairy horse
- enlarged pituitary
- elevated glucose in glucose tolerance test
- pergolide
PPID - 15-23 yrs
PPID - hairy horse
PPID - enlarged pituitary
EMS - elevated glucose in glucose tolerance test
PPID - pergolide
What is the age of onset for PPID? For EMS?
PPID (15-23 yrs)
EMS (6-20 yrs)
What is the cornerstone for making EMS diagnosis?
glucose tolerance testing
T or F:
Elevated resting insulin levels may be indicative of EMS.
True!
It is a good screening test only...
T or F:
The major pathogenesis of insulin resistance in EMS horses is reduced insulin levels.
False!
What are the methods of insulin resistance in EMS?
Reduced insulin receptors
Insulin receptor malfunction
Defect of signaling pathways
Interference w/translocation or fxn of GLUT4
Which of the following are not true regarding laminitis pathogenesis?
a) Decreased endothelin-1 (ET-1) leads to vasoconstriction
b) Increased NO leads to vasodilation
c) Insulin is a slow vasodilator
d) Insulin reduces platelet activity
e) Thromboxane and 5-HT induce vasoconstriction
a) Decreased endothelin-1 (ET-1) leads to vasoconstriction (no - INCREASED ET-1)
d) Insulin reduces platelet activity (no; increases activity)
e) Thromboxane and 5-HT induce vasoconstriction (not 5-HT technically but 5-hydroxy tryptamine)
Which of the following are not true regarding horses w/EMS?
a) inflammatory cytokines are elevated
b) monocytes move out of adipose tissues, thus stimulating a pro-inflammatory state
c) FFAs are elevated
d) maximization of the lipid storage capacity for adipocytes stimulates macrophages
d) TNFa is stimulated by insulin
b) monocytes move out of adipose tissues, thus stimulating a pro-inflammatory state (no, they move in)
d) TNFa is stimulated by insulin (no, TNFa is stimulated by inflammatory cells)
What are 3 times when resting insulin or glucose plasma concentrations are not helpful?
Active laminitis (pain & stress)
When insulin resistance is mild and insulin concentrations are still within normal range
Pancreatic insufficiency has resulted in DM
T or F:
The CGIT should be used when EMS is suspected and resting insulin is high.
False!
That would kinda be a waste...it is better to use it when EMS is suspected but resting insulin is LOW.
Normal insulin sensitivity is defined by blood glucose concentration returning to baseline or below by ________.
45 minutes
When should dextrose be administered during a CGIT?
Sweating
Muscle fasiculations
Profound weakness
Blood glucose <25mg/dL
The ultimate lowered threshold for developing laminitis is also known as...
...prelaminitic syndrome
Which of the following are OK carbs to feed to an EMS horse?
a) lignin
b) pectin
c) monosaccharides
d) hemicellulose
e) oligofructose
a) lignin
d) hemicellulose
(the rest are non-structural carbs)
How much hay should be fed to an EMS horse? How many flakes is this?
Feed 1.5 to 1.75% of body wt
WEIGH the hay!
If an EMS horse cannot be removed from pasture, what can be done?
Pasture early in morn/late in evening
Use grazing muzzle
don't graze after rain
What are the 3 groups of EMS horses?
Obese w/IR
Non-obese w/regional adiposity and IR
Group 1 or 2 animal with concurrent laminitis
Which of the following have NO benefit when treating an EMS horse?
a) Thyro-L
b) Banamine
c) Cr
d) Metformin
e) V
f) Gabapentin
c) Cr
d) Metformin
e) V
(also Mg)
Which of the following do not describe the pathogenesis of PPID?
a) Benign pituitary adenoma
b) Loss of DA inhibition to pars intermedia
c) A primary hypothalamic disease caused by oxidative injury
d) Causes constitutive secretion of ACTH by the pars intermedia
e) Increased ACTH leads to increased glucocorticoids
a) Benign pituitary adenoma (no, it is just hyperplasia)
d) Causes constitutive secretion of ACTH by the pars intermedia (no, pars intermedia secretes POMC which is cleaved into ACTH and other things)
Which of the following are associated with PPID?
a) sole abscesses
b) suspensory breakdown
c) decreased appetite
d) failure to lactate
e) UTIs
a) sole abscesses
b) suspensory breakdown (this is rare)
e) UTIs
(also increased appetite, persistent lactation, infertility, immunosuppression, etc)
Which of the following clin path signs are consistent with PPID?
a) neutropenia
b) lymphopenia
c) hypersegmented neutrophilia
d) hyperglycemia
e) hypocholesterolemia
b) lymphopenia
c) hypersegmented neutrophilia
d) hyperglycemia
(also mild anemia, increased liver enzymes, cholesterol, and triglycerides)
Which test is considered the gold standard for PPID diagnosis?
Overnight dex suppression test is what he said in the notes but in lecture he said no gold standard other than necropsy and histo...you decide which is the true answer!
When would you expect cortisol levels to be higher in horses?
Long days (summer months) have higher cortisol
Which of the following are not associated with PPID positive horses?
a) Cortisol suppression post domperidone administration
b) Insulin resistance
c) High ACTH concentrations in September
d) Cortisol suppression to 3ug/dL @ 12 hrs
a) Cortisol suppression post domperidone administration (no, domperidone would increase ACTH in PPID horses)
c) High ACTH concentrations in September (this is when ACTH is seasonally highest so high ACTH may be spurious)
How much should domperidone increase ACTH in PPID horses? How long should this take?
3x increase in ACTH by 4 hrs
Which of the following treatments are effective for PPID?
a) Dopamine agonist
b) Serotonin antagonist
c) Dopamine antagonist
d) Seratonin agonist
a) Dopamine agonist (pergolide)
(note - the serotonin antagonist, cyproheptadine, doesn't work)
What are some routine health care measures that should be taken with PPID horses?
Dental management
Deworming
Hoof care/farrier
Body clip in summer
Monitor BCS
Special diet considerations (senior diets)
Choose hyperlipidemia or hyperlipemia for the following:
- triglyceride level of 250mg/dL
- pathophysiologic response
- normal response
- triglyceride level of 750mg/dL
- common in ponies
lipidemia - triglyceride level of 250mg/dL
lipemia - pathophysiologic response
lipidemia - normal response
lipemia - triglyceride level of 750mg/dL
lipemia - common in ponies
Inappropriate fat mobilization is the definition of...
...hyperlipemia
Which of the following do not describe fatty acid metabolism?
a) hormone sensitive lipase inhibits insulin
b) Glucagon and cortisol increase lipolysis and inhibits insulin
c) lipoprotein lipase drives VLDLs into tissues
d) insulin and heparin activate lipoprotein lipase
e) hormone sensitive lipase increases lipolysis
a) hormone sensitive lipase inhibits insulin (no, insulin inhibits HSL)
b) Glucagon and cortisol increase lipolysis and inhibits insulin (both increase lipolysis but only cortisol inhibits insulin)
Which of the following increase lipolysis?
a) insulin
b) cortisol
c) glucagon
d) ACTH
e) hormone sensitive lipase
f) lipoprotein lipase
b) cortisol
c) glucagon
d) ACTH
e) hormone sensitive lipase
Hyperlipemia is characterized by a profound increase in which of the following?
a) insulin
b) thyroid hormone
c) lipoprotein lipase
d) hormone sensitive lipase
e) cortisol
d) hormone sensitive lipase
Choose insulin antagonist or negative energy balance for the following:
- obesity
- signalment (age/breed)
- pregnancy/lactation
- underlying disease
- stress
antagonism - obesity
antagonism - signalment (age/breed)
BOTH - pregnancy/lactation
Neg Energy Bal - underlying disease
Antagonism - stress
How does pony carbohydrate metabolism differ from normal horses?
Increased baseline insulin
Impaired glucose tolerance
Insulin resistance
Increased FFA release from adipocytes
T or F:
Progesterone increases lipolysis.
True!
Progesterone will suppress insulin
What should you always request when performing bloodwork on a pony or mini-horse?
Triglycerides!
Predict relative values of the following for a pony with lipemia?
- PCV
- total solids
- FFAs/TGs/Cholesterol
- liver enzymes (SDH, GGT, AST)
normal - PCV
increased - total solids
increased - FFAs/TGs/Cholesterol
increased - liver enzymes (SDH, GGT, AST)
How is lipemia treated?
Treat underlying disease
Feed 'em! (parenteral and/or oral)
Fluid, electrolyte, and acid/base correction
Insulin (glargine)
What are some potential complications to parenteral nutrition when treating lipemia?
thrombosis and throbophlebitis
Which of the following are not good measures to prevent lipemia?
a) keep BCS at 3/9
b) feed low carbs/high roughage
c) fat supplementation
d) reduce stress
e) periodic blood sampling for TGs
a) keep BCS at 3/9 (naw, keep it more normal like 5)
c) fat supplementation (noooooooooo)
Which of the following can cause hypothyroidism?
a) high iodine
b) low iodine
c) glargine
d) Thyro-L
e) diets rich in kelp and seaweed
a) high iodine
b) low iodine
e) diets rich in kelp and seaweed
You see a foal in Oregon that has thyroid gland hyperplasia. Which other issues might be concurrent?
a) mandibular brachygnathism
b) ruptured digital extensor
c) goiter
d) hyperthermia
e) dry hair coat
b) ruptured digital extensor
c) goiter
e) dry hair coat
(mandibular prognathism, angular limb deformities, hypothermia)
What are two proposed causes of anhidrosis?
downregulated beta 2 receptors
decreased epinephrine production
T or F:
Anhidrosis horses have normal sweat glands.
True!
How is anhidrosis diagnosed?
Give terbutaline and look for a response (not usually done though)
Which treatment of anhidrosis may have good effects?
a) give beer daily
b) move to cooler, drier climate
c) Thyro-L
d) Acupuncture
a) give beer daily
b) move to cooler, drier climate