Certifier Exam Study - Focus On

Front 1

Thrombocytosis in cats.
MC signs?
other CBC findings?
MC cause/disease?

Back 1

plt>700,000/uL
MC signs = GI, endocrine (hyperthyroid)
lymphopenia = MC CBC finding
MC causes = infectious inflammatory

Front 2

Bacteremia in 66 cats and antimicrobial susc. of isloates.
MC isolate?
best Abx choice?

Back 2

88% single sp.
45% gram+
43% gram-
12% obligate anaerobes
77%=enro
69%=chloramphenicol
67%=gentamicin
64%=Clavamox

Front 3

JAVMA 2011
ITP in dogs: tx and predictors of outcome
2 signs assoc with neg prognosis?
what is risk w/ each sign?

Back 3

age 5 mo - 15 yr
MC breed = Cocker Spaniels
MC sign = petechiae
84% survived to discharge
9% relapsed
melena (60% SOD) or incr BUN (50% SOD) = worse prognosis -- vs. 90% without

Front 4

JAVMA 2006
Idiopathic Neutropenia (IN) in dogs: 11 cases - response to tx? risk factors? clinical features?

Back 4

Idiopathic neutropenia dogs: younger (<4yrs) lower NO counts
In all dogs with IN - remission w/in 18 days with pred
WBC=low in all dogs
Neut=0-2380
Hct=26-35.9% (8/11 anemic)
plt=<200,000/uL (3/11 decr. plts)

Front 5

JVIM 2010
Contrast enhanced U/S for focal splenic lesions in dogs.
Sn of each phase?
Sp of each phase?

Back 5

Early vascular phase: hypoechoic pattern strongly associ w/ malignancy; Sn=38% Sp=100%
Late vascular phase: hypoechoic pattern strongly assoc w/ malignancy; Sn=81% Sp=85%
Parenchymal phase: No diff. btwn malignant & benign lesions

Front 6

JVIM 2010
Plasma AT activity as dx; prognostic indicator in dogs: Retrospective study of 149 dogs.
At what level highest Sp?
Name 3 other lab abnormalities?

Back 6

Decr AT = leukocytosis, incr PTT, decr plt, decr alb, incr bili
Dx = IMHA, panc, hepatopathy, neoplasia
Incr mortality across study population
Incr OR for death if AT<60% (9.9 OR); <30% (14.7 OR)
AT<60% = Sn 58% Sp 85% for mortality

Front 7

JVIM 2011
Evaluation of serum NT-pCNP as a dx & px Biomarker for Sepsis.
What is the cutoff? Sn? Sp?
What type of sepsis is it least useful for?

Back 7

Sepsis (29), non-infectious SIRS (34), control (49)
Cutoff of 10.1: AUC=0.71, Sn=65.5%, Sp=89.2% for diff. between (Sepsis) vs (NISIRS/control)
Poor Sn for septic abdomen --> after exclusion Sn=94%, Sp=89%
Conclusion: good biomarker for sepsis excl septic abd; not related to survival

Front 8

JVIM 2011
Effect of Experimental Endotoxemia on TEG parameters, 2nd & 3rd hemostasis in Dogs.
Earlier marker?
What time to assess?

Back 8

D-Dimers are earliest marker!
Endotoxemia signs = v/d, lethargy, abd pain
1 hour: leukopenia (2.5) + D-Dimer incr 2X
4 hour: incr T, PT, aPTT
decr fibrinogen, decr APC, Prot.S, TEG alpha&MA
Conclusion: TEG and APC not good screening tools

Front 9

Outcome following splenectomy in cats. Name 1 variable assoc with neg. outcome? #1 Disease.

Back 9

Weight loss assoc with negative prognostic outcome.
Presenting complaint = palpable abd mass (58%), anorexia (47%)
MCT=53%
HSA=21%
LSA=11%
MST=197 days; MST=3 days if weight loss pre-op; MST=293 days if no wt loss pre-op

Front 10

JVIM 2007
Neutrophil Fxn in Septic Dogs.

Back 10

Phagolysosomal burst = lower in sepsis;
Septic dogs had sig. incr. phagocytosis of opsonized E.coli
*diminished oxidative burst*

Front 11

JVIM 2009
Prothrombotic & Inflammatory effects of IV hIVIG in dogs
Name 5 changes assoc. with IVIG

Back 11

1 g/kg
mild decr plt (med 200,000/uL) while in normal range
leukopenia (med 3.5)
incr TP, incr FDPs, incr thrombin-AT complexes, incr CRP
promotes hypercoagulability and inflammatory state

Front 12

JVIM 2009
Serum [acute phase protein] in dogs with AIHA.
Predictor of hospital stay?
Survival?
Assoc with what 2 variables on CBC?

Back 12

APP= CRP, alpha-1 acid glycoprotein (AAG)
alb=neg APP
At dx: Incr AAG & CRP; normalized over days 9-365 with dz stabilization
APP: not predictor of survival, hosp. stay, # blood transfusions
APP: correlated with PCV & WBC
CRP at admit lower for those who had rec'd steroids

Front 13

JVIM 2009
Peripheral nucleated RBC as px indicator in heat stroke.
What is cutoff? Sn? Sp?

Back 13

n=40 dogs
nRBC = 36/40 (90%) at presentation
Median = 24 cells/ 100 WBC; 1.48 x 10^3/uL
Incr in died (22) vs. survived (18); incr nRBC with RF/DIC
*18 nRBC/100WBC at presentation = Sn 91% Sp 88% for death*

Front 14

JVIM 2008
Post-op bleeding in retired racing greyhounds
What happens to PCV, plt, PT, AP, AT, FDP, vWF

Back 14

n=88 with OHE or castration
26/88 bleeding 36-48 hrs post op
Antiplasmin & AT were sig decr.& vWF incr in bleeders
Post-op all dogs had: decr plts, shorter PT, incr fibrinogen, incr AP; Bleeders had decr Hct
Conclusion: Not primary or secondary defect but fibrinolysis defect

Front 15

JVIM 2007
Anticoagulant effects of LMWH in healthy cats
What is peak time for antiXa levels?
for Daltaparin, Enoxaparin, UFH?

Back 15

Measured antiXa, TEG, PT, aPTT
4 hour post enoxaparin: near tx antiXa levels in humans, but mean was below target
4 hour post daltaparin: lower antiXa than enoxaparin
UFH antiXa target @ 4 hours and trough
LMWH = 2 hours post admin = peak antiXa activity

Front 16

JVIM 2009
Anti-endothelial cell Abs in dogs with IMHA & other diseases associ with incr risk of TE.
Are they present?
Are they predictive?

Back 16

2/91 sick dogs had +AECA
0/21 IMHA dogs had +AECA
0/20 SIRS, sepsis, both had +AECA
Conclusion: RARE in dogs with TE

Front 17

JVIM 2008
IMHA tx, outcome, prognostic indicators in 149 dogs
4 predictors at diagnosis
3 predictors at first 2 weeks of tx

Back 17

Predictors of death at dx: petechiation (4X OR), incr BUN, bands, thrombocytopenia
1st 2 weeks predictors of fatality: incr. BUN, t-Bili, petechiae --> if all present then 16X risk of death
92% survival rate after 1st 2 weeks

Front 18

JVIM 2008
Portal Vein Thrombosis in 6 cats
MC cause?
other causes?

Back 18

6/6 = hepatic disease
3/6 = congenital PSS
2/6 = neoplasia
1/6 = pancr/hepatic necrosis
2/6 acute; 4/6 chronic

Front 19

JVIM 2007
Transient hyperammonemia due to urea cycle enzyme deficiency in irish wolfhounds.
Bile acids?
Citrulline level?
What age resolved?

Back 19

Defects in arginine succinase or arginosuccinate synthetase
In all 17 pups: incr ammonia with normal bile acids (except 1); no PSS
Incr citrulline persisted despite normalized ammonia (with incr. glutamine and asparagine thru alternative NH3 pathways)
Resolved at 3 months.

Front 20

JVIM 2006, JAVMA 2010
Hyperphosphatasemia and concurrent adrenal gland dysfunction in apparently healthy Scottish Terriers.

Back 20

2006: ALP 1.7-17X elevated; 6/7 normal histopath; 1/7 regional chronic cholangitis without cholestasis
2010: 6 ALP vs 0 nALP dogs had incr post ACTH cortisol
17/17 ALP vs 15/17 nALP dogs had incr in at least one post ACTH non-cortisol hormone
ALL ALP and most nALP histopath showed vaculoar hepatopathy (reticular pattern)

Front 21

JVIM 2008
Anti-erythrocyte Ab & disease assoc in Anemic and non-Anemic dogs.
Which Ig?
What cutoff? IMHA vs other dz?
% anemic vs non-anemic?

Back 21

147 anemic vs 145 nonanemic dogs
IgG +RBC >5% is Sn87% and Sp83% for IMHA
Anemic dogs sig. more likely to have +IgG, IgM, or both (17%) vs. nonanemic dogs (8%)
IMHA sig incr IgG +RBC vs. any other dz
IMHA, infectious, ITP most likely to have + antiRBC Ab

Front 22

JVIM 2006
Retrospective study of incidence and classification of bone marrow disorders at a VTH
MC cause?
primary vs secondary?

Back 22

Dysmyelopoiesis syndromes = MC secondary to neoplasia
Congenital (1), myelodysplastic (27), 2ndary dysmyelopoiesis (33)
Neoplasia = MC cause: 1. acute leukemia 2. lymphoma 3. MM 4. MH

Front 23

Heat stroke in dogs 54 cases risk factors for death
Conditions assoc with death?

Back 23

DIC (28/54) and ARF (18/54) assoc with death
Overall mortality 50%
At admit hypoglycemia (<47), PT>18s, aPTT>30s at admit incr risk of death
Cr>1.5 after 24 hrs, delayed admin >90min, seizures, obesity = incr risk of death

Front 24

JVIM 2010
Antithrombotic effect of enoxaparin in clinically healthy cats - venous stasis model
AntiXa correlation?
What time decr thrombus formation?

Back 24

At 4 hour decr thrombus formation (100%)
Slight decr at 12 hour but not significant (91%)
AntiXa levels did not correlate with thrombus formation; antiXa is poor predictor of antithrombotic effects

Front 25

JVECCS 2010
Hypocalcemia and septic peritonitis in cats

Back 25

Incr LOH and ICU stay but not assoc with decr prognosis

Front 26

JVIM 2007
Incidence and clinical relevance of hyperglycemia in critically ill dogs.
At admit vs. developed?
Difference in survivors vs nonsurvivors?
Length of hosp stay?

Back 26

245 dogs; BG>120
16% dogs had incr BG 74% at presentation, 26% developed
Length of hosp = shorter if incr BG at presentation vs. developed
71% discharged; 29% died/euthanized
Nonsurvivors (med 176) had sig. incr BG vs survivors (med 139)

Front 27

JVECC 2010
SC UFH & TEG

Back 27

Within 3-5 hours max TEG change
INCR R: TEG too Sn to monitor
Return to baseline within 12 hours

Front 28

JVECC 2010
IMHA lactate

Back 28

Nonsurvivors incr @ 4.8mmol; survivors 2.90mmol
If normalized w/in 6 hours --> ALL survived 100%
Only 71% survived if persistently elevated lactate @ 6 hr
Sn 60% Sp 77% cutoff of 4.4mmol at admit