AAVSB VTNE Exam Questions

Correct answer: Subcutaneously

Regular insulin, NPH, glargine, and PZI are all types of insulin that can be injected subcutaneously into the layer of fat just beneath the skin.

Regular insulin is the only type of insulin that may also be delivered intravenously or intramuscularly, depending on the individual patient's needs. Insulin is not delivered orally to animals.

Correct answer: 22 to 30 mm tube

Adult horses and cattle will need endotracheal tubes ranging in size from 22 to 30 mm. 

All other ranges are too small or too large.

Correct answer: 6 mL

Convert patient weight from pounds to kilograms: 60 lbs / (2.2 lbs/kg) = 27.27 kg

Calculate the patient dose in mg: 27.27 kg x (22 mg/kg) = 600 mg

Calculate the concentration of drug: 1 g (or 1000 mg) in 10 mL volume = 100 mg/mL

Convert mg of drug to ml:  600 mg / (100 mg/mL) = 6 mL

Correct answer: Struggling patients

When mask inductions are performed, it is common for patients to struggle. Other concerns include waste anesthetic gas exposure, inability to protect the patient's airway, and difficulty quickly transitioning to a smooth anesthetic plane. Patients struggle due to anxiety, stress, and fear. In patients that are conscious, it is not recommended to use masks or box inductions without injectable medications on board. 

The remaining options are incorrect: mask inductions are not financially prohibitive, they are able to be used with several different inhalants, and equipment is readily available.

Correct answer: Are you providing vitamin C supplementation?

Guinea pigs and primates cannot synthesize vitamin C and require supplementation. Guinea pigs lack the enzyme that converts glucose to ascorbic acid. While guinea pig pellets may be "supplemented" with vitamin C, vitamins degrade in this format; you have no idea how much the pet is getting daily. Ideally, we do not recommend pellet feeding this species at all. If guinea pigs eat sufficient amounts of fruits and vegetables containing vitamin C, they do not need extra supplementation. However, those fed pellets or insufficient fruit and vegetables should be given 50 mg of a vitamin C treat per day.

Questions to ask of all pets, but especially of guinea pigs, include:

• What they feed -  including all fruits and vegetables, feeding frequency, and quantities. If pellets are fed, we want to know the brand and the amount fed.
• Inquire about exercise – rodents need exercise to maintain healthy digestion like other species.
• Do they have any questions or concerns? Does the pet have any abnormalities?
• What does the enclosure look like?
• What do the feces look like?

Plenty of other questions can be asked and should be asked, especially with our small herbivorous animals. Remember that many health issues, including dental disease and obesity, occur in guinea pigs, secondary to improper husbandry. Getting a good history up front is crucial to allowing you to provide the owner with the best information possible for the pet.

Correct answer:     Volume (ml) = Drug dosage (mg/kg) x Patient body weight (kg) 

                                                                    ^{_____________________________________________}

                                                            Drug concentration (mg/ml)

The correct answer is that the volume in ml will equal the drug dose, either in mg/kg or µ/kg, times the body weight in kg, divided by the drug concentration in either mg/ ml or µ/ml. But this is the only correct answer because all the units match. Of course, you can always use a mix and match of units and then do the conversions, but this is much more difficult and leaves room for significant under or overdosing of drugs secondary to miscalculations. 

All other answers mix and match units without then providing a conversion factor so must be interpreted as incorrect. 

Correct answer: Ferrets

Leuprolide acetate is a reproductive drug used in ferrets for the treatment of hyperadrenocorticism. Leuprolide is a synthetic analog of GnRH, which stops the production of sex hormones and symptoms associated with hyperadrenocorticism, such as pruritus and hair loss.

Leuprolide can be used to treat inappropriate egg-laying in cockatiels. Leuprolide may also be helpful in treating aggression in male iguanas. Leuprolide is not used in goats.

Correct answer: Elevated creatinine

Librela™ (bedinvetmab) is a monoclonal antibody directed against nerve growth factor, a key player in the pain pathway. It has been shown to be very safe and effective at controlling osteoarthritis pain. Studies suggest pain control is comparable to that of NSAIDs in dogs, but it is considered safer than NSAIDs in dogs with underlying kidney disease.

You want to explain to your client that what is listed on the package label as possible side effects include any abnormal findings in an animal in the study, regardless of whether it was from the drug. The drug has been used for several years in Europe with minimal side effects. You explain that most dogs show no abnormalities or pain at the injection site, and some may develop elevated BUN levels. However, other reported side effects in the research include bacterial skin infections, urinary tract infections, and inflammation at the injection site (swelling and heat).

The elevated BUN was not associated with kidney dysfunction or clinical signs, and the drug has minimal metabolism pertaining to either the liver or kidneys; thus, it can be used safely in animals with underlying diseases.

Be sure to explain to clients that—while new in the U.S. as of 2023—it has been used in Europe much longer, so more real-time results show that it is very well-tolerated. Remind the client that drug companies in the U.S. must put on the label information any negative/adverse effects that happened while the clinical trials were ongoing, regardless of whether the drug had anything to do with it or not.

Clearly communicate possible risks to the owner, but note the difference between commonly seen side effects (e.g., pain at the injection site) vs. those uncommonly seen (e.g., a rise in BUN but not creatinine, lethargy, or anorexia) makes this a viable option for a pet with stage 2 kidney disease.

Correct answer: Opioids before delivery

When anesthetizing an equine dystocia patient, we want to avoid using opioids before delivery to minimize the negative effects to the fetus and the mare before delivering. Pain management can easily be provided by an epidural, which reduces the need for other analgesics pre-delivery. Premedication with xylazine to effect and induce with ketamine. More importantly, minimize anesthetic time and monitor the patient’s oxygenation status.

Correct answer: Buccal mucosa

Chronic ulcerative paradental stomatitis (CUPS) is associated with inflammation of any soft tissues contacting crowns when the mouth is closed. This can include oral mucosa, palatal mucosa, buccal mucosa, margins of the lips, and epithelial surfaces of the tongue. It is associated with gingival recession and significant calculus. It is both painful and creates bad breath.

Inflammation of the pulp is called pulpitis. Inflammation of the periodontal ligament and associated structures (gingiva, alveolar bone, cementum) is called periodontitis. It is important to differentiate the terms paradental and periodontal. Inflammation of bone (or osteitis) is most commonly associated with bony infection (osteomyelitis).

Correct answer: 56 mg

61.6 lb = 2.2 kg/X

X= 28 kg

0.5 mg/kg x 28 kg = 14 mg per dose

If the pet receives the medication every six hours, this would be four times daily, making the total daily dose 56 mg.

If we only evaluated it every eight hours, or three times daily, the total dose would be 42 mg/day.

Forgetting to convert lbs to kg and multiplying 61.1 lbs by 0.5 mg results in 30.55 mg/dose x 3 daily doses of 91.65 mg. If dosed 4x daily, it would be 122.2 mg. However, if we used pounds, we would be overdosing the dog.

Correct answer: Non-steroidal anti-inflammatory drugs

Laminitis is an inflammatory disease of the laminae in the feet. Causes include overfeeding, an unrelated infection or illness elsewhere in the body, medications, and hard ground conditions.

Treatment is supportive and includes treating any predisposing conditions, non-steroidal anti-inflammatory drugs, improving blood flow to the feet, low caloric density feeding of hay exclusively, soft bedding to rest, and corrective shoeing.

Correct answer: Fish and amphibians

Benzocaine is an anesthetic that depresses the central nervous system. It is often used for euthanasia of frogs and amphibians. Benzocaine is relatively expensive; however, it is easy to administer and works quickly.

Barbiturates are used to euthanize most species, including cats and dogs. The main drawback is that they are controlled drugs. 

Poultry, birds, and laboratory rodents are most often euthanized using carbon dioxide or cervical dislocation. 

Iguanas, snakes, turtles, tortoises, and other reptiles may be euthanized via carbon monoxide (bottled gas only), decapitation, or the administration of barbiturates. 

Correct answer: Triple sugar iron agar slant

The culture medium used to determine if an organism has the ability to utilize glucose, sucrose, and lactose is the triple sugar iron agar slant. Glucose fermentation can be detected in the butt of the tube, and the slant indicates the utilization of lactose and sucrose. Based on pH levels, the medium will turn yellow or red.

Christensen’s urea agar slant is a culture medium used to determine urease production. The motility medium is used to determine bacterial motility (flagella use). The indole test medium determines an organism’s ability to split indole from tryptophan.

Correct answer: Soluble carbohydrates in excess of normal energy requirements

Horses have adapted to a diet high in carbohydrates (about 80%), serving as their main energy source. The remaining portion of the diet usually consists of about 5% fat and 7-12% protein. All three are required to meet the overall needs of the species. However, a horse who does not get much exercise and is fed excessive grains and sugary carbohydrates like molasses, as well as any animal who consumes more soluble carbohydrates than are their energy requirements, can have an increased risk of obesity due to their body storing the excess as either fat or glycogen.

The quality of the protein may affect some nutrients and overall health, but will not lead to obesity. High protein levels can negatively affect digestion and metabolism, since horses aren't designed to digest these levels, but they will not lead to obesity.

Diets high in fat (> 5% fat content) may lead to weight gain or weight maldistribution, especially when combined with lower carbohydrate amounts. Further, this can lead to poor overall gut health, creating additional health concerns.

Correct answer: Left flank

When working with ruminants, knowing their anatomy and physiology and how organs sit helps you determine what approach is best and where best to prepare the animal for surgery. Most ruminants with rumen bloat or rumen stasis have either engorged in too much feed or ingested a foreign body, preventing gas eructation. Knowing that the rumen resides against the left body wall makes the left flank the natural way to approach a rumenotomy. Local anesthetic via an inverted L block is commonly used before incising this area.

The left paralumbar region is the most used location to surgically treat traumatic reticuloperitonitis. This approach allows access to the reticulum, diaphragmatic area, and other vital organs.

A right paralumbar fossa region incision would provide easy access to a vast array of structures. These include but are not limited to the greater omentum and mesoduodenum and some of the duodenum, the pyloric area, omasum, and even the kidneys, bladder, and uterus. This approach may be used commonly for abomasal volvulus or intussusception.

For cattle, laparotomies often use a standing approach. This most easily facilitates the exploration of the abdominal cavities with manipulation, and standing helps minimize the risk of evisceration. Thus, approaches common in small animal medicine would not generally be considered when discussing cattle. Therefore, a ventral midline incision from the xiphoid to the pubis would not be practical or necessary in this species.

Correct answer: Gabapentin 300 mg x #42 capsules; Amantadine 100 mg tablets/capsules x #21; and Carprofen 75 mg  #14 tablets

First, convert 44 lb to kg by dividing by 2.2: 44/2.2 = 20 kg.

For gabapentin, 15 mg/kg x 20 kg = 300 mg — it is 3 capsules daily for 2 weeks, or 42 capsules.

For amantadine, 20 kg x 5 mg/kg = 100 mg — it is once daily, so 21 tabs/capsules are needed. This medication helps with chronic pain to help minimize wind-up/central sensitization. Usually, using it in patients with longstanding pain helps improve overall pain management.

For carprofen (NSAID), we want to dose closer to the ideal body weight, so we will round down. 44 lbs/2.2 = 20 kg x 2.2 mg/kg = 44 mg every 12 hours. However, we want to lower the dose, not round up, so we will do 1/2 of a 75-mg tablet (37.5 mg) every 12 hours. Thus, you would dispense 1 tablet per day x 14 days, hence 14 tabs.

The gabapentin dose range is wide and could be as high as 600 mg without an issue, but it wasn't what was prescribed by the veterinarian. Further, 300 mg is the correct mg. Still, if only 28 capsules were prescribed, it would only be for q 12-hour administration for 2 weeks, which would not last long enough if given every 8 hours.

The veterinarian wanted 21 days of the amantadine.

The veterinarian wants to round down the rimadyl dose and treat for 2 weeks. We could do 1.75 of the 25 mg tablets to get the dose at the current weight, but again, the vet would like the dose lower because of obesity and to be liver and kidney-sparing.

Correct answer: Acepromazine

Acepromazine is a phenothiazine tranquilizer used to sedate patients before administration of general anesthesia. Acepromazine can cause peripheral vasodilatation, which can lead to hypotension and hypothermia, both of which are further compounded with hypovolemia.

Opioids, propofol, and isoflurane are considered to be relatively safe drugs for animals with hypovolemia when given for sedation.

Correct answer: Kappa-receptors; butorphanol

Mammalian species have been shown to have primarily mu-receptors that neuromodulate pain (among other physiological responses). In many birds, on the other hand, kappa-receptors dominate. This is key to remember and know when designing a pain management strategy and implementing it. One wants to ensure that the correct drug, at the right dose, will be most effective and safely administered to the specific species.

Hydromorphone is a full mu-agonist and thus, would be less likely to have significant beneficial effects in avian species. However, some studies show some analgesic and sedative properties with the medication.

Butorphanol is a partial agonist-antagonist. It acts as an agonist at kappa-receptors, inducing pain relief, and an antagonist at the mu-receptors. In mammals, with predominantly mu-receptors, the sedative properties guided by kappa effects are more robust than the pain management properties of the mu-receptors, making it more effective as a sedative and less beneficial for more than short procedures and mild pain. However, the opposite is true in birds, making it an ideal pain management tool for avian species.

Thus, the correct response includes the notion that birds have kappa-receptors primarily, and butorphanol, with its kappa agonist effects, would be most effective for analgesia in birds.

Further research is needed to elucidate proper multimodal pain management in birds more clearly. Still, butorphanol, NSAIDs, and gabapentin have been used successfully in combination as part of a multimodal approach.

Correct answer: Kill cells and/or microorganisms

A chemotherapy drug (antineoplastic agent) kills cells. The term is most commonly thought of when referring to cancer medications. They attack cells by 5 different mechanisms of action and include some antimicrobials. Examples include vincristine (cancer, plant alkaloid) and doxorubicin (antibiotic).

Antagonist drugs reverse the effects of other substances. Agonist drugs bind to and activate receptors to produce specific responses. For example, hydromorphone is an agonist at opioid receptors and naloxone is its antagonist. Antiemetic drugs suppress vomiting and can work on the nervous system (centrally) and/or gastrointestinal tract (peripherally). Examples include maropitant and metoclopramide.