AAVSB VTNE Exam Questions

Correct answer: 24 to 48 hours

Anesthetic procedures cause sluggish swallowing reflexes and decreased tone in the lower esophageal sphincter. This risks stomach contents entering the pharynx and esophagus with serious complications. Prior to any anesthetic procedure, food should be withheld from cattle for 24 hours (roughage) and 48 hours (grain & concentrates). Water should be withheld for 8 to 12 hours.

Dogs, cats, and horses should have food withheld for 8 to 12 hours prior to an anesthetic procedure. However, many studies are showing that shorter times are needed. Young animals, diabetics, and animals < 2 kg, should be fasted for shorter periods of time.

Small ruminants should have food withheld for 12 to 18 hours prior to an anesthetic procedure.

Correct answer: Feline panleukopenia

Ferrets are not susceptible to feline panleukopenia.

Ferrets are susceptible to the following:

• Human influenza: They can both receive the infection from humans and transmit the infection to humans.
• Canine distemper: They should be vaccinated with a killed canine vaccine.
• Heartworms: Preventative medication is recommended. While their infection is closer to that of a dog, their clinical signs more closely resemble those seen in cats.

Correct answer: Moderately stressed

When taking a medical history, gathering the owner's (farmer, producer) opinions on behavior and underlying chief complaint is important. This helps demonstrate what they are seeing. Animals do not always behave the same when the veterinary staff is on-site. Thus, we may not witness the behaviors of concern.

This animal is moderately stressed. Heifers, prior to mating, act like normal cows and are usually not fearful or overly wary of their environment.

Relaxed cattle:

• Stand or walk calmly and graze or casually lie down while ruminating
• Hold their tails in a neutral position, hanging down, relaxed
• When curious, they approach something with composure; the head is held up, and the tail is in an inverted "U" shape
• When content, they use their ears and point them toward a noise, threat, or something that interests them
• Also when content, they often groom herdmates and nuzzle people or each other

Mildly stressed cattle:

• Have slightly widened eyes with the head only slightly elevated and a closed mouth
• May turn their heads to the side and move away from sounds or people
• If stress arises while actively grazing or lying down, eating ceases, and they stand; they then usually seek out companionship with other herdmates, thereby moving away      from the threat
• May maintain a relaxed tail position or sway it slightly

Moderately stressed cattle:

• Commonly have widened eyes with visible sclera
• May dart their eyes around, constantly searching for danger
• Often try to escape (lowering their heads and darting away), but they will simply freeze if escape isn’t feasible
• Tightly hold the tail close to the body, sometimes even tucked between the legs; alternatively, they may hold it up, forming an inverted "U" if overtly alert and threatened
• Startle at the drop of a hat and may show twitchiness or jumpiness

Severely stressed cattle:

• Are at risk of causing damage to themselves, other animals, and people
• Have wide eyes, with sclera visible but also rolling
• If bulls, they may charge
• May paw at the ground
• Often point their heads (and, if present, horns) toward a perceived danger
• Often face a threat with their heads lowered but swinging side to side
• May wag their tails vigorously — this can often be a precursor to a kick, so watch the tails
• Are the most likely to kick, and remember, cattle can kick in all directions – front, side, and backward

Correct answer: Monthly

Crash carts are centralized, moveable stores of medications and equipment and are easily accessible in emergency situations. In addition to medication, crash carts usually hold needles, syringes, catheters, endotracheal tubes, a laryngoscope, and an Ambubag (bag resuscitator) in case the cart is needed, away from oxygen and airway supplies. Some hospitals can get by with a small tackle box or toolbox as the crash cart, while others who commonly treat emergencies may use a large-wheeled cart that also has a defibrillator. The contents of these carts may vary with the veterinary practice and setup of the hospital, treatment room, triage area, and other factors.

Expiration dates on all items on a crash cart should be checked at a minimum, monthly, and always after any cart supplies are used.

Correct answer: Outer ear

The pinna is the flap of skin around the ear and is made up of cartilage and skin. What we can see visibly with the naked eye makes up the pinna. The purpose of the pinna is to collect vibrations of sound waves and direct them into the auditory canal that leads to the middle and inner ears. The pinna in dogs, for example, can stand up straight in the air (like with a German Shepherd, or remain floppy, as with a Labrador Retriever). In many species, this portion of the ear is very mobile and they can consciously move the ears towards the sound.

The bottom and top eyelids are referred to as the inferior and superior eyelids. The lower lip is referred to as the labium inferius oris.

Correct answer: Prolonged capillary refill time

Perfusion is the process by which the body delivers blood to peripheral capillary beds to deliver nutrients and oxygen. A delayed capillary refill time indicates that the body's ability to deliver blood into the capillary beds after blanching is diminished. This occurs due to poor perfusion as well as secondary to vasoconstriction, as may occur with medication administration or toxins. Perfusion involves cardiac output, hemoglobin, and oxygen consumption. 

Tachypnea refers to an elevated breathing rate. This can occur for a variety of reasons, including fever, pain, medications such as opioids, or primary respiratory or cardiac disease, for example. Thus, it is also a non-specific finding not directly related to perfusion. 

Tachycardia describes an increased heart rate. It may indicate a compensatory change to maintain cardiac output, but can also occur with pain, stress, or a variety of primary heart diseases or secondary disease states including dehydration, anemia, medications, hyoxemia, hypercarbia, and more.

A weak pulse may indicate a variety of things, from decreased cardiac output to low blood pressure and more. It doesn't specifically indicate poor perfusion, though it can be present when decreased perfusion occurs.

Correct answer: 2.5-mm aluminum filter

2.5-mm aluminum filters or thicker ones are required to prevent soft radiation. Soft radiation refers to the lower 1/3 of the energy beam. While it is too weak to pass through the patient and create a usable image, it can still be a source of exposure. Thankfully, using a simple aluminum filter, a minimum of 2.5-mm in size, prevents exposure. The filter is placed at the tube window where the primary beam exits. Other filters may be used, such as beryllium for human mammography, but aluminum is most common in veterinary medicine.

The other options are incorrect because they are too small or do not represent the minimum filter size needed to protect against soft radiation exposure. This filtration reduces the intensity of the x-rays but not the overall spectrum of energy produced.

Correct answer: Antibiotic’s lowest concentration that prevents visible bacterial growth

For each antibiotic and each organism, there exists a breakpoint. This breakpoint is a number that either describes the MIC or the diameter of the zone of inhibition. This zone of inhibition is created by measuring the diameter of the area inhibited by the antibiotic on antibiotic colony growing disks. The MIC refers to the actual concentration at which bacterial growth will not occur. They both represent a value at which an organism is susceptible to or resistant to a specific antimicrobial.

The serial dilution of a bacterial isolate growing in broth describes how the Kirby-Bauer Disk Diffusion susceptibility test is achieved to determine the MIC of certain antibiotics for a specific bacterium.

Fastidious organisms are those that need particular growing conditions and nutrients to grow. Often, these organisms are difficult to culture and require the use of incubators and carbon dioxide gas to help increase the proliferative ability of the bacteria in the media.

Correct answer: Alpha₂-agonists

In a cow with a live fetus requiring general anesthesia for a c-section, recommended example protocol and considerations include:

• No premedication
• Ketamine-based induction protocol
• Maintenance with iso or sevoflurane
• Perform an epidural to provide analgesia and reduce the need for other analgesics
• Minimize anesthesia time

However, avoid these agents or circumstances:

• Alpha₂-agonists
• Acepromazine
• Opioids before delivery – if the epidural is insufficient post-delivery pain management, an opioid can be considered.

When selecting an anesthetic protocol, you must keep in mind the side effect profile of the drugs, the metabolism, how they may affect the fetus, and any anesthetic complications that may result from the use of a specific protocol.

Correct answer: 40 

Calculate how much one animal will need: 550 pounds x (1 mL/22 pounds) = 25 mL/animal

Calculate how many 25 mL doses are in a 1 liter bottle (1000 mL): (1000 mL/bottle) / (25 mL/dose) = 40 doses

Correct answer: Phenothiazine tranquilizers

Acepromazine is a phenothiazine. These drugs are commonly used for pre-anesthetic sedation combined with an opioid or benzodiazepine, for example.

Examples of benzodiazepines include midazolam (Versed®), diazepam (Valium®), and alprazolam (Xanax®).

The most commonly used anticholinergic drugs in veterinary medicine are atropine and glycopyrrolate.

Ketamine and tiletamine are dissociative anesthetics.

Correct answer: Every 4 to 6 hours

The correct answer is every 4 to 6 hours, with the caveat that if you appreciate the pet showing abnormal signs such as restlessness, vocalization, agitation, or excessive sedation, you may need to evaluate more frequently to ensure that anesthetic recovery is proceeding as planned. Additionally, you will need to assess for dysphoria vs. uncontrolled pain.

Every 8 hours is not recommended as many injectable pain medications last only a maximum of 4 to 8 hours. If we were to wait that long, we would miss the opportunity to give pain medications before the pain became significant. Every 1 to 2 hours may be necessary for critical patients or severely painful procedures, but it is generally not needed. Of course, any time a pet is out for a walk, being assessed for vitals, or receiving other treatments, this time should also be used to assess pain. Catching it at any time is valuable, and that information should be passed on to the veterinarian.

Correct answer: 16 ml/kg

The recommended blood donation volume for equine patients is 20% or about 16 ml/kg, with replacement of the volume via crystalloids, post-venipuncture, recommended. Some texts will say up to 33% blood volume is acceptable, but that would be in dire situations, and careful monitoring of the donor animal would be warranted.

Correct answer: 57 mg

Convert 25 pounds to kilograms. Since 1 kg equals 2.2 lbs, divide 25 lbs by 2.2 to get 11.36 kg.

At 5 mg per kg, the dose for an 11.36-kg dog is 11.36 kg × 5 mg/kg = 56.8 mg. The nearest whole number is 57 mg.

Correct answer: Toxic change

Large numbers of Döhle bodies on a blood smear are suggestive of toxic change associated with neutrophils and, when present in large numbers, may suggest a robust stimulation of production with a shortened maturation time. Excess Döhle bodies can be associated with toxins or may also be due to certain inherited conditions.

Large numbers of Döhle bodies are not a sign of hypersegmented neutrophil nuclei, autoagglutination, or hemolysis.

Small Döhle bodies may normally be seen in some species but are more commonly seen in horses and cats vs. other species.

Correct answer: Isosthenuric; equal to

When evaluating urine, we compare the density of the liquid to distilled water. Distilled water is 1.00.

Urine-specific gravity (USG) must be interpreted in the face of dehydration, primary underlying kidney disease, or post-renal causes of concern. It can be used to evaluate the kidneys’ ability to concentrate from the renal tubules or dilute filtrates and helps in assessing if the body can maintain osmotic and water balance.

-sthen = strength

-iso = the same

-hypo = less than

-hyper = greater than

Isosthenuria is a fixed specific gravity recognized as 1.008 to 1.013 (depending on the species). This suggests that the glomerular filtrate is at the same specific gravity as the plasma. It isn’t diluted nor concentrated and represents kidney disease. (65% of the kidneys’ function no longer exists once this occurs). Isosthenuria in the presence of azotemia (elevated BUN/Crea) confirms kidney disease. We cannot discern if it is reversible or not simply because it is present.

While normally, a single USG without comparison doesn’t reflect kidney function or abnormality, in the face of azotemia, we need to rehydrate a patient and re-evaluate USG after fluid therapy has ceased to determine if the underlying disease remains.  A reading of 1.010 in the middle of the day in a well-hydrated patient may still be normal, and the patient may not have underlying renal disease.

Hyposthenuria describes USG < 1.008. This suggests the proper ability of the tubules to dilute urine, lowering the specific gravity of plasma.

Hypersthenuria or baruria occurs at > 1.012-1.013 (depending on species). Here, the tubules are concentrating water to hold on to it, and the USG is higher than the plasma.

Ideally, you want to use a species-specific refractometer to evaluate USG because standard human refractometers can cause falsely high or falsely lower readings with various species, from cats to exotics and more.

Correct answer: Blocks nerve signal conduction

Drugs with the suffix -caine are sodium channel blockers, commonly used for local anesthesia. Examples include lidocaine, bupivacaine, and mepivacaine. These drugs are very effective and relatively inexpensive anesthetic drugs across multiple species.

These drugs are not used as inhalant anesthetics, antimicrobials, or diuretics.

Correct answer: Draw an imaginary line around the anesthesia machine

You want to ensure you are cognizant of that imaginary line encircling the surgeon and associated sterile field, the operating table (and the patient), and the instrument tray. You don’t want to cross that. However, the anesthesia machine and any other non-sterile equipment would not be considered within that imaginary space.

Remember that when you pass sterile equipment to the surgeon, onto the mayo stand, or to the assistant, you never want to cross that imaginary line, only stand adjacent to it. Always stand to one side of the surgeon so that the surgeon never turns his or her back to the patient.

Correct answer: They are used in patients with zero mobility for long durations

Slings like the Anderson sling are commonly used in down large animal patients. The sling can:

• Assist those patients who are recumbent but retain some ability to stand, just for short durations, or with limb injuries who aren't fully weight-bearing on one limb. 
• Assist recumbent or weak patients with underlying illness to provide relief of muscles on the down side and improve circulation while relieving the weight-bearing load. 
• Be used short term in a patient who cannot support any of their weight, because it can cause respiratory compromise over time if they heavily rely on the sling to maintain an upright position.
• In the short term, provide a patient with improved limb mobility and relieve muscle soreness/tension on dependent sides, regardless of the degree of recumbency.
• Be most useful in patients who still retain the ability to stand and support at least a portion of their own weight. In these patients, they can be used longer term, because respiratory compromise isn't usually of concern.
• Assist a patient in standing, stabilize once they are up, and aid in supporting body weight.
• Be primarily used to assess neurological and orthopedic status and disease progression and to improve circulation in the short term in fully recumbent animals who cannot stand at all in a sling. (Ideally, only 25% of an animal's weight should be supported for any duration.)

Correct answer: 250-270 °F (121-132 °C) and 15-27 PSI

You will often find gravity air-displacement sterilization units as the table-top autoclave in most small animal facilities. Heated distilled water turns to steam, which forces air out of a port. The pressure builds with the air release, and the steam builds until it reaches the desired temperature and pressure, 250-270 °F (121-132 °C) and 15-27 PSI. Once finished, all the steam will convert back into water. This temperature range will destroy most organisms, with manufacturers recommending about five minutes over the standard time labeled for the unit to ensure adequate organism kill rates.

Generally, most units take 15 minutes to reach the appropriate temperature/pressure. Units will take three to 15 minutes to sterilize the contents inside fully. However, longer may be needed for large packs or items and may be beneficial to ensure adequate microbial kill time. Most units can be either manually or automatically vented. A minimum of 15 minutes should be expected to permit venting and release sufficient moisture, preventing condensation on the packs. Newer or more expensive models may have a drying cycle to avoid condensation accumulation.