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Quiz Session - Attempts With Random Questions

AAVSB VTNE Exam Questions

Page 4 of 58

61.

The veterinary surgeon has asked you to place their patient in the prone position for an upcoming procedure. Which of the following has been requested?

  • The veterinary surgeon has asked for the patient to lay on their abdomen with the back and neck exposed

  • The veterinary surgeon has asked for the patient to lay on their right side

  • The veterinary surgeon has asked for the patient to lay on their back with the abdomen and chest exposed

  • The veterinary surgeon has asked for the patient to lay on their left side

Correct answer: The veterinary surgeon has asked for the patient to lay on their abdomen with the back and neck exposed

The prone position calls for the patient to lay on their abdomen with the back and neck exposed.

The right lateral recumbency position calls for the patient to lay on their side with the right side down. The left lateral recumbency position calls for the patient to lay on their side with the left side down. The dorsal recumbent position calls for the patient to lay on their back. This position is ideal for surgical procedures that require access to the abdominal and thoracic cavities.

62.

What is a potentially significant side effect of acepromazine?

  • Hypotension

  • Hypovolemia

  • Hypoxia

  • Hyperventilation

Correct answer: Hypotension

Acepromazine is a tranquilizer that blocks alpha-1 adrenergic receptors, leading to peripheral vasodilation and hypotension. This is normally manageable in otherwise healthy patients.

Acepromazine does not change intravascular volume status to cause hypovolemia, depress respiration to cause hypoxemia, or increase the respiratory rate sufficiently to cause hyperventilation. However, horses may develop tachypnea secondarily to excitement, commonly seen in the species. 

63.

What laboratory procedure is performed to examine tissues removed during a biopsy?

  • Histopathology

  • Culture and sensitivity

  • Cytology

  • Trichogram

Correct answer: Histopathology

Histopathology studies the microscopic appearance of tissues and how they interact. When tissues are removed during a biopsy procedure, histopathology is necessary to provide a definitive diagnosis.

Cytology studies the microscopic appearance of individual cells. Culture and sensitivity is a microbiology test where organisms are grown and then tested for sensitivity to different treatments. Trichogram analysis evaluates hair shafts under a microscope.

64.

You are working with a herd of alpacas. When you first came to the farm, the diet was obviously poor, and the animals were obese, with body condition scores (BCS) averaging 4.0/5. You are returning three months later to re-evaluate the group and their BCS and husbandry. When re-evaluating these animals, you determine they have improved, showing body condition scores ranging from 3.0/5.0 to 3.5/5.0. 

What does a 3.5/5.0 mean overall?

  • Slight fat cover over the ribs and other bony processes

  • Slight cover over bony structures

  • No visible, palpable fat or muscle between bones and skin

  • Excessive fat covers the entire body with a smooth, rounded appearance

Correct answer: Slight fat cover over the ribs and other bony processes

In camelids, using a BCS system out of 5, a 3.0 is considered ideal. Animals have an overall smooth appearance with a slight fat cover over the ribs and other bony processes. The ribs and spinal processes can be easily appreciated with light pressure and have a uniform overall good lean muscle mass.

Animals with a BCS of 2/5 will have a slight cover over the bony structures. But their bony processes are usually visible without needing to palpate, and these animals are thin.

Animals without visible, palpable fat or muscle between bones and skin are emaciated (1/5).

Animals with excessive fat covering the entire body with a smooth rounded appearance are morbidly obese at 5/5.

65.

Which of the following describes allodynia?

  • A pain response to a stimulus that is not usually painful

  • Increased sensitivity to painful stimuli

  • Complete loss of sensation

  • Decreased sensitivity to painful stimuli

Correct answer: A pain response to a stimulus that is not usually painful

Allodynia is a painful sensation from normally non-painful stimuli. Examples include light touch, routine movement, and mild temperatures.

Hyperalgesia is increased sensitivity to lessening painful stimuli. Hypnoanalgesia is a decreased sensitivity to painful stimuli. Anesthesia is a complete loss of sensation.

66.

You have a small animal patient you classify as ASA III to V. Which of the following drugs should be avoided in the face of liver disease?

  • Acepromazine

  • Hydromorphone

  • Propofol

  • Etomidate

Correct answer: Acepromazine

In patients with significant liver disease to warrant an ASA III-V rating, acepromazine should not be utilized as it is metabolized via the liver and excreted via the kidneys.

When anesthetizing a patient with significant liver disease, recommendations include:

  • Use reversible drugs whenever feasible
  • Maintain with sevo or isoflurane
  • Maintain blood pressure and fluid balance
  • No premedication or use of an opioid, if needed
  • Preoxygenation pre-induction is a must
  • For mild to moderate disease, consider propofol, etomidate, or alfaxalone induction
  • For severe disease, consider mask induction (however, many patients do not tolerate this stressor without premedication)

67.

Though not currently controlled by the DEA, which of the following medications may likely become controlled soon?

  • Xylazine

  • Dexmedetomidine

  • Gabapentin

  • Ketamine

Correct answer: Xylazine

Xylazine, an alpha-2 agonist, is used in animal medicine for sedation and analgesia, often in short procedures. It is reversible and commonly combined with additional drugs for multi-modal anesthesia/sedation and pain management. However, recently, it has shown up in the illicit drug market in combination with opioids such as fentanyl. It is not a drug approved for human use and is not currently scheduled under the DEA controlled substances regulations. Various states have passed regulations to control it, recognizing concerns for abuse and illicit use. It has been in the news since early 2023, and discussions are ongoing at the congressional level about controlling it.

Dexmedetomidine, also an alpha-2 agonist, is not controlled and is commonly used in small animal medicine. It hasn’t to date been seen in the illicit drug market and remains non-controlled.

Gabapentin, a neuropathic pain management medication originally developed as an anti-seizure drug, is regulated by individual practices and in some states, but is not federally controlled by the DEA.

Ketamine, an NMDA receptor antagonist, is used for pain management, wind-up prevention/treatment, sedation, and as part of a multi-modal pain management/anesthetic protocol. It has been a controlled drug for years because of its use in the illicit drug field and its abuse potential. It is a Schedule III drug that has been regulated since 1999.

68.

In order to ensure that an intravenous catheter remains patent, it should be flushed regularly with which of the following solutions?

  • Heparinized saline

  • EDTA

  • 5% dextrose solution

  • Sterile water

Correct answer: Heparinized saline

To ensure intravenous catheters remain patent, they should be flushed regularly with heparinized saline. Heparin is an anticoagulant agent that helps prevent clots. The use of heparinized saline will prevent blood clots from forming in intravenous catheters so they remain open and free-flowing. Normal saline can also be used to flush catheters.

EDTA, 5% dextrose solution, and sterile water are not used to maintain catheter patency.

69.

Which organ system includes the kidneys?

  • Renal

  • Hepatic

  • Endocrine

  • Integumentary

Correct answer: Renal

Renal is a descriptive term for kidney, hepatic for liver, endocrine for hormones, and integumentary for skin/nails/hooves.

70.

When helping to develop a pain management plan for a surgery or procedure, you should ask yourself all of the following questions, except:

  • What medications were used in other patients with the same procedure?

  • How painful will the procedure be for the patient?

  • What is this patient's normal behavior and demeanor?

  • Does the patient have any conditions or past drug sensitivities that would preclude the use of specific drugs or drug classes?

Correct answer: What medications were used in other patients with the same procedure?

When creating an initial pain management plan, you want to ask yourself several questions to help determine the level of pain control needed, the safety of various drugs in this specific patient, whether sedation and pain management will be required, and how far in advance. You want to assess the procedure being performed and the level of pain it will provide and choose a pain management plan that will appropriately manage the level of pain expected.

You need to know if the patient is high strung, anxious, easily agitated, or aggressive ahead of time and ensure you take that into account in your premedication and post-management of the patient. Finally, if your patient has underlying contraindications for specific drug classes, this must be known upfront. For example, alpha2-agonists would be contraindicated in patients with underlying heart disease.

Treat each patient as the individual they are. While it is nice to have a baseline, knowing what protocols work for what procedures, and what each veterinarian may be most comfortable using, each patient needs their own plan.

71.

When assessing an anesthetized patient, what is an indicator of perfusion?

  • Mucous membrane color

  • Pulse oximetry

  • Respiratory rate

  • Capnography

Correct answer: Mucous membrane color

Mucous membrane color is an indirect indicator of circulation. The patient should have a normal mucous membrane color, or perhaps slightly paler following anesthesia. Other indicators of circulation used to assess anesthetized patients include heart rate, heart rhythm, pulse strength, and blood pressure.

Pulse oximetry is an indicator of oxygen saturation. Respiratory rate and capnography are indicators of ventilation.

72.

Tendons are included in which major organ system?

  • Musculoskeletal

  • Integumentary

  • Skeletal

  • Circulatory

Correct answer: Musculoskeletal

The musculoskeletal system includes all of the bones, joints, muscles, tendons, and ligaments found in the body. Tendons are connective bands of tissue that link muscles with bones.

The integumentary system includes the skin, nails, beak, feathers, or fur. The excretory system includes the kidneys, ureters, urinary bladder, and urethra. The circulatory system includes the heart and blood vessels.

73.

In ultrasonography, the artifact of reverberation indicates the presence of which tissue interface?

  • Soft tissue-gas

  • Soft tissue-bone

  • Soft tissue-fluid

  • Soft tissue-soft tissue

Correct answer: Soft tissue-gas

Reverberation occurs at an interface with gas or air. Examples include the skin surface and air when a probe is not getting adequate contact (more gel needed), and soft tissue with gas (such as within the respiratory tract and bowel). It appears as evenly spaced white lines on the far side of the interface.

Soft tissue-soft tissue interfaces will produce echoes of varying intensity and brightness. These changes form the principles of diagnostic ultrasonography.

Soft tissue-fluid interfaces may produce no artifact but, more commonly, there is some degree of thorough transmission artifact and far-field enhancement. This appears as increased echogenicity on the far side of the fluid.

Soft tissue-bone interfaces produce acoustic shadowing. This appears as a black area (hypoechoic) in the far-field to the interface.

74.

What can be done to improve the contrast when performing a wet mount microscopic urine sample evaluation?

  • Lower the condenser and partially close the iris diaphragm

  • Raise the condenser and partially close the iris diaphragm

  • Raise the condenser and fully open the iris diaphragm

  • Lower the condenser and fully open the iris diaphragm

Correct answer: Lower the condenser and partially close the iris diaphragm

When evaluating urine microscopically, gently mix the samples. Ideally, a minimum of 5 mL of urine is warranted. This is then spun down to obtain the pellet. Discard all but 10% of the total volume gently (0.5 mL if 5 mL total was present). Resuspend the pellet in the remaining supernatant. Then, place a drop on a slide with a coverslip with or without stain, depending on hospital protocols, comfort level, the end goal, and other factors.

If contrast is difficult to achieve, you can improve this by lowering the condenser and partially closing the iris diaphragm. By lowering the condenser, you are reducing illumination and can view:

  • Use the low power field (LPF) to ID casts and look at crystals, sperm, cells, mucus, or lipid droplets.
  • Use the high power field (HPF) to ID red and white blood cells, epithelial cells, crystals, and organisms.

Note that samples that are not resuspended after spinning may ultimately yield a non-representative sample.

75.

Your doctor has just handed you a bone marrow aspirate sample that she obtained. You should do all of the following, except:

  • After removing the bone marrow aspiration needle, take a pull slide and drop methylene blue on it with a cover slip to let it dry

  • Make one or more smears with a slide-to-slide smearing (or pull slide) technique

  • While simultaneously making an aspirate smear, place a portion of the sample in an EDTA vacutainer tube

  • Place a portion of the sample in a red-top vacutainer tube

Correct answer: After removing the bone marrow aspiration needle, take a pull slide and drop methylene blue on it with a cover slip to let it dry

When doing a bone needle aspirate, the sample is precious. The veterinarian doesn't want to remove the bone needle until they are sure a sufficient sample has been obtained. Thus, before removing the needle, take a pull-slide sample, place a drop of methylene blue and a cover slip, and ensure sufficient bone marrow cells are present. Only once confirmed can you then remove the bone needle.

Once you obtain a sufficient sample, immediately place it in the EDTA vacutainer to prevent clotting or have your collection syringe primed with an anticoagulant. Ideally, one person puts the sample in the EDTA tube, and another starts making a few pull slides (slide-to-slide smears).

Once the EDTA tube is filled, sufficient slides have been made, and the methylene blue slide evaluated confirms bone marrow cells are present, place any remaining sample into a red-top tube, and the veterinarian can safely remove the needle.

76.

What is the term used to describe the period after anesthesia is given, when the patient transitions from consciousness to unconsciousness?

  • Induction

  • Sedation

  • Intubation

  • Extubation

Correct answer: Induction

Induction is the anesthetic phase when the animal leaves consciousness. Induction is typically followed quickly by intubation and administration of inhalant anesthesia.

Sedation is the administration of a sedative or tranquilizer in order to decrease the patient's arousal or stimulation level. Intubation is the insertion of a tube into the patient's trachea. Extubation is the removal of a tube from the patient's trachea.

77.

Complications may result from failing to remove an endotracheal tube before the patient returns to consciousness. All of the following may occur except:

  • Aspiration secondary to reflux of gastric acid

  • Tube damage from patient chewing

  • Airway blockage

  • Aspiration or swallowing of a portion of the tube with exuberant chewing

Correct answer: Aspiration secondary to reflux of gastric acid

Usually, patients are extubated when overt signs of impending waking up occur and when the anesthetist is sure the patient will be able to protect their own airway. In some species, regaining the swallowing reflex (dogs) alerts you to an impending return to consciousness. In contrast, for others, coughing (ruminants) may be more indicative of waking up. Regardless, we try to keep the tube in long enough that the animal can protect its own airway, to prevent aspiration, but also not long enough that they could damage the tube via chomping on it even to the point where they break off a piece. This piece could be aspirated into the trachea or, less concerning and less likely, ingested into the esophagus. In some, the tube may hinder breathing or block the airway if the patient is fighting against it, panicking. 

However, some brachycephalic breeds of dogs, such as the English bulldog, often breathe better with the tube than without it. The tube for them is like breathing through a garden hose, while their normal airway permits them to just breathe through a straw. Still, we generally want to ensure we prevent chewing of the tube and that it is pulled when signs of consciousness and an ability to protect the airway are demonstrated. Remember, the factors that trigger extubation vary with the individual species and require keen attention to the patient during recovery.

78.

A veterinarian asks you to dispense Clavamox®. These tablets are scored, suggesting halving the tablet is okay.

However, you must be sure to advise your client of all of the following, except:

  • Clavamox is light-sensitive and must be kept in the blister pack until use

  • Wrap the unused half of the tablet in the blister pack and put in a closed pill container

  • Make sure to use the remaining half of the tablet for the next dose

  • Storage of the tablets should be below a maximum of 77°F (25°C)

Correct answer: Clavamox is light-sensitive and must be kept in the blister pack until use

Because the tablets are scored, the drug amount is uniformly contained within each half, permitting splitting. Thus, if giving half of a tablet, we can feel comfortable that the pet is getting the correct mg per dose. However, upon opening the blister pack, the medication can degrade easily, meaning drug stability may be negatively affected by halving the tablet. We want to protect the tablet from the air and moisture to minimize this degradation.

Therefore, the best practice recommendation is to have the client put the unused portion back into the blister wrapping and put it in a sealed pill container. This will protect it from the air. Further, ensure clients are storing the tablets appropriately. They should not be refrigerated but should also not be kept in conditions at temperatures exceeding 77°F (25°C), such as outside, in a warm car, in a warm house, etc.

79.

A 14-lb cat has treatment instructions to receive intravenous fluids at 20 mL/hr for 48 hours. In preparing a treatment plan estimate for the owner, what supplies should be listed in anticipation of this treatment plan?

  • One 1000 mL bag of fluids

  • One 250 mL bag of fluids

  • One 100 mL bag of fluids

  • Two 1000 mL bags of fluids

Correct answer: One 1000 mL bag of fluids

Calculate the total volume of IV fluids anticipated to be administered: 20 mL/hr x 48 hrs = 960 mL

The best fit for this patient's needs would be a 1000 mL bag of fluids.

80.

What is the appropriate endotracheal tube size range for swine? 

  • 6 to 14 mm tube

  • 9 to 16 mm tube

  • 9 to 18 mm tube

  • 7 to 12 mm tube

Correct answer: 6 to 14 mm tubes

Swine utilize endotracheal tubes ranging in size from 6 to 14 mm.

Foals utilize endotracheal tubes ranging in size from 9 to 16 mm.

Calves utilize endotracheal tubes ranging in size from 9 to 18 mm.

Sheep and goats utilize endotracheal tubes ranging in size from 7 to 12 mm.

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