AAVSB VTNE Exam Questions

Correct answer: High risk for severe clinical signs

Calculate amount of methylxanthine ingested: 3 ounces x (400 mg/ounce) = 1200 mg

Calculate the dosage the dog ingested: 1200 mg / 10 kg = 120 mg/kg

This is approximately twice the threshold for severe clinical signs.

Correct answer: Local anesthetic

Bupivacaine provides local anesthesia by blocking sodium channels needed for nerve signal transmission. It is not effective topically.

Bupivacaine is not an opioid analgesic (butorphanol and buprenorphine, for example), anesthetic induction agent (such as propofol), or calcium channel blocker (such as amlodipine).

Correct answer: Daily; to prevent biofilm

Each day at the end of your dental procedures, part of your daily routine should include draining the water lines. This will help prevent biofilm (adhered bacteria forming a film over a surface that can be very difficult to remove) and free bacterial buildup.

Correct answer: Just under 3 tablets

Convert the weight from pounds to kilograms: 20 pounds / (2.2 pounds/kg) = 9.1 kg

Calculate the toxic dose: 9.1 kg x (8 mg/kg) = 72.8 mg

Calculate number of tablets: 72.8 mg / (25 mg/tablet) = 2.9 tablets

Correct answer: All listed choices have increased excretion with loop diuretics

Loop diuretics inhibit renal tubular resorption of certain electrolytes, including sodium, potassium, and calcium.

Extracellular fluid follows sodium, so these medications are effective at removing the excessive fluid in congestive heart failure patients.

Correct answer: There is no genetic link to cryptorchidism

There is, in fact, a genetic link to cryptorchidism, commonly seen in family lines, though a genetic test to identify possible candidates has not yet been elucidated. It is thought to be a sex-linked autosomal recessive trait.

All other statements are factual. The temperature within the abdomen is too high, and spermatogenesis does not occur unless the testicle has descended. Testicles retained in the abdomen are at higher risk for neoplasia. The retained testicle produces testosterone despite the undescended location. Thus, animals bilaterally cryptorchid will display secondary male sex characteristics despite no exterior testicles.

Correct answer: Walk the pet in shady areas to relieve themselves 

It is critical that you discuss the following points with the owner and have the information in writing for later reference:

1. The type of medication received and how it works. Why it is being given, the duration of treatment with this drug, and any necessary recheck testing parameters, like bloodwork or imaging.
2. The course of treatment and expectations, such as remission or complete cure vs. palliative care.
3. Any possible side effects, steps to take if noted (do they call the office? Do they give a medication to relieve the side effect? Etc.)
4. Drug hazard periods – in other words, how long could the pet’s bodily fluids (urine, feces, vomitus) be contaminated and a potential risk to other animals or humans?
5. If they must clean up feces, urine, vomitus, or other bodily fluids, ensure the owner knows to wear gloves and, despite the gloves, wash their hands for 20 seconds or more with warm soapy water.
6. Sunlight helps degrade agents within urine or feces.  So, ideally, walk the pet in a low-traveled area with lots of sunshine, where no children play. Suppose the dog has free access to the backyard or other dogs in the household have access to where the treated dog evacuates. For these reasons and for general hygiene purposes, you should pick up feces after each defecation. But remember to wear gloves and wash hands well after removing them.

Correct answer: Cortisol

Cushing's syndrome, or hyperadrenocorticism, is caused by elevated cortisol produced by the pituitary or adrenal gland tumors. Cushing's disease has a higher incidence in dogs than in cats. Clinical signs include weight gain, a pot-bellied appearance, increased drinking and urination, lethargy, and muscle weakness.

High levels of glucose may indicate diabetes mellitus. High levels of thyroxine may indicate hyperthyroidism. High levels of luteinizing hormone occur prior to ovulation in intact female dogs.

Correct answer: Contact law enforcement

We want to de-escalate the situation with difficult clients as best as possible.

1. Invite an angry client to an exam room or other area with a door to provide privacy, though take another staff member with you as a safety buffer and witness.
2. Sit down beside the client. Not having an exam table or desk between you is a more relaxed and friendly position. However, if you are fearful of the client, this may not be in your best interest. This is to attempt to aid the situation, so if the client fails to respond, putting distance between you may be in your best interest.
3. First, thank the client for permitting you to help determine the problem.
4. If the client starts laying into you right away, expressing concerns, let them voice their complaints. If the client doesn’t initiate conversation, prompt them by asking, “Could you explain to me what your problems are?"
5. Use active and reflective listening skills.
6. Be empathetic.
7. Agree with the client wherever feasible.
8. Do not justify any clinical action that is cause for concern. If you made a mistake, discuss it and offer options to rectify the situation.
9. Place hospital policies in a positive light. Try to point out that you are doing something because it is medically appropriate. For example: Regarding a rabies vaccination—while it is required by law—you could point out that your area has some of the highest rabies cases, and it may help to highlight that it is protecting the client's pet and family.
10. Try to provide an acceptable solution.
11. Permit the client to save face, apologize, or de-escalate without much intervention.
12. Don’t take the client’s behavior personally.
13. Don’t argue with the client — the client is, theoretically, always right.
14. Utilize various conflict resolution strategies to work with the client and reach a mutually acceptable understanding.

If, no matter what you do, you feel physically threatened at any time, you cannot get the client off the ledge, or you fear for the safety of your staff or an animal, contact the police. If the owner is under the influence of drugs or alcohol, you may not be able to reason with them, and no matter how good your communication skills are, you may not be able to diffuse the situation.

Correct answer: Mastication

Mastication is the process by which food is ground down by the teeth to facilitate more efficient digestion, also known as chewing.

Ambulation is the medical term for moving around. Rumination is the process of digestion within the compartmentalized stomach of ruminant animals (cattle, goats, sheep). Demarcation is the medical term for marking off boundaries.

Correct answer: Identify hyperoxia

When monitoring a patient under anesthesia, using an ECG machine remains a valuable tool. 

Hyperoxia occurs when cells are exposed to an overabundance of oxygen or, alternatively, a greater than the normal partial pressure of oxygen. This rare occurrence in veterinary medicine is not generally identified on an ECG. However, ECGs can help:

• Provide cardiac rate and rhythm real-time assessment
• Screen patients for underlying electrolyte abnormalities (think about that blocked cat with potentially elevated potassium. Look for that spiked T wave).
• Alert you to any impending changes in electrical patterns
• Demonstrate hypoxemia

However, always remember to monitor not just the machines, but your patients as well. An ECG can still demonstrate electrical activity even if the heart has stopped beating, so it isn’t the end-all be-all. You still need a multi-modal approach to patient monitoring.

The limitations of ECGs further solidify the need to monitor not just your machines but patient parameters, both visual, auscultable, and more. Limitations include:

• Artifacts
• Cautery devices
• Heating devices
• Patient movement
• The leads simply being too dry
• Pulseless electrical activity (PEA) where the patient is in cardiac arrest may only manifest as a slight ECG abnormality, falsely giving you confidence that the patient is still doing well.

Correct answer: Periodontal probe

Periodontal probes examine periodontal tissues for pocket depth, recession, and hyperplasia. They are smooth on all sides with a blunt tip. The normal sulcus depth in dogs is up to 3 mm, while in cats, up to 1 mm represents a healthy mouth. 

Curettes have a cutting edge and rounded tip, so they can be used both above (supragingivally) and below (subgingivally) the gum line. Scalers, while similar to curettes, have a cutting edge and a sharp tip that can damage delicate gingiva, so they should only be used supragingivally. Shepherd's hooks, or explorers, have smooth sides with a sharp tip. They can be used to detect subgingival calculus but do not have a sharp edge for removal.

Correct answer: Flush

The flush valve forces oxygen into the circuit without releasing the additional anesthetic agent. Caution must be exercised when using the flush valve since it quickly increases the pressure within the circuit. 

Incorrect terms include pop-off valve, mitral valve, and Bain circuit.

Correct answer: Remove infected soft tissue from periodontal pockets

Subgingival curettage actually describes the process of removing infected soft tissue from periodontal pockets. One can use a curette or periodontal incision.

Root planing helps remove any gross calculus and cementum around the tooth root using a curette. One uses various strokes in various directions to achieve this.

Root planing also removes microorganisms and toxins that have caused necrotic debris along the periodontium.

Root planing can be done closed, when no flap is needed for areas less than 4 mm in depth. Sometimes, open root planing using a gingival flap to access the debris may be required.

It is adequate to only remove superficial layers of cementum to achieve periodontal debridement, the goal of root planing.

Correct answer: 25g needles and mepivacaine

Small needles and local anesthetic drugs are needed for nerve blocks during lameness assessments, not colics.

Equine colic patients routinely receive rectal exams, analgesia, and nasogastric tubing as part of their initial assessment. Vacutainer tubes for blood and abdominocentesis samples are indicated on a case by case basis.

Correct answer: Hydromorphone

Emergence delirium occurs as patients are recovering during the post-operative period as a result of the gas anesthetic. This behavior is very transient and usually resolves within the first few minutes post anesthetic recovery, thus, requiring no intervention.

Dysphoria describes a patient demonstrating signs of anxiety, stress, agitation, depression, or unease that is not attributable to pain. The most common causes of this behavior include medication-related changes. Often, opioids are most commonly associated with dysphoric behavior in veterinary patients. Animals may act dysphoric either because the pain med dose was too high, or they can be nauseated or restless from the medication. However, other factors may play a role, which can happen with drugs other than opioids.  

Deciphering whether a patient is painful vs. dysphoric can be difficult. But if evaluations of pain such as palpation at the incision site or other known previously painful areas produce no pain, the patient is not mentally appropriate or reacts inappropriately to normal stimuli, this must be considered. We do not want to administer additional pain meds until this is ruled out. Thus, the pure µ opioid agonist hydromorphone would not be an appropriate choice. Most patients already have an opioid on board, especially when hospitalized post-surgically or for a painful condition such as pancreatitis, parvovirus, or others. Pure opioid agonists commonly can lead to dysphoria, especially in older patients and patients with increased anxiety prior to surgery. Patients with underlying medical conditions may also be more prone to this reaction. Thus, it would not be an appropriate first choice.

Valium or midazolam are benzodiazepines and, as anxiolytics, may help remove any anxiety component to the behavior. However, it will not reverse the negative effects of any opioids on board. If the procedure was relatively short, it might be additive with any previously used Benzodiazepines. However, in low doses and with monitoring, it can be beneficial.

Butorphanol is an opioid agonist-antagonist with sedative properties. We commonly use this to help with anxiety and calm patients down, for example, those in respiratory distress. It has mild pain management properties, though short-lived vs. sedative properties. It may partially reverse any pure µ opioid agonists on board, thus, minimizing the dysphoria while maintaining some pain management.

Finally, if an opioid was used intraoperatively and one is concerned that the patient is not adequately metabolizing it, the patient is not responding to other treatments, or as a first-line, naloxone is the true reversal (antagonist) for pure µ opioid agonists such as fentanyl, hydromorphone, and morphine. Thus, it should be considered. Even patients who had no surgical procedure but received opioids may benefit from this medication. However, note that while it will immediately remove the drug, it is short-acting. We commonly see patients "re-narc," meaning that the opioid will reattach to the receptors once naloxone is out of the system. So care must be taken, and patients should be monitored closely. Often, giving one dose is sufficient to remove the dysphoria. Because enough drug remains, they then have adequate pain management once it is metabolized.

Correct answer: Correction of gastric dilatation-volvulus

Gastric dilatation-volvulus (GDV) is a surgical emergency and does not allow for fasting time. GDV occurs when the stomach dilates and rotates, leading to distributive shock and poor perfusion to the stomach.

The correction of a ruptured cranial cruciate ligament, a castration, and an ovariohysterectomy are elective surgeries where fasting is feasible.

Correct answer: The drug is compatible with midazolam

Pantoprazole is a proton-pump inhibitor (PPI). It is used for its antacid benefits and is commonly used in patients with IBD, reflux-related conditions, esophagitis, and generalized GI upset. It is the injectable version of the oral drug omeprazole. It was initially prescribed once daily, but studies suggest that it should now be twice daily, and that has been reflected in the most recently published PDRs.

Pantoprazole is a human drug used off-label in animals. It is compatible with:

• Ampicillin
• Cefazolin
• Ceftriaxone
• Dopamine
• Epinephrine
• Furosemide
• Opioids
• Potassium chloride

However, it is incompatible with the following (i.e., it shouldn't be given IV in a line used to administer these drugs): dobutamine, esmolol, mannitol, midazolam, and various multivitamins. Solutions with zinc may also be incompatible, so watch which fluids you administer it with.

It is generally diluted to a 4 mg/ml solution when reconstituted. It should be given no faster than over two minutes, but is most commonly given over 15 minutes. It is dosed at 0.7-1 mg/kg IV q 12 hours, though most vets usually start at the higher dose.

Correct answer: Cough suppressant medication

Laryngeal paralysis occurs when the arytenoid cartilage movement is paralyzed due to damaged laryngeal nerves. Signs of laryngeal paralysis include a change in the animal's voice, stridor, and difficulty tolerating exercise.

With emergency decompensation, dogs are stabilized with sedation, anti-inflammatory medication, and oxygen supplementation. In severe cases, intubation and treatment for hyperthermia is often necessary. Surgical treatment to open the airway is by a procedure called a laryngeal tie-back.

Cough suppressant medications have minimal benefit, since the clinical signs are caused by a narrowed laryngeal opening and not a problem with coughing from the trachea or lungs.

Correct answer: Castration

Castration is the surgery of choice for prostatitis. The prostate is an accessory sex gland, so it is heavily affected by the hormones produced by the testicles.

Anal sac removal, placement of a purse string, or an intestinal resection would not benefit patients with prostatitis.