AAVSB VTNE Exam Questions

Correct answer: Loss of balance

Middle or inner ear infections may cause a fluid imbalance or swelling within the structures of the ear. This causes vestibular signs in animals, including loss of balance. This can include rolling around and having trouble righting themselves, falling, or related signs. Middle or inner ear infections also cause vomiting, ataxia, weakness, vomiting, or other signs of motion sickness. Additionally, non-balance-related signs consistent with an ear infection, including shaking of the head and ear pain, may be seen. Dogs may or may not have external ear discharge or external ear infection. Dogs may demonstrate changes in sleep, appetite, and hearing and may have a low-grade fever. 

Middle and inner ear infections do not cause photosensitivity (sensitivity to sunlight), generalized pruritus (itchiness), or limping.

Correct answer: Antiseptic

An antiseptic is a substance that inhibits the growth of microorganisms when applied to or on living tissues, either by destroying them or inhibiting their development. Examples of antiseptics used in veterinary medicine include chlorhexidine, iodine, alcohols, phenols, and quaternary ammonium.

An antibacterial is a substance that inhibits the growth of bacteria.

A disinfectant destroys or permanently inactivates many organisms. Disinfection is the removal or eradication of pathogens from inanimate objects via chemical or physical means.

A virucidal agent is a substance that kills viruses.

Correct answer: Epistaxis

Clinical signs of oral disease can be specific and non-specific to the oral cavity. They can include:

• Facial swelling
• Facial rubbing (though this could also indicate allergic disease)
• Sneezing or snorting after eating or drinking something
• Ptyalism (drooling) either with eating or when nothing is in the mouth, and the mouth is closed
• Dropping food while eating
• Pain on opening the mouth
• Difficulty opening the mouth
• Chattering of the lower jaw, also known as Jaw Opening Reflex
• Dysphagia (trouble swallowing)
• Oral bleeding
• Resenting touch or handling of the head
• Varying degrees of appetite change from no change to complete anorexia
• New or unusual aggression or snippiness when handled, touched
• Oral bleeding

Epistaxis is not generally considered a sign of oral disease. However, with oral-nasal fistulas or some tooth root abscesses, we can see an extension into the nasal cavity and may see epistaxis. But, generally speaking, it would not be associated with oral disease specifically. 

Causes of epistaxis can include nasal foreign body, infectious, inflammatory, neoplastic, or coagulopathy.

Correct answer: Cranial vena cava

The cranial vena cava is the preferred venipuncture site in ferrets when a large sample is needed. If the ferret is calm and two restrainers are available, it is possible to draw blood from the cranial vena cava without sedation. However, sedation is often required to minimize stress and ensure a proper sample without hemolysis. We all know how wiggly and active healthy ferrets can be. For more debilitated patients, restraint alone is often sufficient.

The jugular vein may be used for large samples, but the subcutaneous fat and thick fur in the area make visualization difficult. The cephalic vein can be used for small volumes, but it is most commonly used for IV catheter placement, not blood draws.

Correct answer: Survey radiography

Survey radiographs are quick, non-invasive, and usually do not require sedation/anesthesia. They can assess musculoskeletal structures, pleural space, cardiorespiratory tissues, and diaphragmatic integrity. Because they can image the entire body, if the patient is stable enough to acquire the images, then they are the most comprehensive of options.

Ultrasonography is also quick, non-invasive, and usually does not require sedation/anesthesia. The pleural space, pulmonary surfaces, cardiovascular structures, and diaphragm can be evaluated in skilled hands. Ultrasound cannot evaluate bones for traumatic injury and does not completely assess the lungs.

Contrast radiography is not indicated for routine use. This method is reserved for rare circumstances where specific pathology indicates. Injectable water-soluble organic iodide contrast agents should only be administered to patients that are hydrated and have stable cardiovascular status. Contrast radiography is used primarily to improve the visualization of organs or structures not evident in survey films. These procedures take time and skill and are not performed for routine assessments immediately following trauma, but may be performed once a patient has stabilized.

Computed tomography provides all the benefits of survey radiographs and more, but requires deep sedationor general anesthesia, and cost precludes its routine use.

Correct answer: Diabetes mellitus

High levels of glucose in the urine can indicate diabetes mellitus. Diabetes is a disorder of insulin deficiency or resistance, resulting in elevated blood glucose as the cells starve. Eventually, the kidneys cannot filter back all the blood glucose and some spills over into the urine. Glucose is not found in urine under most normal circumstances.

Glucosuria is not associated with hypoadrenocorticism, diabetes insipidus, or lymphoma.

Correct answer: Time the sample was collected

Of course, including sample collection time and date is never wrong but is not relevant to obtaining a complete diagnosis. 

Factors pertinent to the cytology and diagnosis include:

• The patient's unique identifier, name, and client information
• Full signalment of the animal
• Brief history
• Any diagnostics, including bloodwork, radiographs, previous cytologies
• The site where the sample was collected
• If the mass was superficial or deep; freely moveable or attached; firm or soft; any other descriptors and quantifiers that may be relevant
• Size of the mass, if measured
• Speed of growth
• If ulceration is present

Correct answer: Stimulates female ovulation and male testosterone production

Luteinizing hormone (LH) is a pituitary hormone of the anterior lobe that stimulates female ovulation and male testosterone production. LH is also responsible for the secretion of progesterone and the conversion of follicles to the corpus luteum.

Follicle-stimulating hormone (FSH) is a pituitary hormone of the anterior lobe that stimulates female ovarian follicle growth (oogenesis) and male spermatogenesis. It also stimulates the follicular cells to produce and secrete estrogens. 

Thyroid-stimulating hormone (TSH) is a pituitary hormone of the anterior lobe that stimulates thyroid production of T₃/T₄. Thyroid hormone homeostasis occurs via the interactions among the hypothalamus, the thyroid and the anterior pituitary glands. 

Adrenocorticotropic hormone (ACTH) is a pituitary hormone of the anterior lobe that stimulates corticosteroid production by the adrenal cortex.

Correct answer: A handheld retractor used to lever tissue away from bone during surgery

A Hohmann retractor is a handheld retractor with a single blade. It is primarily used in orthopedic surgery to lever tissue out of the way for better visibility. Any surgical instrument described as "handheld" requires a surgical assistant to hold it in place during the procedure.

A Weitlaner retractor is a self-retaining retractor with blunt, raked tips that ratchet to hold tissue apart. A Gelpi retractor is a self-retaining retractor with a single tip, commonly used to retract muscles during orthopedic or neurosurgery. A Senn retractor is a commonly used handheld, double-handed retractor for skin, muscle, or fat. One blade is smooth while the other has three blunt or sharp prongs. 

Correct answer: Cribbing

Horses, especially those confined, may demonstrate displacement or redirection-type behaviors, and these are often seen as repetitive in nature. Horses may paw repetitively at a door, stall, or the ground. Some degree of pawing is a normal part of obtaining water and food for the species, so careful evaluation needs to occur around when the behavior occurs to further elucidate it.

Other repetitive or "stable vices" demonstrated by some horses include wood chewing, stall walking or weaving, and kicking at the stall. Animals who cannot do what they want, such as go out to pasture or eat, may perform these acts, perhaps out of boredom or frustration.

Cribbing, however, is not the same as periodic wood chewing. Wood chewing is like chewing on wood, such as on the doors, stalls, or branches. Doing it to excess would constitute a repetitive behavior. Horses who have free-range access may chew on or eat bark normally. Sometimes, however, it could represent insufficient fiber intake in their diet, which should be noted and brought to the attention of a farmer, veterinarian, or other caregivers.

Cribbing is generally considered a stereotypy, a repetitive behavior with no discernible immediate function. Typically, these are observed in wild horses kept in captivity. Perhaps it is a stress response to husbandry practices and confinement. Additionally, cribbing is more than just wood-eating. The horse grasps a stationary object with all its incisors, then arches its neck, leans back, and sometimes gulps air, causing a characteristic grunting noise. The behavior is not seen in free-ranging animals. The origin of this behavior is multifactorial. It is not just a behavioral manifestation of anxiety, but also may involve nutritional and management issues.

Correct answer: Emotional outbursts of laughing, crying, or yelling

We all grieve and handle loss or impending loss in different ways. Emotions will run high when owners decide about end-of-life care and choosing euthanasia vs. hospice vs. hospitalization. Grief can manifest with crying, yelling, dismay, and more. The natural reaction to grief doesn’t necessarily warrant mental health intervention.

However, indications where the veterinary staff may want to intervene and recommend or provide resources for mental health intervention include:

1. The owner hints at suicide by suggesting that without the pet, they have no reason to live.
2. The owner requests that the veterinarian or veterinary staff lie to a family member, including a child.
3. There is discordance among family members about end-of-life wishes. If multiple family members are involved and no one can decide what to do—euthanize or not—for example, a social worker or other professional may be beneficial to discuss the ongoing issues and help them make the right decision for them.
4. The owner is wishy-washy — they express fear and anxiety about the care, plans, and making decisions, yet cannot verbalize what they want to do.
5. The owner cannot comprehend the underlying disease, problem, or needed decisions to move forward.
6. If the animal is in hospice care, and it is constantly interfering with the owner's work and care, undermining its effectiveness.
7. The owner asks a veterinary team member to lie to a family member, friend, or child. We must be honest, and this means telling the truth despite an owner’s request not to do so. Having a mental health provider involved often helps with explanations and understanding.
8. The owner verbalizes trouble adjusting to the impending loss of life.

Other reasons may also cause you to question a person’s ability to emotionally handle a situation. You may be concerned about substance abuse and the safety of family members, staff, or other animals. In any instance, getting help for those in need is appropriate. You can only offer the resource and take the first step. We may recommend a pet support group, individual therapy, a social worker’s input, or various means to provide the owners with the help they need. A great resource is Lap of Love, an in-home euthanasia service. They provide numerous resources for pet support and loss.

Correct answer: Expectorant

Expectorant medications help clear viscous respiratory secretions by thinning the consistency. They have limited use in respiratory conditions.

The other three options are routinely used when treating heart failure:

• ACE (angiotensin-converting enzyme) inhibitors modulate the renin-angiotensin-aldosterone system (RAAS) and promote vasodilation.
• Positive inotropes increase heart contraction strength. Examples include digoxin, epinephrine, or dobutamine.
• Vasodilators allow smooth muscle vascular relaxation which can decrease preload and afterload or help treat systemic high blood pressure. Examples include nitroprusside or nitroglycerin.

Correct answer: Photon

A photon is a packet of electromagnetic energy with no atomic mass. X-ray beams are composed of photons.

An isotope is an atom with a different number of neutrons and the same number of protons. A nuclide is an atom defined by the number of protons, neutrons, and nuclear energy state. A nucleotide is an organic molecule that serves as a building block for nucleic acids, such as DNA.

Correct answer: Gently hold the head down in a horizontal position

Especially important and helpful in horses, but can be used in most species, gently hold the animal’s head horizontally down until the animal develops sufficient coordination and strength to stand and when it seems stable enough on its feet as well. For horses specifically, you can hold the head down with a hand or knee on the dorsal neck behind the skull. When the horse feels ready to rise, you will feel it trying to move. By placing the head lower than the shoulders/neutral position, we are taking advantage of the animal’s sense of equilibrium. However, by keeping it off the ground, we also have some control over the horse in case something happens or the horse tries to stand too quickly and is at risk of hurting itself or others. If the horse can lift you, the animal is likely strong enough to stand and support itself. Always keep safety in mind and have a way to get out of harm's way.

Holding the head above the shoulders gives the animal more power and they may try to get up, overpowering you with ease. You do not want to be resting on the shoulders, as this is too dangerous of a place to be, and you have no control over the head. Finally, suppose you place a knee on the animal. In that case, you want to do it on the neck's dorsal aspect behind the skull's base, not on the lateral neck, where you will, again, have no control of the head.

Correct answer: Roughage 

Goats and sheep differ based on their oral cavity anatomy. Both species have very active mobility of the tongue and lips, allowing various foods to function in their diet. Goats thrive when grazing on areas with browse or many plant species. Goats are active foragers who eat highly digestible grass parts. Additionally, they will consume various fruits, leaves, and flowers. 

Sheep are roughage grazers who will eat grass and high-quality plant parts.

Always ensure, regardless of what you provide for these species, that they have sufficient fiber to ensure normal rumination. To promote rumen health, fiber should equate to more than 50% of the dietary intake.

Ensure that a minimum particle size of 1-2.5 cm is provided to stimulate normal eructation. If you must use a pelleted feed, ensure you provide free access to hay to ensure that sheep and goats obtain sufficient fiber intake while hospitalized.

Correct answer: Bladder marsupialization

Goats commonly produce bladder stones. They can become lodged anywhere in the urinary tract and most commonly cause an obstruction in the area of the vermiform appendage (urethral process). This area is at the tip of the penis and is a tube-like skin extension. Other locations are less common for obstruction.

A urethral process amputation involves removing this appendage with a scalpel. Because it is the most likely site of an obstruction in the species, it is a routine procedure and was likely already performed — it is not considered a salvage procedure.

A tubal cystotomy helps divert urine away from the urethra and to a collection system to allow the swelling to subside. It is combined with a vermiform appendage amputation and cystotomy/urethrotomy to remove stones. However, this is also a common procedure and not considered a salvage procedure.

A PU, similar to what is performed in cats, creates a different urethral opening from which the goat can urinate, making them “urinate more like a female.” This means that the animal’s penis no longer functions normally and can no longer breed. Since this is a pet, it is not likely to be an issue, and probably has already been performed, as a complication can be stricture.

Bladder marsupialization is considered a salvage procedure when all else fails. It can be done as a last resort for patients who have had PUs that stricture or fail to prevent obstructions. It creates a permanent orifice between the body wall circa the prepuce and the bladder. This prepubic cystostomy creates a permanent opening with post-op risks, including urine scalding and urinary tract infections.

Correct answer: Bleeding from the toes can happen for 12-24 hours post-operatively and isn’t cause for concern.

Animals after a declaw (onychectomy) surgery are painful. Ensure owners understand that pain medication should be administered as directed, not as needed, as pain can delay healing and increase the chance of chronic pain in the future. Review signs of pain, including no signs of lameness, decreased appetite, lethargy, and not wanting to move. Review facial expressions (using the Feline Grimace Scale) that may help owners recognize a painful cat.

Bleeding post-operatively is not a common sequelae, and if owners notice bleeding, the patient should be re-evaluated.

Animals should be sent home with an e-collar and explicit instructions to always keep it on. Licking at the incision sites can open them, delay healing, and increase the risk of chronic pain and infection.

Ensure the owner knows to use litter that won’t enter the incision area. Paper litter is ideal, something like CareFresh, because it can easily be seen if stuck to the foot and removed, and doesn’t usually irritate the toes.

The owner should check all digits a few times daily. If the owner notices swelling of one or more toes or the cat isn’t using one of the paws, this is cause for concern, and the pet should be re-evaluated. It could be that the pain management isn't sufficient or there is something abnormal with the incision.

It is imperative that the owner keep the cat from running, jumping, and playing. It is especially important after this type of surgery. Jumping can be hard to prevent in cats, but jumping must be prevented with this surgery. Jumping can put undue force on the paws and digits. It can cause significant damage or delay healing and contribute to chronic lameness or neuropathic pain. Advise clients to keep the patient in a small room without furniture or something to jump on, or—more ideally—a large dog crate with a litterbox, food, and water available until healing has finished.

Owners need to understand the procedure well before it is completed. However, it is key to remind them post-operatively that the procedure removes their cat's ability to defend themselves by removing their natural defenses. Emphasize that they should remain as indoor cats from here forward.

Correct answer: Greyhound

Class I malocclusions (neutroclusion) occur when one or more teeth are in an abnormal position (misaligned). The maxilla and mandible develop a normal relationship to each other. A Class I tooth may be pointing in the wrong direction or rotated. Common examples include rostral crossbites and linguoversion (also called base-narrow canines).

Class II-III malocclusions affect jaw length rather than tooth position alone.

Class II malocclusions (distoclusion) occur when the maxilla is forward (maxillary prognathism) and the mandible develops caudally (mandibular retrognathism). Other names include brachygnathism, overbite, and parrot mouth. These are most commonly observed in dolichocephalic dogs (long maxilla and narrow skulls).

Class III malocclusions (mesioclusion) occur when the mandible is forward (mandibular prognathism) relative to the maxilla (maxillary retrognathism). Other names include prognathism and underbite. These are commonly observed in brachycephalic dogs.

Additional malocclusions may be described, such as those created by an abnormal number of teeth in the mouth and other abnormalities that are non-specific, such as wry mouth. This simply pertains to various occlusal abnormalities that occur unilaterally. 

Correct answer: p.r.n

A collection of Latin abbreviations are commonly used as part of prescription writing, and it is important for veterinary technicians to be familiar with these. The Latin phrase pro re nata means "per required need" and is abbreviated as p.r.n.

n.p.o means "nothing per os" or nothing orally. b.i.d means "two times a day". q.h means "every hour".

Correct answer: Palatal ostium

Guinea pigs and chinchillas are small in size and stature but also have a limited range of motion of the mouth, making visualization difficult. Additionally, the presence of the palatal ostium, a tiny donut-shaped opening that exists between the posterior and anterior oropharynx. This makes visualization of their glottis physically impossible. Blind intubation can be both challenging and cause damage to the surrounding tissue. Additionally, if too many attempts are made, hypoxia can result.

Rodents cannot vomit, so this is not a concern while intubating rabbits or performing anesthesia.

Other rodents are often not intubated simply due to such small size (hamsters, gerbils).

Laryngospasm isn’t appreciated in these species. The complications arise due to the inability to visualize the area and the need to do blind intubations unless visualization cameras are readily available and a skilled user intubates rapidly.

Finally, these species are large enough for catheterization; often, the cephalic vein is used. Interosseous needles can be used if needed if IV access isn’t feasible and IV fluid support or additional medications are warranted.