ICVA NAVLE Exam Questions

Correct answer: Choke

In a dog, when we see them trying to vomit and not being able to (retching unproductively), especially in a large barrel-chested dog, we think bloat (GDV). Chinchillas are a species that cannot vomit.

The likely cause in this patient is the raisins, which were very small and improperly chewed and lodged in the patient's esophagus. We also see patients with dental disease develop this. Still, it is not the dental disease itself causing it, but the inability to sufficiently chew their food and larger particulate matter being swallowed and getting stuck. If untreated, the pet will eventually die.

Diagnosis is similar to a presumptive foreign body in any species, and includes radiographs and bloodwork to monitor overall health status. Once stable and well-hydrated, removal of the foreign material, often via endoscopy, needs to occur. Once the obstruction has been removed, the chinchilla can be nutritionally supported with IV fluids and herbivore critical care until the gut returns to normal function.

Some animals can progress to bloat or gas tympany. When the esophagus is obstructed sufficiently, animals fail to eructate and release stomach gases. These animals will be painful, and lethargic. Radiographs can also confirm this diagnosis. The removal of foreign material should alleviate this condition as well. In an emergency—as with dogs with GDV—the gas can be relieved with aspiration using a needle if needed. That being said, animals who have progressed to bloat have a guarded to grave prognosis for a return to full gut function and status.

The pawing at the mouth and other drooling signs do not support a diagnosis of pneumonia.

The clinical signs of a foreign body generally do not include respiratory distress or pawing at the mouth.

Correct answer: Metabolic alkalosis

This patient is displaying classic signs of diabetes mellitus. Given the history of pu/pd for the past month or more, this dog has likely been diabetic without intervention for a while. As a result, his body, not getting sufficient glucose to provide energy, started converting fatty acids into usable energy (ketone bodies). As a result, he has developed Diabetic Ketoacidosis (DKA). The hallmarks of DKA include elevated glucose, ketonuria, glucosuria, and metabolic acidosis.

Thus, findings on this patient's bloodwork may include:

• Hyperglycemia
• Dehydration (elevated bun, crea, PCV, HCT)
• Hyperlactatemia
• Hypokalemia
• Hypomagnesemia
• Patients with concurrent pancreatitis may also have liver value elevations. Even if pancreatitis isn't documented via ultrasound, these values may still be elevated
• Elevated triglycerides
• Elevated cholesterol
• Azotemia
• Finally, these patients can have profound metabolic acidosis (not alkalosis) secondary to ketone production

Correct answer: Measure resting respiratory rate per minute; if > 30 or trending upward, seek help

You discuss with the client that cats can show signs of heart failure in various ways. It depends on where the fluid goes and if it is a left-sided, right-sided, or fulminant cardiac failure. You explain that a great way to monitor the cat without disturbing Fluffy is to watch his sleeping/resting respiratory rate. Wait until he has been asleep for a good period, not just when he falls asleep after playing with the laser pointer for 20 minutes. Count the rise and fall of the chest as one breath and count how many per minute. Most cats fall < 30 breaths per minute. However, it is more than just the number. It also includes trends. Suppose his resting rate is 18 for months and months and suddenly jumps to 24 while still normal. In that case, it may be unrelated to heart disease but could signal that things are changing. Perhaps medications are needed, or alterations in doses of current medications are warranted.  

Coughing is not a sign of heart failure in cats, while it is almost always present in dogs. Cats cough with asthma/airway disease but not generally with heart disease.

Telling the owner that there is nothing to monitor isn't accurate. However, it is valuable to tell the owner, so that she is prepared, that sometimes the only sign of heart failure is sudden death and to be prepared for that possibility. However, without an echocardiogram, you can only say he has a murmur, meaning abnormal blood flow, potentially. Tell the owner to wait for the echo before considering the heart murmur to be pathologic.

Cats aren't the most cooperative with the palpation of their femoral pulses. If too much or too little pressure is applied, it can affect the ability to detect it. We do not want owners to get hurt; further, heart rate changes do not let one know if impending failure is coming.

Correct answer: Hyperproteinemia

In burn patients, two distinct physiologic phases occur.

First, the resuscitation phase starts right after the injury. This consists of depleting circulating volume, increased vascular permeability, and the loss of protein-rich fluid. This fluid dumps into the interstitial space leading to edema of damaged and undamaged tissue. As a result, hypoproteinemia (not hyper) develops as edema fluid and fluid loss from the skin surface.

Secondly, we have a hypermetabolic/hyperdynamic phase. This occurs about three to five days after the initial burn injury. This is mediated by cortisol, catecholamines, and glucagon (counter-regulatory hormones). Now, cardiac output actually increases, and vascular permeability normalizes. The metabolic rate also increases at this time, leading to a negative energy balance and related changes, including fever. Energy requirements can increase more than three times the basal metabolic rate.

A third concern arises secondary to inhalation injury, providing a secondary means for systemic problems, including respiratory disease and failure. Direct thermal burns and chemical irritation can lead to interstitial damage, and three to five days post-injury, can cause mucociliary dysfunction, and patients have an increased risk of developing bronchopneumonia.

Correct answer: Cost

Sounds strange, as cost does play a big role in our decision to purchase a piece of equipment, but it needs to be one of the last things we consider. We need more information to know what is out there.

Let's use an example. Your practice hasn't had the caseload until now to have in-house blood lab equipment. However, you are doing more surgeries and emergencies and want results immediately. So, you have a need for a new piece of equipment.

You need to gather information on the various companies that make in-house labs, the types of machines offered, and the way the machines work. (How are the results achieved? Do they use serum or whole blood? Do the devices integrate easily with your computer software program? Are there cartridges that you need? Slides? What do those components cost, and how much money could you then charge for the results/ run the bloodwork?)

First, determine what you want to buy, and then you want to be able to evaluate the return on your investment. You want to calculate how much revenue a new blood machine can generate and do the math. This will help you determine what you may need to charge and what impact this will have on clients (will they see it as too much money, or will they see it as a positive, getting immediate results). It will also let you know how soon you can pay it off.

You want to evaluate the blood machine warranties and any service contracts. (How accessible is the company? Can you get assistance anytime you need it, or would you have to wait to help with troubleshooting?)

Once you have evaluated the pros and cons of the various blood machines, the companies and services/warranties, other things offered and assessed, and your return on investment. You can compare the costs of multiple products. You may choose the more expensive product because it offers more perks, you can charge the client less yet run more tests, or you are simply more familiar with the company. Whatever the reason, cost, though important, shouldn't be the only factor used in choosing new equipment.

Correct answer: Incontinence

Dogs and cats can have inappropriate elimination of urine and/or feces for various reasons. These include behavioral causes such as submissive urination or urine marking. This dog is intact, so urine marking does need to be considered. It could be to mark territory or for other behavioral reasons associated with the puppy. The dog may not be marking, but the urination may occur due to stress or anxiety secondary to the new puppy in the house.

We can also see incomplete house training, though not likely an issue with this pet. Medical conditions can lead to urinary accidents, including endocrine diseases like diabetes or renal abnormalities, cognitive dysfunction, seizure disorders, pain (arthritis, IVDD), and even incontinence. Especially in an intact dog, we must also have prostatic disease high on the list. The dog may have a prostatic infection, abscess, cyst, or benign prostatic enlargement that is causing pressure on the urethra, and the dog may not be able to hold his urine as long. A urinary tract infection in an intact male dog is uncommon unless there are other underlying triggers, such as bladder stones or prostatic disease, but that, too, can lead to elimination issues.

A full physical exam and diagnostics would be needed to rule out underlying medical causes. If no medical reasons are found, then behavioral evaluation can begin.

Incontinence, while it can happen, is extremely rare in intact male dogs unless there is an underlying medical condition such as ectopic ureters, which we would expect to have manifested clinical signs at a much earlier age. 

Correct answer: Fog fever

Fog fever, AKA bovine atypical interstitial pneumonia (a misnomer since acute lung injury changes are actually typical), or ABPEE (Acute Bovine Pulmonary Edema and Emphysema) occurs in animals when suddenly changed from sparse, dry forages to greener lusher pastures. The issue is that L-tryptophan from the lush forage converts into a pneumotoxic agent (3-methylindole). This causes varying degrees of pulmonary edema, hyaline membranes, emphysema, and alveolar epithelial hyperplasia. Most animals will develop mild cases that resolve in two to three days. However, some become severely ill and develop full-blown Acute Respiratory Distress Syndrome (ARDS). Those with ARDS will have acute interstitial pneumonia grossly and histopathologically.

The lack of coughing helps differentiate this from other pulmonary causes of ARDS and similar entities. Parasitic diseases and BRSV are generally associated with coughing and not necessarily pasture change in recent history. Plant toxicities, such as moldy sweet potatoes or perilla mint, could lead to similar signs. Acute interstitial pneumonia as an entity is usually associated with feedlot cattle and not a recent change from pasture to pasture. This latter entity is not fully elucidated as to the cause. However, it also may result from the same pneumotoxic compound leading to fog fever.

Thus, the history, type of cattle rearing system (pasture vs. feedlot), and clinical signs help differentiate this disease from others.

 Correct answer: Real‐Time Reverse Transcription Polymerase Chain Reaction (rRT‐PCR)

In an outbreak situation, where real-time answers are needed rapidly, the rRT-PCR is considered the fastest test. It has a decent sensitivity and specificity, especially for the rapidity at which results may be obtained. Further, since this test isn’t affected by antibodies, specimens from all animals can be tested regardless of vaccination status, clinical illness, or health status. While fresh specimens are ideal, this testing can detect inactivated viruses when isolation isn’t feasible.

All other modalities are usable and may help confirm the diagnosis. Still, they take time and have varying sensitivity and specificity. That being said, rRT-PCR is only effective during the viremic stage. Thus, antibody detection assays may still be warranted as a follow-up step.

Classical Swine Fever (CSF), aka hog cholera, is another febrile, highly contagious disease of pigs, with virulent strains causing almost 100% morbidity and mortality. It is reportable on the national and global level (OIE (Office International des Epizooties)) World Organization of Animal Health.

CSF remains endemic in Asia, Central and South America, and the Caribbean (posing a threat to the U.S.) and can be seen sporadically throughout Europe. Disease origin is not understood. CSF used to be endemic in the U.S. but was eradicated in 1976. CSF is in the Flaviviridae family and is a Pestivirus. It relates to BVD (bovine virus diarrhea) and sheep’s Border Disease (B.D.). It is less resilient in the environment than ASF. Still, it can survive some curing processes and frozen products for months to years.

As with many swine diseases, signs are often non-specific but can include depression, significantly elevated temperatures, lying down, and huddling with other sick animals. Diarrhea or constipation and sometimes vomiting. CNS signs like abnormal walking and eventual hindlimb paresis or paralysis may be seen. Young growers may develop seizures; most die in three weeks or less. Less virulent strains may also demonstrate conjunctivitis and emaciation. Lesions will include petechial and ecchymotic signs of hemorrhage in various areas of the body. Helpful in the diagnosis is also finding single or multiple infarcts in a normal-sized spleen along the border, lymph nodes with subcapsular hemorrhages, and pulmonary and renal cortical hemorrhages. Microscopically, there will be evidence of panencephalitis. Leukopenia may also be present, but this must be differentiated from acute salmonellosis, erysipelas, and ASF. Further, lesions can be similar to other diseases, and this is a reportable disease. Eradication, vaccination strategies, and legislation banning importations help control/prevent disease in various areas. 

Primary transmission occurs via oro-nasal direct or indirect contact or ingesting contaminated foods. The tonsils are the initial source of viral replication. Airborne spread is possible experimentally and potentially can occur via semen and humans as fomites.

CSF crosses the placenta, causing infection in fetuses during pregnancy. Depending on the strain, time of infection, and virulence, we can see abortions and stillbirths. If a sow is infected at 50–70 days of gestation, live births with persistent viremia seem normal initially, then develop congenital tremors, termed "late-onset CSF." They shed tons of infected virus particles and serve as significant viral reservoirs. Further, congenital CSF can lead to mummification, congenital malformations, cerebellar hypoplasia, and more.

Correct answer: Vitamin C 3–6 mg/kg/day

Scurvy, or vitamin C deficiency, can occur in nonhuman primates, humans, and guinea pigs, since none of these species can produce their own vitamin C. Supplementation is required by a complete, well-balanced diet is required. However, if necessary, supplementation can be provided by 3–6 mg/kg/day. This will prevent the onset of scurvy (jaw, skin, and other abnormalities can result secondary to lack of vitamin C). The dose to treat vitamin deficiency vitamin C is 25–50 mg/kg/day.

While vitamin D is required to prevent disease, sufficient quantities are present in commercial diets, and if sun exposure is provided, this further helps vitamin D production. However, if supplementation is needed, the target dose is 2.5 IU/g/day

Finally, vitamin E tends not to be of concern. Target doses would be 50–100 mg/kg/day. 

Correct answer: Remove any obstruction

This rabbit is showing signs suggestive of GI stasis. Before radiographs and bloodwork, you may not know the underlying cause. However, With a thorough physical exam, one may identify dental disease, such as significant points, or upon discussion with the client, identify significant deficiencies in diet. Always ensure to ask owners detailed information about diet, including recent changes. For example, many clients will have financial concerns and stop feeding fresh veggies and fruits, providing only pelleted food, and restricted Timothy hay. This can commonly result in GI stasis. Peroperclient education about diet, the need for high-fiber foods, free choice hay, and appropriate fruits/veggies (pellets aren't needed when fed proper ratios of the above) is crucial to preventing further episodes. You would want to  discuss your recommendations for therapy including

1. Rehydration (Fluid therapy, ideally IV in her case)
2. Nutritional support (e.g., herbivore critical care) to help stimulate gut motility
3. Improve gut motility - this is accomplished via pain management, and nutritional and fluid support. Some people use medications as well, such as metoclopramide or cisapride. Still, studies are equivocal to date, and some veterinarians use them and recommend them, while others do not feel that it improves clinical outcomes.
4. Finally, we must restore the GI microbiome to replenish the healthy bacteria.

Depending on the severity of clinical signs and radiographic findings, hydration, and nutrition orally may not be feasible, if the stomach and gi are grossly distended. Once the gut starts moving again, syringe feedings may be instituted. However, food should always be available to the rabbit, including hay, so that she can eat when she wants to eat. Additional support may be necessary if more serious diseases are present, such as hepatic lipidosis.

Surgical intervention is only required if an obvious foreign body has been found or exploratory is warranted for another reason. Most cases of stasis respond to medication management, even if there is a large accumulation of fur in the stomach secondary to decreased hydration, increased grooming due to reduced fiber in the diet, and the pathophysiology of GI stasis.

The maintenance fluid rate for rabbits is 80-100 ml/kg/day as they have higher fluid requirements than cats and dogs. Initial fluid rates can be as high as 10-20 ml/kg/hr for the first few hours to ensure rehydration, improve the clinical picture, and support blood pressure. 

Correct answer: Chemotherapy can be discontinued once remission has been achieved

Despite its prevalence in the feline population, less evidence and research is available for the treatment of lymphoma in cats. We do know that, as in dogs, drugs with activity against high-grade lymphomas (and intermediate) include:

• Cyclophosphamide
• Doxorubicin
• Vincristine
• Methotrexate
• Prednisone
• Lomustine (CCNU)

Cats' tolerances and side effect profiles of the drugs vary. Cats are not as sensitive to the cardiotoxic effects of doxorubicin. However, they are still susceptible to renal damage and, thus, if used, should be closely monitored for the development of uremia and isosthenuria, ideally before each injection.

Steroids are known to increase the risk of the onset of congestive heart failure in patients with underlying cardiomyopathy. They should be avoided when feasible in these patients.

Cats with renal lymphoma often have involvement of the CNS at the time of diagnosis or will soon develop it. Thus, a multiagent protocol, including medications penetrating the CNS, is important, such as CCNU. If not treated, CNS lymphoma can lead to paralysis, among other signs, and it can be permanent if not treated promptly.

Finally, we do not have sufficient studies to suggest that in cats, we can stop chemotherapy once we reach a state of remission. Thus, therapy usually continues at a maintenance dose for a year or longer.

Correct answer: Antibiotics

Feline hyperesthesia syndrome is a diagnosis of exclusion. It does seem to have a higher prevalence in the Oriental breeds, including the Siamese, Persians, Abyssinians, or Burmeses. Generally, animals are one to five years old at diagnosis. There is no one specific treatment that has been shown to be fully effective in every patient. Basically, it is a hypersensitivity to a normally non-noxious stimulus (such as simple touch/petting) that triggers an inappropriate response.

Cats may aggressively groom or bite themselves (especially at flanks and tail bases). They may run around the home, have rippling of the muscles along their spine, and in severe cases, have seizure-like activity. They may cry out and even paddle with their feet, seemingly hallucinating.

Referral to a specialist, such as a dermatologist, neurologist or behaviorist, or all three, may be warranted to determine if there is an underlying etiology.

A food trial can be undertaken in case food allergy/dermatological reasons are contributing. Along the same lines, if allergies can contribute, ensuring proper flea/tick preventatives are used, even in indoor cats and even if no fleas are seen, is paramount.

Medications can be tried, such as atypical seizure medications with neurologic pain management properties like gabapentin or pregabalin. Typical seizure medications like phenobarbital can be tried. Behavior modification meds such as Selective Serotonin Reuptake Inhibitors (SSRIs) (fluoxetine) or Tricyclic Antidepressants (TCAs) such as amitriptyline may be helpful in some patients.

If diagnostics show no obvious causes, it becomes a trial and error to see what works for each patient. It may be that a combination of options is necessary. We still do not fully understand the condition, and more research is essential.

The condition may be maladaptive pain syndrome. Some patients may respond to anti-inflammatory medications such as Onsior or steroids.

Behavior modification in the home may also be beneficial, looking for other contributing factors such as inter-cat aggression, prevention of touching in trigger areas, and other related stressors.

Have owners log the behavior's frequency, type of activity, and when it occurred. Have the owner note what happened before, during, and after.

The prognosis is fair if a full workup and rule-outs have been appropriately considered.

Antibiotics are not indicated as there is no evidence that infection plays a role in the pathogenesis, despite not fully understanding this condition.

Correct answer: Babesiosis

Babesia bovis and B. bigemina represent one small and one large Babesia species of at least six species of Babesia known to affect cattle. They are the most common in the Western hemisphere. Babesia is a reportable disease in the U.S. Clinical signs are as with this patient or others on the farm and can include sudden death, abortion, icterus, anorexia, depression, fever 104–107.6°F (40–42°C), elevated heart and respiratory rates, anemia, with hemoglobinuria and hemoglobinemia.

Referred to as bovine babesiosis, piroplasmosis, Texas fever, redwater, tick fever, and tristeza, it will infect cattle as well as American bison, water buffalo, African buffalo, white-tailed deer, and reindeer. Thankfully, they are uncommon in wildlife populations and are unlikely to contribute as reservoirs.

Transmission occurs via ticks in the Boophilus genus. B. bovis can be transmitted by both stages of ticks, while B. bigeminia can only be transmitted by nymphs or adults. Through fomites that have been exposed to blood, both may be spread.

The disease is caused by intravascular red blood cell destruction as the organisms reproduce. In addition to mechanically pulling apart the RBCs as the organism replicates, they also induce a general osmotic fragility to all red cells, leading to massive destruction with minimal parasitemia required. Some animals will experience further immune-mediated destruction by their own spleen's removal of healthy and damaged cells.

Animals may also develop CNS disease with seizures, opisthotonos, hyperexcitability, coma, and death. This results from anoxia in the brain or destroyed red cells blocking the vessels' blood flow.

Eradication and prevention are critical for the prevention of vector exposure. This farm's vector control program must be amended, updated, and enforced. Methods to control ticks are paramount, and disinfection of equipment used for routine procedures such as dehorning or castrations must be ensured at all times. 

Differentials for this condition would include leptospirosis, chronic copper toxicity, bacillary hemoglobinuria, anaplasmosis, trypanosomiasis, or theileriosis. Theileriosis and trypanosomosis are both reportable as well. 

Correct answer: Providing a humane “good death” is you making a sacrifice for her

Sadly, finances played a big role in deciding not to pursue care for these clients. However, the dog’s current quality of life, clinical disease severity, cost of care with no guarantee of survival, and overall well-being were grave. A decision to euthanize was a sacrifice for the owners but in the patient’s best interest. Verbalizing this to the clients so they do not feel the decision was forced upon them because they lack finances is critical. We want them to know that it is a reasonable decision based on the severity of her clinical signs and the suffering ensuing if they took her home without hospitalization. Ensure they recognize that she is suffering; they brought her in the first place because they realized that. That would only continue if they took her home against medical advice.

Suppose you want to provide your clients with measurable parameters to evaluate the dog’s quality of life. In that case, you can use the mnemonic HHHHHMM: Hurt, Hunger, Hydration, Hygiene, Happiness, Mobility, and More good days than bad. This patient lacks all these things now. Putting our patient’s well-being first is key, while being compassionate and understanding of the owners’ concerns, beliefs, and wishes. An owner must realize that the quality of a pet’s life, regardless of how short it may be, is paramount to a humane life. In this case, yes, the prognosis is guarded, but with time, money, and treatment, she may improve, survive, and lead a healthy life. However, there are no guarantees even if they had all the money in the world. We want to take the emphasis off money and put it on the well-being and welfare of the patient.

Correct answer: Use of replacement gilts

One can talk about breeding, growing, or both when using an open herd. If a farmer plans to have all stages of growth and production vs. only grower animals, for example, it is their choice. However, the best recommendations for disease prevention and management include:

1. An All-in/All-Out (AIAO) practice where all animals are culled or removed simultaneously (either for disease or due to age-appropriate culling for the food supply) and replaced with all new animals. 
2. A single source for animal replacement, obtaining all pigs from the same farm effectively minimizes disease occurrence. Getting all animals from a single source is ideal for reducing the risk of endemic diseases (e.g., PRRSV, with its many variants and minimal cross-protection). It lessens the chance of different variations of the same disease entities from occurring and from introducing new strains of diseases.

When new animals are brought in, the timing also matters. If animals are culled together/leave the farm together and brought in, appropriate time needs to be devoted to proper cleaning and disinfecting before bringing in a new herd. This ensures a minimally contaminated environment and lessens the risk of exposing new animals to new pathogens. Further, it reduces the chance that new animals could trigger a disease outbreak.

The number of animals introduced matters as well. The more animals that are introduced, the higher the risk of infectious disease through herd immunity. If all are obtained from a single source, it may lessen the risk secondary to large numbers. The higher the population density, the higher the risk of disease occurrences, stressors, behavioral issues, etc.

Suppose a farmer plans to use replacement gilts as they are breeding. In that case, this is not an  AIAO strategy. Introducing new animals into the current herd increases the risk of exposure to new strains of diseases or diseases not yet seen by the current herd or the replacement gilts.

Ultimately, goals include maximizing both the individual and the herd's immunity by practicing sound biosecurity and management practices.

Correct answer: If the area is warm and painful, the kitten should be evaluated ASAP

Umbilical hernias are true hernias, meaning they are contained within a peritoneal sac. They are usually congenital due to abnormal embryogenesis. In the fetus, the vitelline duct, stalk of the allantois, and the umbilical vessels all pass through the umbilical ring. Normally, that aperture closes at birth. What remains is referred to as the umbilical cicatrix. An umbilical hernia results if this fails to contract, improperly forms, or is too large.

Usually, umbilical hernias are incidental findings on abdominal palpation, and they are often soft and reducible; with deep palpation, you can usually determine the opening size. In some animals, herniation of the falciform fat occurs, and a delayed closing of the ring happens, so you may not always feel a definable ring. Uncommonly, intestines or other structures may be palpable but are usually reducible into the belly.

Advise the owner, since this is a relatively large hernia, that if the sac is warm or painful and she cannot push it back into the belly, it is a true emergency as the patient could have GI obstruction/strangulation. However, this is very uncommon. Most umbilical hernias can easily be repaired at the time of spay. If performing the repair long after an animal was spayed (when you can incorporate the hernia into the incision and ensure to remove the sac before closing the body wall), one palpates the hernial ring, reduces any material /content if needed, incises the skin directly over the belly button. If the omentum can be ligated at the neck of the hernia, excise the sac and its contents. However, if there aren't any adhesions, you can also invert the sac with contents into the abdomen. Close the defect edges using a simple interrupted pattern with a monofilament, absorbable, synthetic sutures such as PDS, Maxon, Monocryl, or Biosn. For hernias that cannot be removed this way, an elliptical incision may be needed around the swelling to prevent damage to the herniated structures. If organs are involved, a normal midline incision should permit full exposure of the abdominal contents and exploration of the abdomen for intestinal viability. Then, repair the defect. 

Correct answer: Changing disinfectants from a peroxygen biocide to a phenolic disinfectant

Measures in an integrated management approach would include:

1. Change disinfectants from phenolic to peroxygen biocide like Virkon S® for equipment disinfection. Peroxygen products are great choices for routine environmental decontamination and footbaths, with rapid onset of activity. Further, it is environmentally friendly. Finally, it is more broad-spectrum than a phenolic compound.
2. Separate the sick into sick pens and the parturient animals into maternity pens
3. Good colostrum management
4. Separate footwear that is used only in specific pens and animal groups and not worn from one area to another
5. Strict hygiene protocols for proper hand disinfection as well as all equipment in between handling any sick animal or pregnant animal
6. Ensure separation of all feeds
7. Ensure the use of clean bedding in both pens
8. Have one person manage the calves who won’t handle other animals (sick or otherwise)
9. Avoid purchasing replacement animals from Salmonella endemic farms. Ideally, an all-in-all-out strategy is best.
10. Promptly separate out and treat any animals showing clinical signs
11. Ensure proper environmental cleanup
12. Ensure adequate rodent control to minimize environmental contamination and fomite transmission
13. Vaccines vary with efficacy and the age of the animal. Depending on your area’s incidence, epidemiology, and other factors, they may be recommended or not. Know the local data and how to interpret it before recommending for or against Salmonella vaccinations. Vaccines are available for S. enterica Typhimurium, Dublin, and Newport variants.

Correct answer: Clean the area with povidone-iodine or chlorhexidine scrub before evaluation/repair

Eyelid lacerations are common in horses, often because they too quickly pull away when their harness gets caught on something like a hook or nail or food bucket. The prominence of a horse's eye and their easily startled nature predisposes them to these injuries. In most cases, the trauma is usually just to the lid without globe damage, though corneal ulceration may result. Lacerations may also occur due to other trauma or blunt compression, in which the globe is more likely to be affected.

Never use chlorhexidine or povidone-iodine scrub anywhere near the eye, as these scrubs can be highly toxic to ocular tissue. A commercially prepared, ocular povidone-iodine solution may be used to flush ocular surfaces if necessary, allowing it to remain on the cornea for two minutes, then rinse with sterile saline. Scrubbing the flap should also be done with saline and a safe topical solution, not surgical scrub.

Do not remove any portion of the damaged lid. The eyelid margin must be repaired and replaced using a minimum of a two-layer closure, never suturing the conjunctiva or penetrating it. Even if viability is questionable, attempt to replace the tissue. Debride with a dry sponge or use a blade to scrape debris away. Avoid cutting any tissue off. Removal/improper eyelid margin repair can lead to chronic exposure to keratitis, trichiasis, or chronic keratoconjunctivitis. Make all attempts to preserve eyelid function or, at minimum, ensure they can sufficiently protect the globe. Even tissue that looks dead, due to the high vascular nature of the area, often heal well despite appearances.

When closing full-thickness lacerations, make sure to identify the tarsus (tarsal plate), the white connective tissue layer of the eyelid. This layer is critical to close first and is usually about 3/4ths deep in the lid. This is the layer where deep sutures are first placed, avoiding contact with the conjunctiva.

Administer tetanus vaccine prophylaxis. 

Administer broad-spectrum systemic antimicrobials perioperatively and for five to seven days post-op.

Post-operatively, topical broad-spectrum antibiotics should be used every four hours for the first 24–48 hours and then q six hours for seven to ten days, if tissue damage is severe or corneal integrity is questionable; otherwise, they are likely not warranted topically. An eye lavage system may be the best option to ensure compliance (owner and horse).

Systemic anti-inflammatory pain medications for pain management and inflammation control are warranted.

Prevent the horse from re-injuring himself/rubbing at the area.  

Ensure sufficient fly repellent.

Use petroleum jelly under the eye where drainage may occur, to prevent scalding of the area. 

Correct answer: Administer clenbuterol to aid in the replacement and relaxation of the uterus

Animals with dystocias (especially those secondary to hypocalcemia) or animals with hypocalcemia after calving are at increased risk of uterine prolapse. Lack of sufficient calcium leads to a delay in involution and a lack of uterine tone, increasing the risk of prolapse.

Replacement of the uterus first requires hydration (especially if the occurrence happened several hours before identification), cleaning of the affected organ, protecting it until surgery, and a mild presurgical scrub prior to replacement. Replacement can be done in recumbency or while standing; the choice is the doctor’s preference. In some countries, clenbuterol, a Beta-2 adrenergic agonist, can cause relaxation of the uterus and make replacement much easier. However, the FDA forbids the use of this drug in the US in food-producing animals. An epidural anesthetic is recommended, though many claim it is unnecessary. However, pain management needs are greatly underappreciated in food-producing animals, and it is humane to provide this service. If there are any uterine tears, these must be repaired before replacement.

Once the uterus has been replaced, administering oxytocin (5–40 IU IV or IM) can help stimulate uterine contractions, which will help keep it in place and improve the chances of involution, though it is an off-label use for it. Most commonly in cattle, oxytocin is used to aid in retained fetal membranes, for mild to moderate cases of acute postpartum metritis (for which those with uterine prolapse are at higher risk), or to augment uterine contractions during delivery. However, it is frequently used for additional obstetrics-related matters, such as uterine prolapse. 

Correct answer: Feed analysis documenting ionophores in feed higher than expected/acceptable levels

Ionophores have been added to cattle and poultry feed to increase growth and for their properties to combat coccidiosis. This product can increase propionic acid ruminal production with ruminants, leading to improved feed efficiency. A positive benefit is that they can help reduce the risk of rumen acidosis and emphysema. We see toxicosis develop when feed rations are improperly mixed. Horses are the most susceptible livestock, but cattle can also develop clinical diseases.

Diagnosis is based on the clinical signs, postmortem findings, and analytic proof  (ideally) of exposure. Bloodwork can aid the diagnosis, showing elevated liver values, CPK, dehydration, and, sometimes, myoglobinuria.

In cattle, it can be difficult to document ionophore toxicosis. However, this case represents classic clinical signs induced by cardiac damage, subsequent congestive heart failure, and related signs. This, in conjunction with typical necropsy findings, helps with the diagnosis. Ideally, identifying the feed as the source of an excess of ionophores confirms the diagnosis. However, if feed isn't available for analysis, the stomach contents and or tissue can be tested for ionophores. No blood test currently exists to diagnose this toxicity.

Treatment includes removing the source of toxicity and supportive care. Decontamination is also paramount when feasible (activated charcoal and/or gastric lavage). The ultimate goal is to restore cardiac output and perfusion, address abnormal cardiac rhythms, and provide nutrition when needed.