Mammary Neoplasia, endocrinopathy and nutrition

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Can you name the Mammary Neoplasia, endocrinopathy and nutrition

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True or false: mammary neoplasia is the most common tumor in female dogs?
 
Dogs typically present with benign mixed mammary tumors or, if malignant, ________
 
True or false: cats get mammary tumors more often than dogs, but are less likely to get adenocarcinoma?
 
What is the risk compared to an intact dog for a female spayed after her first heat but before her second?
a) 0.05% b) 8% c)26% d)50% e)none of the above 
What are you checking for with chest radiographs, when a patient presents with suspected mammary neoplasia?
 
True or false: bigger malignant tumours have a worse prognosis?
 
True or false: surgery is the treatment of choice for all malignant mammary neoplasia?
 
True or false: OHE should be performed prior to removing mammary masses to prevent further tumor development?
 
Which of the following is the worst prognostic indicator for dogs with mammary neoplasia?
a)multiple masses b)size over 3cm (single mass) c)LN involvement d)distant metastases 
What may be confused with adenocarcinoma of the mammaries in intact female cats under 2 yo?
 
True or false: multiple masses have more effect on prognosis for cats than for dogs with mammary neoplasia?
 
Which of the following is a potential side effect of malnutrition?
a)altered energy metabolism b)negative nitrogen balance c)muscle catabolism d)increased intestinal permeability and chance of sepsis e)all of the above 
What drug would you use in the treatment of inflammatory carcinoma to give them as long as possible?
 
A patient is considered at risk of malnutrition after not eating for __ hours or being under RER for __ hours.
 
 
Hepatic glycogenolysis begins around _ hours after the last meal, and ends around __.
(Exogenous glucose disappears by the start time, gluconeogenesis begins simultaneously, peaks at the end time and tapers off afterwards.) 
 
Ketosis typically begins at _ days into food deprivation
 
Which of the following would be characteristic of cachexia rather than simple starvation?
a)normal appetite until end stage b)feeding increases appetite and body weight c)metabolism is down regulated after 3-4 days d)preference towards muscle breakdown over fat e)down regulation of thyroid hormone levels 
Name a substance that is involved in driving a cachexic state?
 
True or false: when supporting a cachexic patient nutritionally, you should support their metabolic changes, not try to reverse them?
 
Which of the following methods is unacceptable as a form of enteral nutritional support?
a)nutritional encouragement b)appetite stimulants c)force feeding d) feeding tubes e)all of the above are acceptable 
What appetite stimulant would you select if you also wanted an anti-emetic effect?
I'll be nice and give you options! Cyrpoheptadine, benzodiazepines, corticosteroids, mirtazapine. 
This manner of feeding tube is only acceptable in neonatal puppies, kittens or birds due to risks of food aversion and food aspiration.
Essentially force feeding in others. It is placed at each feeding. 
These two types of enteral feeding tubes are the only ones that allow for meal administration, rather than constant small amounts of food?
Name one, get both. 
What type of enteral feeding tube may be left in place the longest?
 
Vomiting may displace these two types of enteral feeding tubes?
 
True or false: the worst potential side effect of a gastrotomy tube is the formation of a fibrous tract between the stomach and body wall?
 
True or false: although it is more expensive, parenteral nutritional supplementation is preferable in most cases to enteral?
 
When feeding a critically ill patient, ___ should be your main calorie source rather than ______, and _____ should be high to spare endogenous muscle components.
 
 
 
To calculate RER, multiply __kcal x BW^0.75
On the first day feed 1/3 RER, 2/3 on the second day, full RER by the 3rd, all in multiple small meals per day. 
The stomach may hold approximately __mL/kg of body weight?
 
Refeeding syndrome involves decreases in all of these except for?
a)insulin b)potassium c)magnesium d)phosphate e)none of the above 
True or false: approximately 90% of canine hypothyroidism cases are primary?
 
Which of the following breeds is not mentioned as being over-represented in hypothyroidism studies or prone to hereditary thyroiditis?
a)beagle b)borzois c)pug d)golden retriever e)doberman 
Which of the following clinical signs would not be associated with hypothyroidism?
a)dry scaly skin, alopecia b)weight loss c)mental dullness d)exercise intolerance e)cold intolerance 
When medication or other illness has altered thyroid levels without causing hypothyroidism, this is termed ______ ____ syndrome
 
Measuring this thyroid hormone parameter in the blood is an excellent screening test- normal results make hypothyroidsm extremely unlikely.
If it is low or low-normal it doesn't necessarily mean hypothyroid though, it could be euthyroid sick syndrome. 
True or false: fT4 is more affected by drugs and disease than TT4, hence it's rarely used as a screening test.
 
True or false: TT3 is less accurate due to greater fluctuations in normal dogs than TT4 (for diagnosis of hypothyroidism)?
 
Which of the following may be a cause of decreased TT4?
a)hyperadrenocorticism b)hypoadrenocorticism c)diabetic ketoacidosis d)heart failure e)all of the above 
For hypothyroidism, which of the following would you expect to be high?
a) TT4 b)fT4 c)TSH d)none of the above 
True or false: anti-thyroglobulin antibodies are confirmatory for a diagnosis of hypothyroidism?
These are the most common antibodies seen with hypothyroidism (50% of patients) 
A positive test (for hypothyroidism) on TSH response is a ___ pre and a ___ post test TT4?
____, ____ 
What's the normal treatment for hypothyroidism, drug wise?
First recheck at 4-6 weeks. 
You expect this change in 1-2 weeks after starting drug therapy for hypothyroidism, this one in 8 weeks, this one in several months.
 
 
 
True or false: hypothyroidism carries a positive prognosis regardless of adult onset or congenital type?
 
The rare, severe form of hypothyroidism causing cerebral dysfunction and coma can be referred to as?
 
True or false: hypothyroidism is more commonly a problem in dogs, hyperthyroidism in cats.
 
Which of the following is least likely to be associated with a hyperthyroidism patient?
a)polyphagia b)hyperactivity c)anorexia d)goitre e)PU/PD 
What is the most common cardiac abnormality in association with feline hyperthyroidism?
 
Name a DDx for hyperthyroidism in cats?
 
True or false: at least one liver enzyme tends to show elevation with hyperthyroid cats?
 
True or false: elevated TT4 count is extremely specific for hyperthyroidism?
 
Hypertension associated with hyperthyroidism, if severe, may cause these ocular complications?
 
In treating hyperthyroidism, we often can unmask this condition by reducing hypertension, and therefore GFR...
Hence it is usually recommended to start with a therapeutic agent that is not curative, to check if this shows up. 
This drug, when given to hyperthyroid patients, inhibits T3 and T4 production without destroying thyroid tissue.
 
This is considered the safest, simplest, and most effective treatment for hyperthyroidism. It kills hyperplastic cells.
Atrophied normal tissue normally returns to function. 
What diet is ideal for iodine restriction required by hyperthyroid patients?
PLEASE REPLACE ANY SLASHES IN THE NAME WITH DASHES. SPORCLE IS NOT SO GOOD ON SLASHES. 
Which of the following is the most commonly observed side effect of methimazole treatment?
a)hepatotoxicity b)blood dyscrasias c)IMHA d)vomiting e)facial excoriation 
True or false: canine hyperthyroidism, unlike the feline variety is uncommon and usually involves thyroid carcinomas?
 
Cushing's syndrome is also termed ___________. Addison's disease is also termed ___________.
More common in dogs. Rare and debilitating in cats. 
 
True or false: as with hypothyroidism, most cases of cushing's are primary to the adrenal glands?
 
Which of the following breeds is not generally predisposed to Cushing's syndrome?
a)poodle b)pug c)dachshund d)beagle e)boxers f)terriers 
Which of the following clinical signs would NOT be associated with Cushing's disease?
a)PU/PD b)polyphagia c)abdominal enlargement d)thickened skin e)alopecia 
This liver enzyme is increased in 90% of cushing's patients.
 
Which of the following is a differential for Cushing's?
a)renal insufficiency b)diabetes mellitus c)hypothyroidism d)all of the above 
Which of the following is the worst (least sensitive) of the three screening options for cushing's disease?
a)urine cortisol:creatinine ratio (UCCR) b)ACTH stimulation test c)LDDST 
Which of the following cortisol nmol/L concentrations would indicate Cushing's after an ACTH stim test?
a)160 b)430 c)470 d)603 
What screening test would you use to differentiate PDH from AT?
A temporary drop in cortisol levels is characteristic of PD-HAC (most of the time, sometimes there is very little effect), with adrenal tumours the cortisol secretion is not mediated by ACTH so it's not affected. 
Which of the following Cushing's treatments would you associate with lysis of the adrenal cortex?
a)mitotane b)trilostane c)selegiline d)none of the above 
Which of the following Cushing's treatment does not target the adrenals directly?
a)mitotane b)trilostane c)selegiline d)ketoconazole 
Which of the following Cushing's treatments blocks an enzyme intermediate in cortisol production?
a)mitotane b)trilostane c)selegiline d)ketoconazole 
PU/PD will resolve in the first month of Cushing's medication, but ____ and ______ will take 3 or more months to normalize.
 
A flatline of under 28 nmol/L pre and post ACTH stimulation test is characteristic of this unusual type of Addison's?
 
If a patient presents with signs of Cushing's but has persistently normal endocrine tests, what else should you measure aside from cortisol?
 
This type of adrenal tumour secretes excess catecholamines, causing episodic hypertension and tachycardia.
 
Describe in order the species, age (in young, middle aged, old) and sex of the typical Addison's patient?
____, _____. _____ 
True or false: a stress leukogram would be characteristic of Addison's?
 
Name the thre elayers of the Adrenal cortex in order from outermost to innermost?
Salt- mineralocorticoids 
Sugar- glucocorticoids 
Sex- sex hormones 
True or false: Addison's can be associated with a decreased ratio of sodium ions to potassium?
 
What is the most common etiology of Addison's?
 
What layer of the adrenal cortex is spared by atypical primary Addison's?
This also tends to be the case with secondary Addison's. 
Name one of the two drugs you might associate with iatrogenic primary Addison's?
 
True or false: Addison's may be iatrogenic in a secondary sense through administration of corticosteroids, which can depress ACTH production through negative feedback.
 
Which of the following breeds is not predisposed to Addison's disease?
a)West Highland White Terrier b)Great Dane c)Toy poodle d)pug e)standard poodle 
What is the nickname given Addison's due to the lack of pathognomonic signs, the waxing and waning of clinical signs and the chronic progression to acute Addisonian crisis?
 
Which of the following signs is not characteristic of Addisons?
a)lethargy b)anorexia and GI signs c)PU/PD d)hair loss e)weight gain 
An _______ ____ is characterised by acute collapse, shock, and sometimes hematochezia or melena due to hypoadrenocorticism.
 
True or false: you can rule out Addison's based on basal serum cortisol levels over 55 nmol/L?
 
This drug may be used in initial treatment of suspected Addison's disease without interfering with ACTH response testing.
 
If the pH measures under ___ this is life threatening and needs to be addressed along with treating the rest of Addisonian crisis signs.
Other signs including high potassium, hypovolemia, possibly hypoglycemia, other electrolyte abnormalities, lack of glucocorticoid and mineralocorticoid (not as urgent). 
True or false: most lifelong patients of Addison's disease do not require mineralocorticoid supplementation?
 
Which medication would you give for mineralocorticoid and glucocorticoid effects?
Prednisone is the choice for glucocorticoid supplementation. 
True or false: Addison's has a much worse long term prognosis than Cushing's?
 

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Created Jan 24, 2014ReportNominate
Tags:nutrition