AAVSB VTNE Exam Questions

Correct answer: The safelight must have a proper filter

In a darkroom with x-ray film, one needs to ensure the unused film remains unexposed and, when processing, that the exposed film doesn't get damaged. To do so, one needs to see properly but safely to prevent film fogging.

Safelight has 3 characteristics to ensure fogging doesn't occur:

1. The bulb is no more than 15 watts
   2. The safelight is mounted 4 feet or higher from the workstation. Light that is closer and higher intensity is more likely to cause film exposure.
   3. The safelight must be properly filtered with a color, usually dark red, to ensure proper removal of the wavelength of light that the film is sensitive to.

Correct answer: Mandibular distoclusion

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: 4-5

Calculate the administration rate in mL/d: 40 kg x (66 mL/kg/d) = 2640 mL/d

Convert time downward in steps: (2640 mL/d) / (24 hr/d) / (60 min/hr) / 4 (there are 4 periods of 15 seconds per minute) = 0.458 mL per 15 sec

Convert mL to drops: 0.458 mL x (10 drops/mL) = 4.6 drops should be counted per 15 sec

Correct answer: Cast padding is popping through at the top of the bandage

The owner was discharged with an e-collar for a reason. Owners always think their pet will not go after the bandage and do not realize that if they leave the room for a second and return, that can be enough time for them to do serious damage. If cast padding is popping up through the top of the bandage, this could be poor bandaging technique, insufficient elasticon at the top, or because the pet was chewing. As long as the bandage remains dry and clean, they do not need to bring the pet in, but the pet should always have the cone on. Be sure to explain to the owner that the pet should wear the e-collar when they leave a room, are asleep, or are out of sight for any reason, especially when left alone for any time. We do not want the pet to go after the cast padding, as it could become a foreign body hazard, cause GI upset, damage the bandage, and cause moisture to build up.

There are six key things to have the owner monitor while the pet is wearing a bandage:

1. Bandage positioning: The owner should evaluate the bandage and note any slippage or looseness of the bandage/splint. If it has slipped significantly, the bandage must be replaced to prevent the splint from shifting. If this shifts, it could prevent fracture union and cause additional complications.
2. Skin irritation around the bandage edge: If noted, while it may not need to be evaluated right away, it could suggest the splint is too long or too sharp and needs to be cut — the pet is licking because it is uncomfortable or other there are other abnormalities, and thus, the pet should be re-evaluated.
3. Bandage discoloration: Staining may occur, changing the color of the bandage. This can be concerning and suggestive of possible wetness on the outside of the bandage or from strike-through if there is interior discharge. This patient should be seen immediately. The bandage must be removed, and the fracture site and skin should be evaluated.
4. Moisture: Anytime a bandage, splint, or cast becomes wet, it must be changed immediately. The risk of bacteria whicking into the area is high. Further, moisture can lead to sores and delay healing.
5. Odor. We all know that bad smell that arises from a wet or infected area. Why owners do not comprehend that this is not normal is hard to say. But if they know from the beginning to look for it and pay attention to the lack of smell regularly, they will be more likely to recognize it when it arises. This can signify infection and should be immediately evaluated.
6. Bandage chewing: We all know the telltale signs of chewing — torn tape, wet areas of the bandage where the pet can reach, or discoloration from moisture. If the owner sees this and the pet hasn't been wearing a cone, the owner should always be advised to keep the cone on at all times. But, the bandage should be assessed and changed as needed. This can be a sign of pain, and the pet's pain protocol may also need to be re-evaluated.

Owners should also be advised to look for signs of pain. If the patient is fully weight-bearing, albeit awkwardly, once the splint and bandage are in place and suddenly stops putting weight on it, or if the patient was not going after the bandage with the e-collar off but suddenly starts to, this could be a sign of pain and the pet should be re-evaluated.

Remind the owner to always have the bandage covered while the pet is outside, regardless of whether the ground is wet. But ensure the owner removes the covering upon returning inside.

Correct answer: Diaphragmatic hernia

Morphine, a pure mu-opioid agonist, is the prototypical opioid, and it is potent and effective in pain management. Still, it has unwanted side effects, including histamine release and a higher incidence of vomiting compared to other opioids.

This drug should be avoided in brachiocephalic breeds (short-snouted) where we do not want any risk of vomiting.

Additionally, in any disease or state where we do not want to induce vomiting or vomiting, such as with a diaphragmatic hernia or intestinal obstruction, morphine would be contraindicated.

Dolichocephalic breeds are less likely to have aspiration develop and thus, can use this drug if desired.

Finally, routine spays, breed permitting, can use morphine, though most practices have gotten away from using it for preanesthetic use and pain management in favor of opioids with much fewer side effects.

Correct answer: Lameness or muscle swelling

The majority of horses demonstrate no clinical signs of Lyme disease. However, commonly seen signs may include a low-grade fever, mild lameness, muscle soreness or stiffness, joint swelling, rash, sensitive skin, uveitis or weight loss. Lyme disease is not easily detected, as clinical signs in horses can be vague and similar to other diseases.

Anemia and icterus are not clinical signs associated with Lyme disease in horses; however, they are clinical signs that are associated with anaplasmosis, another infection caused by ticks of the genus Ixodes.

Correct answer: Arthrocentesis

-centesis is a common medical suffix for withdrawing tissue or fluid with a needle.

• Arthrocentesis: Joint, synovial fluid
• Abdominocentesis: Abdominal cavity, peritoneal fluid
• Cystocentesis: Urinary bladder, urine
• Pericardiocentesis: Pericardium, pericardial fluid

Correct answer: Gastrointestinal tract

Escherichia coli (E. coli) is found in the gastrointestinal tract (including in the saliva) in mammals. There are numerous pathological strains of E. coli which can cause diarrhea, cystitis, and wound infections.

E. coli is not normally found in the lungs, ears, or skin/fur surfaces. Though it can be found in the upper respiratory system, such as in the nares, as well as lower down, in the trachea. 

Correct answer: Flea and tick preventatives

Fipronil is most commonly found in over-the-counter flea and tick preventatives. It is applied topically once monthly. As an environmental treatment, Fipronil is used to control fleas, ticks, ants, cockroaches, beetles, termites, thrips, weevils, rootworms, and mole crickets.

Fipronil is not an active ingredient in heartworm preventatives, hookworm and roundworm preventatives, or tapeworm preventatives.

Correct answer: Plasma fibrinogen

The most abundant coagulation factor in the body is fibrinogen. Produced by the liver, levels decrease with a failing liver and genetic factors and during clot formation (consumption). However, the production of the factor increases in the face of inflammation. Plasma fibrinogen concentrations are measured using heat precipitation. This concentration acts as a marker of inflammation for species such as cattle and horses when elevated. It is simple to perform.

• Fill two hematocrit tubes between 2/3 and 3/4 of the way full with anticoagulated (via EDTA) blood
• Centrifuge both tubes as you would for a PCV
• Break one of the tubes slightly above the buffy coat
• Use one of the unbroken ends to fill a hemocytometer prism
• A hemocytometer allows for manual cell counts
• Read the total protein (TP) line (g/dL) by using the scales for plasma protein concentrations
• Next, heat the second tube in a water bath at 56^▫C (132.8^▫F) for three minutes. This precipitates the fibrinogen.
• Re-spin the heated tube. This causes the precipitated fibrinogen to settle right above the buffy coat.
• Then, break the tube above the buffy coat, and determine the TP in g/dL
• Calculate the concentration of fibrinogen using the following formula:

(TP unheated tube – TP heated tube) x 100 = mg/dL fibrinogen concentration

Additional means to test for fibrinogen include immunological methods and tests for fibrin clot formation. Note that the heat precipitation test is not very accurate when performed in the face of low fibrinogen levels. But since we are evaluating for an elevation in the face of presumptive inflammation, it is considered a valid easy test. 

Plasma protein concentrations are evaluated simply via a refractometer. 

PT/PTT measures coagulation factors, not inflammation, and special analyzers are needed to run these tests. 

C-Reactive protein is produced by the liver and is another indicator of inflammation, but this is a calculated value and not evaluated by the heat precipitation test. 

Correct answer: C-section

Ventral recumbency, or the patient lying on their stomach, would be needed for surgery on the rectal and related areas. These would include perineal urethrostomy (PU), an anal sacculectomy, and rectal fistula surgeries.

For abdominal surgeries, such as ovarian hysterectomies, cesarian sections, and abdominal GI exploratory surgeries, patients are placed in dorsal recumbency. 

Correct answer: Minimize patient’s physical and emotional stress

Our surgical patients are stressed emotionally and physically in an unfamiliar environment due to being fasted, around strangers, and even sick (non-routine procedures). We need to do all we can to take these stressed individuals—some with potentially compromised immune systems—and minimize all risks of complications, including infections.

Having a set written surgical attire protocol or dress code helps lessen the risk of infection. We can:

1. Minimize microbial shedding. This phenomenon arises when bacteria are released into the surrounding environment via a surgical personnel’s body. Microorganisms can be shed from people’s sweat and sebaceous glands and easily contaminate surfaces. Personal protective equipment and proper surgical attire help to minimize contamination by acting as barriers.
2. Define set areas where specific attire should be worn and particular items such as a gown, mask, and gloves are required.
3. Ensure that the dress code is properly posted and shared with all, well before even entering the surgical prep area, to maximize the potential to prevent contamination.
4. At a minimum, properly laundered and unused scrubs, masks, head coverings, and booties are ideal for any dress code.
5. Jewelry, especially for scrubbed-in personnel, should be removed. Still, careful consideration should be given to all personnel in the surgical suite, as anyone can be a source of contamination. This could include earrings, necklaces, and rings.

Correct answer: Local analgesics

All of the answer choices can be used in small ruminants. NSAIDs such as Banamine (flunixin meglumine) and bute (phenylbutazone), alpha₂-agonists, and butorphanol can be used. However, when generalizing across all ruminants and recognizing that herd medicine plays a big role in pain management and overall cost concerns, local analgesics are the number one used modality for pain management. 

The most common local analgesics used are lidocaine and bupivacaine. Various local techniques such as local field blocks, IV regional blocks, paravertebral blocks, and epidurals may be used.

Correct answer: 99.5 degrees Fahrenheit

The normal temperature for both dogs and cats is between 100 and 102.5 degrees Fahrenheit (37.8 and 39.2 degrees Celsius). Some dogs when very excited, for example when at the vet hospital, can get up to 103.5 and still be within the normal acceptable range. Anything over 103.5 would be considered a fever or elevated temperature and should be evaluated further. 

Correct answer: Ketamine

TIVA, or total intravenous anesthesia, allows general anesthesia sans inhalant. Rather than maintain an animal on gas such as isoflurane and provide intermittent boluses of IV anesthetics/sedatives such as xylazine or ketamine intraoperatively, all injectable medications are used.

Combinations commonly used for TIVA include a dissociative such as ketamine with a variety of alpha₂-agonists +/- guaifenesin, ketamine, and a benzodiazepine or a propofol CRI or intermittent boluses of propofol.

Ketamine alone would be insufficient for total anesthesia because, while it provides some somatic analgesia, it does not produce any muscle relaxation, simply a state of immobilization or catalepsy. When given alone, it can increase the risk of excitement on recovery or induce prolonged or unreliable recoveries. When used alone, dissociatives do not produce a state of general anesthesia and thus, would not be sufficient for a TIVA protocol. Additionally, dissociatives increase muscle tone and sensitivity to sound and light, maintain intact reflexes, and can increase both heart rate and blood pressure. By giving other medications, you can balance out these effects to reach a normal steady-state for the heart and body.

Correct answer: Bone cancer 

Bisphosphonates belong to one class of drugs commonly used to treat osteoporosis/osteopenia in humans. However, primarily in dogs, they may be used to treat bone cancers, most commonly as an adjunct therapy in managing osteosarcomas (OSA), and to address any bony metastases or osteolytic lesions secondary to OSA or other cancers. These drugs accumulate on a bone's surface and inhibit osteoclastic resorption, leading to bony formation. Increasing bone density and formation would improve stability and lessen pain in the affected areas. Additionally, strengthening the bone can minimize the risk of pathological fractures, common with OSA and similar cancers.

It would not be beneficial in arthritis, where the loss of bone isn't the problem (osteopenia or osteoporosis). Squamous cell carcinoma and transitional cell carcinomas do metastasize, but not usually to bony lesions. Thus, bisphosphonates would not be indicated.

These medications are costly, and studies have shown mixed results with their use. However, it is worth knowing about them and being able to educate your clients appropriately on all options available to them.

Correct answer: Animals derive more benefits from the human-animal bond than humans

The human-animal bond is a strong entity. For some, it can be hard to define; for others, it is intuitive and easily accepted. Pets are considered family members, comparable to children. We often anthropomorphize, and people may dress their pets in clothes, expect to take them wherever they go, impart human emotions to their pets, and more. But this is becoming more accepted and understood.

Regardless of how an owner acts at the time of euthanasia or when death results, this loss process is traumatic. Some will manifest grief as anger, others denial, and others may be silent and not show emotion. Just because clients aren’t crying their eyes out doesn’t mean the loss isn’t hard for them.

Scientific studies show that humans and animals benefit from the human-animal bond. While it is hard to say who benefits more, research shows improved parameters in people, such as lower heart rates, blood pressure, and enhanced mental parameters due to animal-human interactions. Fewer studies show the benefits of the animal's interactions with people. Thus, we cannot say animals benefit more or less than humans, simply that the relationship is mutually beneficial.

Correct answer: Shepherd’s hook; periodontal probe

A variety of dental explorers are used in veterinary medicine. They include the shepherd’s hook, pigtail, or Tufts explorers, among others. However, in veterinary medicine, we often use a double-sided instrument that includes a shepherd’s hook on one end and a periodontal probe.

A shepherd’s hook has a sharp tip, detects caries and any fractured teeth, allows excellent tactile sensitivity, and is commonly used to detect subgingival plaque and enamel defects.

Correct answer: When placed correctly, the bandage will protect the injury so that exercise does not need to be restricted

Exercise should always be limited when a bandage is in place to help the injury heal faster and decrease the chances that the bandage becomes displaced.

Bandages are not fully waterproof, so it's important that they stay clean and dry to prevent moisture wicking to the skin surface.

Most animals are uncomfortable with the restrictions a bandage places on their mobility and will lick and chew to get it off. When not under direct supervision, an e-collar is often recommended to prevent the patient from prematurely removing the bandage.

Bandage complications can be serious, especially with risk of infection or restrictions on circulation. Odor and swelling are problems that should be addressed immediately.

Correct answer: Butorphanol

Butorphanol is a mixed mu-opioid agonist. The most commonly used mixed opioid agonists in veterinary medicine include butorphanol (a class CIV) and buprenorphine (a class CIII), both of which are controlled. The pure mu agonists are CII (methadone, morphine, fentanyl, hydromorphone).

Etomidate and propofol are both short-acting injectable anesthetic drugs that are not federally controlled substances. However, many states or individual practices treat propofol as a controlled substance due to concerns about misuse and theft. While the drug is abused, it isn't associated with physical dependency, which is the criteria used by the Drug Enforcement Agency (DEA) to determine a medication's need to be controlled.

Dexmedetomidine is an alpha-2 agonist used for pain management, sedation, and other related uses. It is reversible but not a controlled substance.