Equine Medicine

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FELLOWSHIP EXAMINATION
JUNE/JULY 2004
EQUINE MEDICINE
PAPER 1
Perusal time: 20 minutes
Time allowed: THREE (3) Hours after perusal
Answer only FOUR (4) of the six questions.
All questions are of equal value.
Subsections of Questions are of equal value unless stated otherwise
EQUINE MEDICINE 2004 – FELLOWSHIP – PAPER 1
Answer only FOUR (4) of the six questions.
1)
Antimicrobial drugs are important tools in the medical treatment of horses. For each of the
following antibiotics describe the potential adverse effects of administration to both adult horses
and to foals. Your answer should include mechanism(s) of toxicosis, clinical signs and diagnosis
and strategies useful for reducing the risk of adverse effects.
i)
ii)
iii)
iv)
v)
Erythromycin
Gentamicin
Doxycycline
Enrofloxacin
Procaine penicillin
2)
Corneal opacity is a common manifestation of ocular disease in horses. List the causes of corneal
opacity and for each of these describe the pathogenesis, how you would distinguish between them
and what treatments you would use.
3)
Discuss peripheral Cushingoid syndrome (equine metabolic syndrome).
4)
Infectious organisms have unique features that enable the organism to invade the host, evade the
host’s defence mechanisms and cause disease. Describe these mechanisms of pathogenicity for
the following infectious agents or diseases:
i.)
ii)
iii)
iv)
5)
Rhodococcus equi
Salmonella typhimurium
Streptococcus equi subspp equi
Equine Infectious Anaemia
Gastrointestinal motility is complex and effective coordination involves the central, autonomic
and enteric nervous system.
i)
Describe the role of the autonomic and enteric nervous system in gastrointestinal
motility. (6 marks)
ii)
Describe the proposed pathophysiology of ileus in the following conditions:
(9 marks)
a.
Peritonitis
b.
Endotoxaemia
c.
Duodenitis-proximal jejunitis
iii)
Explain the proposed mechanisms of prokinetic action (promotion of gut
motility) by the following drugs: (10 marks)
a.
Lignocaine
b.
Erythromycin
c.
Neostigmine
d.
Metoclopramide
e.
Bethanechol
Continued over/Equine Medicine 2004/Paper 1
Continued/Equine Medicine 2004/Paper 1
6)
Clostridium botulinum and Clostridium tetani produce neurotoxins that cause different clinical
syndromes in the horse.
a.
Describe and contrast the mechanisms and clinical implications of action of these specific
neurotoxins in the neuromuscular system of the horse. (10 marks)
b.
Discuss pathogenesis of botulism in the horse and the diagnosis of the different disease
syndromes it causes in the horse. (15 marks)
END OF PAPER
FELLOWSHIP EXAMINATION
JUNE/JULY 2004
EQUINE MEDICINE
PAPER 2
Perusal time: 20 minutes
Time allowed: THREE (3) Hours after perusal
Answer only FOUR (4) of the six questions only.
All questions are of equal value.
Subsections of Questions are of equal value unless stated otherwise
EQUINE MEDICINE 2004 – FELLOWSHIP – PAPER 2
Answer only FOUR (4) of the six questions only.
1)
A three-year-old Thoroughbred filly in work is presented because she has a cough and has been
racing poorly. Describe and discuss in detail your approach to diagnosis and management of this
filly’s problem. (25 marks)
2)
You are asked to examine a six-week-old Thoroughbred colt. He has been found depressed and
off the suck and spends a lot of time drinking from the water trough. There is a small amount of
watery faeces on his perineum. Clinical examination demonstrates mild dehydration based on
skin turgor, a heart rate of 50 bpm, a respiratory rate of 30 bpm, normal mucous membrane colour
and a capillary refill time of 2 seconds. His temperature is 39.0o C. Close examination shows that
the foal is less responsive than normal to handling, and is apparently blind. Intermittently without
provocation the foal kicks out violently to the rear. Blood is sampled and tested, giving the
following clinicopathologic results:
Colt
Reference Range
Haematology:
RBC x 1012/L
Haemoglobin g/dL
PCV L/L
WBC x 109/L
Band neutrophils x 109/L
Neutrophils x 109/L
Lymphocytes x 109/L
Monocytes x 109/L
Eosinophils x 109/L
12.0
14
0.32
30.2
0.5
23.0
4.7
2.0
0
7-13
11 - 17
0.26 - 0.45
6.5 - 12.0
0 - 0.1
2.5 - 8.5
1.5- 6.4
0 - 0.5
0 - 0.5
Biochemistry:
CPK u/L
AST u/L
Alk Ph u/L
Bilirubin umol/L
Creatinine mmol/L
Urea mmol/L
Glucose mmol/L
Total plasma protein g/L
Albumin g/L
Sodium mmol/L
Potassium mmol/L
Chloride mmol/L
Fibrinogen g/L
Gamma GT u/L
430
180
509
20
0.20
10.0
6
60
25
108
3.6
83
7
12
50 - 270
90 - 450
40 - 400
4 - 40
0.10 - 0.17
4-8
4-8
52 - 72
28 - 40
135 - 145
3.0 - 4.8
99 - 108
2-4
< 30
Describe your approach to the investigation and management of this case. Your answer
should include:
a.
b.
c.
d.
Interpretation of each of the abnormal laboratory results with reference to the clinical
findings
(8 marks)
A list of differential diagnoses
(5 marks)
Details of any further investigations you might initiate
(7 marks)
How you would treat this colt
(5 marks)
Continued over / Equine Medicine Paper 2 / 2004
Continued/Equine Medicine/ Paper 2 / 2004
3) For each of the following clinical situations, outline your approach to further assessment and
treatment, and comment on the prognosis:
4)
5)
a.
A foal born three weeks prematurely, that is limp, poorly responsive, and not breathing,
with a heart rate of 30 beats per minute.
(7 marks)
b.
A weanling Thoroughbred colt that pulled back while being taught to lead, and fell
backwards. Twenty minutes after the accident the colt is still unconscious on the ground.
(6 marks)
c.
A two-year-old Thoroughbred filly with oedematous plaques distributed over her face
and sides of her body.
(6 marks)
d.
A 12-year-old pony mare recently foaled, found stiff and reluctant to move.
(5 marks)
A 16 year old riding pony was stabled for 3 weeks due to a paddock injury. The owners have
noticed the pony is drinking and urinating excessively.
a.
List your possible differential diagnoses and describe the pathogenesis of the
polydipsia/polyuria in each case.
(15 marks)
b.
Describe the diagnostic techniques you would use to establish a specific diagnosis.
(10 marks)
A 19 year old 136kg pony mare is presented for further evaluation of mild colic and diarrhoea.
Four days prior to admission the pony ate 2.5kg of grain, two days later becoming acutely lame.
She was diagnosed with and treated for laminitis. She was given 2 gms of phenylbutazone and 1.3
gms of ketoprofen intravenously and continued on 2 gms of phenylbutazone orally twice daily.
On physical examination she is bright although reluctant to eat and has infrequent pipe-stream
diarrhoea. Her mucous membranes are hyperaemic, with a capillary refill time of 3 seconds. Her
heart rate is 85 beats/min, respiratory rate is 48 breaths/min, and temperature is 38.7oC. No
abnormalities are detected on cardiac, thoracic and abdominal auscultation. All feet are warm
with increased digital pulses, she exhibits pain on circling and front legs are shaking when
standing still. Her initial laboratory results are as follows:
Continued over /Question 5/ Equine Medicine Paper 2 / 2004
Continued/Question 5/Equine Medicine Paper 2 / 2004
Question 5 (continued)
HAEMATOLOGY
RBC x 1012/L
HAEMOGLOBIN g/L
PCV L/L
MCV fl
MCH pg
MCHC g/L
Total WBC x 109/L
BAND NEUT x 109/L
NEUTROPHILS x 109/L
LYMPHOCYTES x 109/L
MONOCYTES x 109/L
EOSINOPHILS x 109/L
BASOPHILS x 109/L
PLASMA PROT g/L
FIBRINOGEN g/L
6.67
143
0.48
43
15.1
352
Normal EQ/TB
6.0 – 12.0
130 – 174
0.35 – 0.47
38 – 49
13 – 16
300 – 390
3.20
0.38
1.54
1.22
0.03
0.03
0
59
5
6.0 - 12.0
0 – 0.20
2.47 – 7.00
1.63 – 4.40
0 – 0.72
0 – 0.96
0 – 0.36
55 – 70
2–4
RESULT
203
214
30
78
6.31
210
9.1
111
54
17
37
2.56
0.74
119
2.17
84
25
NORMAL EQ/TB
<350
<200
<22.0
<350
4.5 – 6.3
87 – 160
3.7 – 7.0
17 – 48
55 – 65
29 – 37
13 – 37
2.78 – 3.32
0.92 – 1.38
136 –142
3.1 – 4.4
95 – 106
27 – 32
RESULT
Neutrophils have toxic changes
BIOCHEMISTRY
AST (GOT) U/L
ALP U/L
GAMMA GT U/L
CK U/L
GLUCOSE U/L
CREATININE umol/L
UREA mmol/L
Total BILIRUBIN umol/L
SERUM PROTEIN g/L
ALBUMIN g/L
GLOBULINS g/L
CALCIUM mmol/L
PHOSPHATE mmol/L
SODIUM mmol/L
POTASSIUM mmol/L
CHLORIDE mmol/L
TOTAL CO2 mmol/L
Describe and discuss your approach to the investigation and management of this case. Your answer
should include:
a.
b.
c.
d.
Interpretation of each of the abnormal laboratory results with reference to the clinical findings
(8 marks)
A list of differential diagnoses
(5 marks)
Details of any further investigations you might initiate
(7 marks)
How you would initially treat this pony
(5 marks)
Continued over/ Equine Medicine – Paper 2/2004
Continued / Equine Medicine – Paper 2/ 2004
6)
A thoroughbred yearling was presented for further investigation of an intermittent fever. The filly
had arthroscopic surgery 2 months previously and was febrile 2 days after surgery. The referring
veterinarian had treated her with a variety of antibiotics and anti-inflammatory therapies. An
ultrasound examination of her thorax by the referring veterinarian a month prior to presentation
showed a small increase in pleural fluid and a working diagnosis of pleuropneumonia was made.
On presentation, the filly is in good body condition and is quiet. The mucous membranes are
congested with a capillary refill time of 3-4 seconds, heart rate is 52 beats/min, respiratory rate is
34 breaths/min and temperature is 38.6oC. Auscultation of her thorax reveals harsh breath sounds.
No abnormalities are detected on auscultation of her heart or abdomen. Ultrasonographic
examination of her thorax confirms the presence of a slightly increased amount of pleural fluid.
The tips of the cranioventral lung lobe have findings consistent with atelectasis or consolidation.
No other abnormalities are seen. Results of haematology and blood biochemical analysis are:
HAEMATOLOGY
RBC x 1012/L
HAEMOGLOBIN g/L
PCV L/L
MCV fl
MCH pg
MCHC g/L
Total WBC x 109/L
BAND NEUT x 109/L
NEUTROPHILS x 109/L
LYMPHOCYTES x 109/L
MONOCYTES x 109/L
EOSINOPHILS x 109/L
BASOPHILS x 109/L
PLASMA PROT g/L
FIBRINOGEN g/L
BIOCHEMISTRY
AST (GOT) U/L
ALP U/L
GAMMA GT U/L
CK U/L
GLUCOSE U/L
CREATININE umol/L
UREA mmol/L
Total. BILIRUBIN umol/L
SERUM PROTEIN g/L
ALBUMIN g/L
GLOBULINS g/L
CALCIUM mmol/L
PHOSPHATE mmol/L
SODIUM mmol/L
POTASSIUM mmol/L
CHLORIDE mmol/L
TOTAL CO2 mmol/L
RESULT
14.9
215
0.67
41
13.3
322
9.40
0
7.14
1.79
0.47
0
0
83
7
RESULT
223
254
22
261
5.2
85
4.5
26
76
28
48
2.93
1.32
137
4.3
100
24
Normal EQUINE / TB
6.0 – 12.0
130 – 174
0.35 – 0.47
38 – 49
13 – 16
300 – 390
6.0 - 12.0
0 – 0.20
2.47 – 7.00
1.63 – 4.40
0 – 0.72
0 – 0.96
0 – 0.36
55 – 70
2–4
EQ/TB
<350
<200
<22.0
<350
4.5 – 6.3
87 – 160
3.7 – 7.0
17 – 48
55 – 65
29 – 37
13 – 37
2.78 – 3.32
0.92 – 1.38
136 –142
3.1 – 4.4
95 – 106
27 – 32
Describe and discuss your approach to the investigation and management of this case. Your answer
should include:
a.
Interpretation of each of the abnormal laboratory results with reference to the clinical
findings
(8 marks)
b.
A list of differential diagnoses
(5 marks)
c.
Details of any further investigations you might initiate
(7 marks)
d.
How you would initially treat this yearling
(5 marks)
END OF PAPER
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