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Emergency Cases Quiz

Clinician's Brief

Toxicology

|March 2014|Web-Exclusive

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7  Questions
Multiple Choice Questions
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Emergency Cases Quiz

This self-quiz reviews 7 different emergency presentations and their associated diagnostics and treatments.

For a complete discussion, refer to the linked article in the correct answer of each question.

Take this quiz by answering the following multiple choice questions.
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A 2-year-old, 15-pound (6.8-kg), neutered male border terrier presented after eating a large amount of candy. The owner found a large number of candy wrappers, along with a dumped-over pumpkin used for trick-or-treating. The owner estimates the dog ate about 8 oz (227 g) of small candy bars, and almost all of the candy ingested contained milk chocolate, judging from the wrappers found on the floor. Ingestion occurred about 1.5 hours previously.

On examination, the dog is bright, alert, and responsive. All vital signs are normal, and no significant abnormalities are found on the physical examination. 

Based on the information provided by the owner, which of the following clinical signs might be expected from this chocolate ingestion?

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Emergency Cases Quiz
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Avery, a 2-year-old spayed domestic short-haired cat, presented with acute onset of tremors. A permethrin-containing flea and tick topical spot-on product intended for dogs had been applied between the cat’s shoulder blades. Avery began “shaking” and became ataxic 30 minutes after application. The owner bathed Avery with liquid dish soap, but 90 minutes later the signs persisted without any indication of being resolved, so the owner brought Avery to the clinic.

On examination, ear and facial fasciculations were present. Avery was laterally recumbent, hypersalivating, and hyperesthetic and had marked generalized muscle tremors. During the examination, she had a grand mal seizure that lasted 5 seconds. Her rectal temperature was 103.3°F (39.6°C) (normal, 100.5°F–102.5°F [38.1°C – 39.2°C]).

What is the most appropriate treatment plan for Avery?

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Emergency Cases Quiz
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A 6-year-old Persian is presented for acute dyspnea.  A heart murmur was detected on auscultation one year previously during a routine examination but was not pursued diagnostically at the time. Heartworm prophylaxis has been given consistently. The owners report that the cat has been slightly quiet over the past three days and has had a decreased appetite. This afternoon, the cat was distressed and dyspneic.

On physical examination, a soft systolic parasternal murmur and gallop sound are noted on auscultation. The cat is tachycardic (heart rate, 240 beats/min) and severely dyspneic (respiratory rate, 90 breaths/min; open-mouth breathing). Mucous membranes are pale pink. Lung sounds are not easily detected on auscultation. Femoral pulses are palpable.

Based on the historical and clinical findings, what is the best course of action?

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Emergency Cases Quiz
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A five-year-old male Siamese cat named Grizzly was brought to the Veterinary Medical Teaching Hospital by a police officer after having been rescued from a house fire. When an unattended candle in the cat's home started a fire that rapidly engulfed the second story, Grizzly ran to the unfinished attic. Insulation beneath the attic floorboards caught fire, melting the linoleum above and filling the attic with smoke. During a routine search for possible human victims, a firefighter found the meowing cat, huddled on the floor, unable to move because of melted linoleum beneath its body. To free the cat, rescuers used a box cutter to cut the flooring and transported him for emergency care still adhered to the melted flooring.

On physical examination, the cat was alert and meowing. He immediately received analgesics, intravenous fluid therapy, and supplemental oxygen via a mask while being assessed for thermal shock and respiratory injuries. Auscultation of the heart and lungs was normal. The cat's oral cavity, eyes, and ears were normal, but his vibrissae were singed. The clinician on duty was able to remove the linoleum from the cat using soft butter on gauze and gentle traction. Some material remained on the paws and ventrum of the abdomen. All four paws were burned but, because of the larger surface area, the rear paws were more severely burned. The hair on the ventral abdomen was singed and matted with melted linoleum. The cat was not in thermal shock and there was no apparent respiratory compromise in spite of the fact that the cat had been in a smoke-filled room. The cat was able to move its paws and digits.

Analgesics, oxygen, and fluid therapy are continued. What is the best approach to immediate burn therapy when respiratory injury has not occurred?

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Emergency Cases Quiz
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Trigger, a 1.5-year-old neutered male German shepherd dog, was presented for ataxia and vomiting. Trigger was clinically normal when his owner left for work in the morning and he had no history of medical problems. When the owner returned 8 hours later, Trigger was ataxic and multiple piles of vomitus were present. The owner rushed Trigger to a local emergency clinic.

On presentation, the clinician noted hypersalivation, mild muscle tremors, and ataxia. Vital signs were within normal limits. Serum biochemistry was unremarkable except for a blood glucose level of 45 mg/dL (2.5 mmol/L).

What are potential causes of hypoglycemia in an adult dog?

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Emergency Cases Quiz
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A 4-year-old, intact male cat presents to your clinic after being hit by a car earlier in the afternoon. On physical exam, the cat is in lateral recumbency with pale mucous membranes and weak femoral pulses. His rectal temperature is 93°F (33.9°C), heart rate: 140 beats per minute and respiratory rate: 60 breaths per minute. In addition, you are unable to measure capillary refill time or obtain Doppler blood pressure, but you are able to place a catheter in the cephalic vein. Secondary assessment reveals a fractured left tibia.

What is the most important initial aspect(s) of shock therapy in this cat?

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Emergency Cases Quiz
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A 3-year-old, spayed female American bulldog presents after eating a loaf of rising bread dough. The owner had set out a loaf of yeast-containing bread dough to rise before dinner. A few hours later, the owner found the empty pan on the floor. The dog was experiencing flatulence, and her stomach appeared bloated. On physical examination, the abdomen was distended, and depression was noted. Heart rate was elevated (180 bpm), and the patient was mildly ataxic as she walked around the examination room. Rectal temperature was slightly subnormal at 99.6ºF (37.6ºC).

With this patient's history, what other clinical signs or complications could be expected?

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Emergency Cases Quiz
7/7  Questions
Multiple Choice Questions
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Emergency Cases Quiz

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