Emergency Medicine/Critical Care practice questions

Answer: C) 10 breaths per minute

• AIncorrect. That's too slow.
• BIncorrect. That's too fast.
• CCorrect. Avoid hyperventilation.
• DIncorrect. Ventilation is needed.

Answer: C) Bladder rupture or urethral injury

• AIncorrect. The signs suggest injury.
• BIncorrect. The signs suggest urinary trauma.
• CCorrect. Imaging and labs help confirm it.
• DIncorrect. The signs suggest urinary trauma.

Answer: B) Gastric dilatation-volvulus

In a large- or giant-breed dog, sudden tympanic abdominal distension with unproductive retching and restlessness is the classic sign of GDV, a rapidly fatal surgical emergency.

• AIncorrect. Intestinal obstruction usually causes productive vomiting and develops more gradually. It does not typically cause sudden gas distension of the cranial abdomen with unproductive retching.
• BCorrect. GDV is common in large and giant breeds. Typical signs are sudden abdominal distension, unproductive retching, restlessness and signs of shock. It is rapidly fatal and needs immediate treatment for shock, gastric decompression and surgery.
• CIncorrect. Pancreatitis typically causes productive vomiting, cranial abdominal pain and anorexia. It does not cause a tympanic, gas-distended stomach with unproductive retching.
• DIncorrect. Ascites builds up gradually, causes a fluid wave rather than a tympanic abdomen, and is not linked to sudden retching after a meal.

Answer: A) Rub about a tablespoon of corn syrup or honey on the gums, then bring the dog in

For a conscious hypoglycemic diabetic pet, owners should rub corn syrup or honey on the gums and have the pet seen promptly. Giving more insulin, fasting, or using xylitol-sweetened products all make hypoglycemia worse.

• ACorrect. These are likely signs of insulin-induced hypoglycemia. A simple sugar on the gums is absorbed quickly and raises blood glucose. Once the dog can swallow safely, more can be given by mouth. The dog should still be checked by a veterinarian promptly.
• BIncorrect. Too much insulin is a common cause of hypoglycemia in diabetic dogs. Giving more insulin would lower the blood glucose further and could lead to seizures or death.
• CIncorrect. A missed or delayed meal can itself cause hypoglycemia. The dog needs a fast source of sugar, not fasting and waiting.
• DIncorrect. Xylitol triggers a strong insulin release in dogs and can cause severe hypoglycemia. It would make the problem worse.

Answer: D) Antidotes work best within hours, before kidney damage

• AIncorrect. Small amounts can be deadly.
• BIncorrect. It causes kidney failure.
• CIncorrect. It's time-sensitive.
• DCorrect. Act quickly.

Answer: C) Keep the exposed cornea moist with sterile lubricant or saline

With a proptosed globe, the technician's first priority is to keep the exposed cornea moist with sterile lubricant or saline. The veterinarian then replaces the globe surgically under anesthesia or removes it if it can't be saved.

• AIncorrect. Dry gauze sticks to the exposed cornea and dries it out, and a snug bandage adds pressure to an already compromised globe.
• BIncorrect. The eyelids are trapped behind the globe and the tissues are swollen. Forcing the eye back in an awake patient can cause further injury. Replacement is a veterinary surgical procedure done under general anesthesia, often with a temporary tarsorrhaphy.
• CCorrect. The proptosed cornea cannot be covered by the eyelids and dries quickly. Keeping it moist with sterile lubricant or saline protects it until the veterinarian replaces the globe or removes it.
• DIncorrect. A topical anesthetic does not protect the cornea, and leaving the globe uncovered and unlubricated lets it dry and become further damaged.

Answer: D) High calcium and kidney injury

• AIncorrect. That's xylitol.
• BIncorrect. That's anticoagulant baits.
• CIncorrect. That's bromethalin.
• DCorrect. Monitor calcium and kidney values.

Answer: A) Heinz body anemia

• ACorrect. Oxidation damages red cells.
• BIncorrect. That isn't typical.
• CIncorrect. That isn't typical.
• DIncorrect. That isn't typical.

Answer: B) Kidneys

Ethylene glycol metabolites cause metabolic acidosis and deposit calcium oxalate crystals in the renal tubules, leading to acute kidney injury. Early signs (CNS depression, ataxia, PU/PD) appear within hours, and prompt treatment with fomepizole or ethanol can prevent renal damage.

• AIncorrect. Ethylene glycol is metabolized by alcohol dehydrogenase, mostly in the liver, but the liver is not the main organ its metabolites damage. Severe liver injury is more typical of toxins such as xylitol in dogs or acetaminophen.
• BCorrect. Glycolic acid causes severe metabolic acidosis. Oxalic acid binds calcium, and calcium oxalate monohydrate crystals deposit in the renal tubules, causing tubular necrosis and acute kidney injury. Calcium oxalate crystalluria supports the diagnosis.
• CIncorrect. Electrolyte and acid-base disturbances can affect heart rhythm, but the heart is not the main target organ. Cardiotoxicity is more typical of toxins such as chocolate (methylxanthines).
• DIncorrect. Vomiting can occur, but GI injury is not the defining lesion. Early signs are CNS depression and ataxia, and the major organ damage is to the kidneys.

Answer: B) Gastrointestinal ulceration and acute kidney injury

NSAID overdoses such as ibuprofen mainly cause GI ulceration and acute kidney injury because they block protective prostaglandins. Prompt decontamination, IV fluids, and gastroprotection are needed.

• AIncorrect. This pattern is typical of acetaminophen toxicosis, not ibuprofen.
• BCorrect. Ibuprofen inhibits the COX-1-derived prostaglandins that protect the stomach lining and maintain kidney blood flow. Overdose causes vomiting, melena, GI ulceration, and acute kidney injury. Very high doses can also cause neurologic signs. Treatment includes decontamination, IV fluids, and gastroprotectants.
• CIncorrect. This is typical of cholecalciferol (vitamin D3) rodenticide toxicosis.
• DIncorrect. Delayed bleeding from vitamin K depletion is typical of anticoagulant rodenticide toxicosis, not NSAID overdose.