Quiz Corner

1. A ten-year-old neutered male Cavalier King Charles spaniel is presented for a recent cough, lethargy, and decreased exercise tolerance. A grade 3/6 heart murmur was noted on routine evaluation 6 months ago.

   On examination, the dog is stable and cardiac auscultation reveals a grade 4/6 left-sided heart murmur at the heart base. Mucous membranes are pink with a prolonged capillary refill time. Pulse quality is fair. Thoracic auscultation reveals diffuse crackles, particularly in the caudodorsal lung fields.

   What is the most appropriate long-term treatment plan based on the top differential?

   1. Diltiazem, atenolol

   2. Supplemental oxygen to stabilize then spironolactone

   3. Furosemide, pimobendan

   4. Digoxin, enalapril

   5. Inhaled fluticasone, albuterol

      	Patient’s value	Reference range
      Temperature	100.1°F (37.8°C)	99.5–102.5°F (37.2–39.2°C)
      Heart rate	160 bpm	60–120 bpm
      Respiratory rate	38 brpm	15–34 brpm

2. A 12-year-old spayed female domestic shorthair cat is presented for severe lethargy and weakness. The owner reports that the cat has been vomiting and anorexic for 3 days with increased drinking and urination for 2 months.

   On physical examination, the cat is dull, with a body condition score of 2/9 and marked dehydration. Thoracic auscultation is unremarkable, but pulse quality is poor. Abdominal palpation reveals a large, soft urinary bladder and bilaterally decreased renal size.

   What is the most appropriate next step based on the top differential for this patient?

   1. Transition to a low-carbohydrate high-protein diet and prescribe lente insulin.

   2. Pass a urinary catheter and start rehydration therapy.

   3. Administer SQ fluids and dispense glargine insulin.

   4. Give maropitant citrate (Cerenia) and fluids subcutaneously and start glipizide.

   5. Admit to hospital for IV fluids and regular insulin.

      	Cat’s value	Reference range
      Temperature	98.2°F (36.8°C)	100–103.1°F (37.8–39.5°C)
      Heart rate	234 bpm	180–220 bpm
      Respiratory rate	34 brpm	16–40 brpm

      Hematology
      Test	Value	Normal
      RBC	10.5	7.12–11.46 M/μL
      Hematocrit	52	28.2–52.7%
      Hemoglobin	16	10.3–16.2 g/dL
      MCV	48	39–56 fL
      MCH	15.2	12.6–16.5 pg
      MCHC	35.2	28.5–37.8 g/dL
      Reticulocytes	15	3–50 K/μL
      WBC	30	3.9–19.0 K/μL
      Neutrophils	25.6	2.62–15.17 K/μL
      Lymphocytes	0.9	1.06–4.95 K/μL
      Monocytes	3.5	0.04–0.53 K/μL
      Eosinophils	0	0.09–2.18 K/μL
      Basophils	0.0	0–0.1 K/μL
      Platelets	482	155–641 K/μL

      Chemistry
      Test	Value	Normal
      Glucose	659	72–175 mg/dL
      Creatinine	2.5	0.9–2.3 mg/dL
      BUN	52	16–37 mg/dL
      Phosphorus	2.8	2.9–6.3 mg/dL
      Calcium	10.7	8.2–11.2 mg/dL
      Sodium	145	147–157 mmol/L
      Potassium	3.5	3.7–5.2 mmol/L
      Chloride	114	114–126 mmol/L
      TCO2 (Bicarbonate)	8	12–22 mmol/L
      Anion Gap	23	12–25 mmol/L
      Total Protein	8.6	6.3–8.8 g/dL
      Albumin	4.6	2.6–3.9 g/dL
      Globulin	4.0	3.0–5.9 g/dL
      ALT	150	27–158 U/L
      AST	66	16–67 U/L
      ALP	52	12–59 U/L
      GGT	4	0–6 U/L
      Bilirubin — Total	0.2	0.0–0.3 mg/dL
      Cholesterol	300	91–305 mg/dL
      Amylase	3800	623–2239 U/L
      Lipase	100	0–45 U/L
      Creatine kinase	760	64–440 U/L
      Hemolysis index	N/A
      Lipemia index	N/A

      Feline Urinalysis
      Test	Value
      Collection	Cystocentesis
      Color	Dark yellow
      Clarity	Clear
      Specific gravity (N = 1.020–1.040)	1.055
      pH	6.5
      Urine protein	1+
      Glucose	3+
      Ketones	3+
      Blood/Hemoglobin	1+
      Bilirubin	Negative
      Urobilinogen	Normal
      Mucus	None seen
      Casts	1+
      Crystals	None seen
      Test	Value	Normal
      White blood cells	2–5	0–5 per HPF
      Red blood cells	2–5	0–5 per HPF
      Bacteria	None	None
      Epithelial cells	Rare (0–1)	1–2 per HPF

(See p. 1157 for answers.)