Test your acumen on clinical medicine

There are no standardized guidelines for clinical veterinarians to follow. Each day we must guess: What is the standard of care?

What does the clinician need to know? Clearly the front-line clinician does not need to know the E point in an M mode of a cardiac echo. In the Dalmatian, the front-line clinician need not know the pathway of purine metabolism, the production of urate stones, the role of the uricase enzyme system or the allantoin elimination.

Answer Key

The front-line and daily clinician need not be troubled with the differences between type II and type III external fixitors or understanding that linear tomography might be needed to identify a fragmented coronoid process.

But the average practitioner must be aware of a much wider range of front-line stuff, such as knowing about the diagnosis of giardia and the various treatments. It would be good for the front-line clinician to understand the differences between hyperthyroid treatment options.

Realistically, the front-line clinician must have the ability to put together a diagnostic plan for a seizure patient, and knowing when to request a urine-creatinine-protein ratio in the face of proteinuria is also within the bounds.

It would be wonderful if we had an omnibook of standards to ensure that adequate information is in the hands of clinicians and that the standard of care is published and known by all before the patients enter the room.

Certainly we all would love the opportunity to take a minimum-information test to see where we stand.

It is suggested that each of us on the front line spend sufficient time studying and reading to be able to answer these assorted sample questions.

It is common knowledge that a state requirement of 15 hours of study per year is inadequate to ensure competency.

This is an open-book test. Clinicians can expect to address these questions with a little investigation. All these questions, except 3, came from the 2004 American College of Veterinary Internal Medicine meeting in Minneapolis.

Clinicians should be expected to know where to find these answers and know when it is time to refer a case.

Minimum information test: Because we each see these problems every day in clinical practice, it's not unreasonable to score 90 percent on this quiz. Give yourself two points for each correct (or closely correct) answer.

(Finish each statement. Turn to page 48 for the answer key.)

• 1. Some controversy exists between conservative therapy and surgery when faced with acute disc disease. With acute intervertebral disc disease, of non-walking dogs, _____________ percent will walk again with conservative medical treatment, and _____________ percent will walk with surgery.
• 2. When managing acute disc disease, cortisones have shown promise when using _____________ and ought to be _____________ in clinical situations extending beyond two weeks because _____________.
• 3. A recent Journal of the American Veterinary Medical Association article linked _____________ with female incontinence, thus calling into question the practice of _____________.
• 4. The confounding presentation of urologic disorders to the clinician seems on the rise. With one of these issues, reflex dyssynergia, _____________ or _____________ are used for skeletal muscle relaxation and _____________ for smooth muscle relaxation.
• 5. More chronic cases of diagnosing the snotty-nose patient are entering our exam rooms. A cold slide on the nose can estimate airflow through the turbinates. When recommending further diagnostics in these situations, considerations in the turbinates are: Decreased space in the turbinates is seen with _____________ and _____________ while destructive rhinitis with increased space is associated with the following chronic inflammation conditions: _____________.
• 6. Commonly seen in the clinical setting, reverse sneezing can be caused by _____________ and _____________, and the latter is best treated with _____________.
• 7. Greater attention has been given to administering whole blood, plasma and such support products. When giving plasma, it is important to avoid _____________-containing fluids.
• 8. A major push has been seen with the blood and plasma substitutes. But a major limitation of hetastarch products in patients with clotting problems is _____________.
• 9. Colloid therapy's major advantage in fluid therapy is that it _____________, and its therapeutic monitoring is best assessed with _____________.
• 10. The diagnosis of inflammatory bowel disease (IBD) is the current rage. But Dr. Michael Willard tempers our thoughts. Many dogs with IBD do not have _____________ and cannot be diagnosed with _____________ only.
• 11. A new method to treat Cushing's disease is being reported from Europe. Clinicians dealing with canine Cushing's patients better be prepared to address informed client questions about _____________.
• 12. Mast cell tumors are one of the more unfriendly tumors in daily practice. The chemotherapy of choice in canine mast cell tumors is _____________, and it is pretty smooth.
• 13. Bladder tumors are fairly common. They can be diagnosed early, but many clients do not select surgery. So on the front lines of clinical medicine for palliative care and available at the local pharmacy is the drug _____________.
• 14. Many bone lesions can be pseudo-tumors. A serologic maker for bone tumors in the dog is _____________.
• 15. A lot of attention has been drawn to the feline lung with new air-delivered medications. But first a diagnosis must be made. The two key radiographic features of feline asthma are _____________ and _____________.
• 16. The key physical sign of feline asthma is _____________.
• 17. The mixing of insulin is becoming more common. Regular insulin works fast and is nice after meals and for ketoacidosis. Lantus, a human product, is designed to provide level insulin for 24 hours. Lente is a combination of 30 percent _____________ and 70 percent _____________. The rapid-acting drug is _____________, while the longer-acting is _____________.
• 18. When selecting insulin, amino acid makeup of the canine is best if it matches the animal protein of _____________ while the feline basic insulin is best if it matches the animal protein of _____________.
• 19. Sometimes insulin seems uneven in its clinical effect. When a family member administers insulin, the best injection site is the skin of the ______________.
• 20. In seizure management, controversies surround two common drugs: phenobarbitol and potassium bromide. For general use in epileptics, _____________ is the best for dogs and _____________ is the best for cats.
• 21. When discussing seizure medications, a key issue is when a drug reaches a serum- steady state. Phenobarbitol takes _____________, and potassium bromide takes _____________.
• 22. For simple in-house blood clotting assessment, two common, practical and easy-to-use methods are _____________ and _____________.
• 23. Proteinuria, in particular microproteinuria, has garnered increased attention recently. One simple conclusion on proteinuria is that clinicians need to spend more time and energy diagnosing and monitoring proteinuria because it indicates _____________.
• 24. Basic electrocardiology looms as an important tool. Sometimes forgotten is the importance of the mean electrical axis in the electrocardiogram. In the dog _____________ is normal and in the cat _____________ is normal. A _____________ MEA in lead II is cause for alarm.
• 25. Pulmonary hypertension commonly is overlooked in the differential, partly because of our inability to diagnose the signs. But on the cardiac ultrasound _____________ of the right ventricle is very strongly associated with this clinical state.
• 26. Immune-mediated hemolytic anemia can be a messy clinical condition, and sometimes distinguishing between autoagglutination and rouleaux formation can be confusing. An immediate need is to rule between these two. This can be accomplished simply in the clinic laboratory with a _____________.
• 27. Immune testing and serology is used with increasing frequency. And while some of the tests provide little or no information, ANA testing in a red blood-cell immune case is _____________ because _____________.