NAVLE Feline Internal Medicine Questions and Answers — Questions and Answers
Question 1: A 12-year-old female spayed Domestic Shorthair cat is presented with a 2-month history of progressive weight loss despite a ravenous appetite (polyphagia). The owner also reports occasional vomiting and restlessness. On physical examination, you note a heart rate of 230 bpm, a thin body condition, and an unkempt haircoat. Which of the following is the most likely diagnosis?
- Diabetes mellitus
- Chronic kidney disease
- Hyperthyroidism (Correct answer)
- Inflammatory bowel disease
Correct answer: Hyperthyroidism
The combination of weight loss with polyphagia, tachycardia, and hyperactivity in an older cat is classic for hyperthyroidism. Diabetes mellitus can cause weight loss and polyphagia but is not typically associated with tachycardia or hyperactivity. Chronic kidney disease usually presents with weight loss and polyuria/polydipsia, but often with a decreased appetite. Inflammatory bowel disease typically involves weight loss, vomiting, and/or diarrhea, but not the other clinical signs noted.
Question 2: Which dietary modification is considered most critical in slowing the progression of chronic kidney disease (CKD) in cats?
- Increased sodium to encourage drinking
- Restricted phosphorus (Correct answer)
- Increased high-quality protein
- Grain-free formulation
Correct answer: Restricted phosphorus
Restricting dietary phosphorus is a cornerstone of managing feline CKD and has been shown to slow the progression of the disease. While moderate protein restriction is also part of therapeutic renal diets, phosphorus restriction is considered more critical for slowing progression. Excessive sodium restriction is not recommended, and increasing protein is contraindicated in later stages. Grain-free formulations have no proven benefit for CKD.
Question 3: A 9-year-old, obese, male neutered domestic shorthair is diagnosed with diabetes mellitus. Which insulin type, when combined with a low-carbohydrate diet, offers the highest probability of achieving diabetic remission in a newly diagnosed cat?
- Glargine (Correct answer)
- NPH
- Vetsulin (Lente)
- Regular insulin
Correct answer: Glargine
Glargine insulin, a long-acting insulin analog, has been shown to result in better glycemic control and a higher probability of remission in newly diagnosed diabetic cats compared to other insulins like PZI or Lente (Vetsulin). NPH has a short duration of action in cats, and regular insulin is used for emergencies like DKA, not long-term management.
Question 4: A 7-year-old cat presents with a history of chronic vomiting, diarrhea, and weight loss. Bloodwork reveals a low serum cobalamin (Vitamin B12) level. Concurrent inflammation of the intestine, pancreas, and biliary tract is suspected. What is this condition called?
- Feline Infectious Peritonitis (FIP)
- Lymphocytic-plasmacytic enteritis
- Triaditis (Correct answer)
- Exocrine pancreatic insufficiency (EPI)
Correct answer: Triaditis
Feline triaditis is the concurrent inflammation of the pancreas (pancreatitis), biliary tract (cholangitis), and small intestine (inflammatory bowel disease). This combination of conditions is common in cats and often leads to malabsorption, resulting in clinical signs like vomiting, weight loss, and hypocobalaminemia due to impaired intestinal absorption. While the other conditions can cause similar signs, 'triaditis' specifically refers to the inflammation of these three associated organs.
Question 5: A 1-year-old male cat from a multi-cat household presents with a distended abdomen, fever, and lethargy. Abdominocentesis yields a viscous, straw-colored fluid with a high protein content. Which simple, in-house test can be performed on the fluid to strongly support a diagnosis of effusive Feline Infectious Peritonitis (FIP)?
- Serum coronavirus antibody titer
- Fluid cytology
- Rivalta's test (Correct answer)
- Fluid bacterial culture and sensitivity
Correct answer: Rivalta's test
The Rivalta's test is a simple and affordable test that involves adding a drop of the effusion fluid to a tube of distilled water and acetic acid. A positive result (the drop retains its shape) is caused by the high protein and fibrin content typical of FIP effusions and has a high positive predictive value for FIP. While not definitive, it is a strong supportive indicator. Coronavirus titers are often non-diagnostic as many cats are exposed to feline coronavirus without developing FIP. Cytology typically shows non-specific pyogranulomatous inflammation, and bacterial culture will be negative.
Question 6: A 6-year-old Maine Coon cat presents in acute respiratory distress. Physical exam reveals a heart murmur, gallop rhythm, and crackles on lung auscultation. A thoracic radiograph shows cardiomegaly and pulmonary edema. Echocardiography confirms hypertrophic cardiomyopathy (HCM). In addition to oxygen therapy, which medication is most critical for initial stabilization of this cat's congestive heart failure?
- Atenolol
- Clopidogrel
- Benazepril
- Furosemide (Correct answer)
Correct answer: Furosemide
Furosemide, a potent loop diuretic, is the most critical initial medication for a cat in congestive heart failure (CHF) secondary to HCM. Its primary function is to reduce fluid volume by promoting urination, which alleviates pulmonary edema and relieves respiratory distress. Clopidogrel is an anti-platelet drug used to prevent aortic thromboembolism but does not treat CHF. Atenolol (a beta-blocker) and benazepril (an ACE inhibitor) may be used for long-term management but are not the first-line emergency drugs for reducing pulmonary edema.
NAVLE Feline Internal Medicine Questions and Answers
A 12-year-old female spayed Domestic Shorthair cat is presented with a 2-month history of progressive weight loss despite a ravenous appetite (polyphagia).
The owner also reports occasional vomiting and restlessness.
On physical examination, you note a heart rate of 230 bpm, a thin body condition, and an unkempt haircoat.
Which of the following is the most likely diagnosis?