ANSWERS

1. List 4 signs of oral pain.
   • Drooling and excessive salivation.
   • Dysphagia (difficulty swallowing).
   • Pawing at the face or rubbing the face along the ground.
   • Refusal to eat.
2. A client telephones the surgery and explains that her dog has been playing with a stick earlier in the day, and is now subdued and reluctant to eat. What advice would you give?
   
   • Take a full history (see module 2).
   • Advise that the dog is brought promptly to the surgery since it is possible that a portion of the stick has remained lodged within the pharynx/palate and may require surgical removal.
3. The client in Q2 has examined the dog thoroughly herself and is adamant that there is no foreign body in the mouth. She does not particularly want to come down to the surgery and would rather see how the dog is the next morning. What further advice would you give?
   
   • Explain that a fragment may be deeply embedded and thus not visible - if this is the case infection and abscessation may arise.
   • Explain that any injury to the mouth will require a course of antibiotics due to the fact that the mouth contains many bacteria and is an ideal environment for infection to spread.
   • If the dog is unable to eat or drink then nutritional support and fluid therapy may be necessary.
   • Reiterate that it is definitely in the dog's best interest to be examined as soon as possible by the veterinary surgeon.
4. How would you remove a fish-hook embedded in a patient's lip?
   With care! Fish-hooks have a barb which will prevent them from being easily pulled out. Sedation or general anaesthesia may be necessary. If the animal is amenable, it may be possible to perform the procedure with the aid of a local anaesthetic spray applied to the buccal mucosa. An assistant should restrain the animal whilst you attempt to push the shaft further into the tissues until the barb comes out through the skin. Once the barb is free, the shaft may be cut and the 2 parts of the hook removed independently. Antibiotics are advisable since the mouth is a prime site for bacterial infection.
5. A client telephones the surgery. Her kitten has swallowed a needle and thread. The kitten is still lively and has eaten her supper, but the client is very worried about the long-term implications. What advice would you give?
   
   • The kitten should be brought to the surgery immediately for radiography to discover the position of the needle.
   • Advise owner not to pull any cotton that may be attached and protruding from the mouth.
6. What is haematemesis, and when might this be seen?
   The vomiting of blood. This may be seen if the gastric lining is irritated, for example by the presence of a large foreign body within the stomach.
7. What conclusion would you draw from the observation of an animal assuming the "praying position"?
   That the animal is suffering abdominal pain.
   Abdominal guarded and a tucked up abdomen are other signs.
8. Define the following: gastric dilation & gastric torsion.
   
   • Gastric dilation - an extremely serious condition in which gas builds up within the stomach; also known as "bloat".
   • Gastric torsion - the rotation of the stomach through 180 or 360 degrees that occludes both entrance and exit of gas.
9. Give 3 other names by which gastric dilation syndrome may be known.
   
   • Bloat.
   • Volvulus syndrome.
   • GVD (gastric volvulus dilation).
10. List 6 signs of gastric dilation.
    
    • Restlessness.
    • Retching/belching.
    • Bloated stomach.
    • Swollen anterior abdomen (producing a hollow drum-like sound when tapped).
    • Dyspnoea.
    • Collapse.
11. What type of animal is predisposed to gastric dilation?
    Large, deep-chested breeds of dog such as the Great Dane.
12. A dog is brought to the surgery clearly suffering from gastric dilation. The stomach is hugely inflated and the dog is unconscious. It is going to take the veterinary surgeon at least 10 minutes to reach the surgery. If the pressure in the stomach is not eased, the dog will die. What methods could you employ to endeavour to save the dog's life?
    
    • Intubate to maintain the airway and pass a lubricated stomach tube down the oesophagus.
    • Pierce the left abdominal wall with a wide-bore intravenous catheter (16G) at right angles to the skin at the point of maximum distension.
13. State 1 complication that could arise from each of the first aid measures in your answer to Q12.
    
    • If the stomach has twisted and the tube is forced, the oesophagus may be ruptured.
    • If gas is released too rapidly, the blood trapped in the posterior vena cava is suddenly released and floods into the heart which will overload it and cause cardiac failure.
14. Which species is particularly prone to total prolapse of the anus?
    The hamster.
15. Describe the first aid treatment that you would carry out when presented with a hamster suffering total prolapse of the anus.
    
    • Take a full history (see Module 2).
    • Clean and moisten the prolapsed tissue in order to rehydrate the mucosa.
    • Then lubricate with sterile KY Jelly or Xylocaine gel in order to aid the reduction of the prolapsed tissue.
    • Attempt to replace the prolapsed tissue (if this proves impossible, keep the hamster warm and the tissue moist until the veterinary surgeon arrives).
    • Spray the area with local anaesthetic to try to prevent further straining.
    • Prevent self trauma - Elizabethan collars are not hugely effective in species as small as hamsters, so close observation will be necessary.
    • It may be necessary for the veterinary surgeon to place a purse-string suture around the anal ring to keep the prolapsed tissue in place.
16. Which species is particularly prone to fly-strike?
    Lagomorphs (rabbits and hares).
17. What is another name for fly-strike?
    Myiasis.
18. Describe the first aid treatment that you would carry out when presented with a rabbit suffering from fly-strike.
    
    • Take a full history (see module 2).
    • Ask an assistant to restrain the rabbit.
    • Put on protective gloves and an apron.
    • Use a water-based barrier cream on the raw tissues of the wound to prevent irritation when an insecticide spray is applied.
    • Apply an effective insecticidal spray to kill the maggots.
    • Use thumb forceps to remove any mature maggots and make sure they are disposed of carefully (ideally ensure that they are dead by putting them into a bowl of industrial methylated spirit).
    • Next use electric clippers to remove the fur from the edges of the wound until a border of 2cm of healthy skin is exposed all around the affected area.
    • Use a mild antiseptic solution such as dilute Povidone Iodine to gently cleanse the area.
    • Dry the area carefully (the rabbit may suffer hypothermia if left wet).
    • Fluid therapy may be necessary if the rabbit is shocked or if large areas of tissue are exposed (through which water is lost as in burns/scalds).
    • Keep the rabbit warm and observe closely until the veterinary surgeon arrives.
    • Assist with the administration of analgesia and antibiotic therapy under the direction of the veterinary surgeon.
    • Anaesthesia may be necessary in order to clean up extensive, painful wounds.
19. Define the following: evisceration, rupture and hernia.
    
    • Evisceration - the escape of an organ/organs from a body cavity.
    • Rupture - the escape of viscera via a traumatic tear to a muscular wall.
    • Hernia - the escape of viscera through a natural body opening in a muscular wall.
20. What is the difference between a reducible and an irreducible hernia?
    A reducible hernia is one where the viscera may be replaced back into the body cavity via the original defect, whilst an irreducible hernia is one where it is necessary to surgically enlarge the defect in order to replace the escaped viscera.
21. What is the term used to describe a hernia or rupture in which the arterial supply to the escaped viscera has been cut off due to severe swelling or twisting?
    Strangulated.
22. State 2 sites commonly affected by hernias.
    
    • Umbilicus.
    • Inguinal canal.
23. A client telephones the surgery. Her neutered male cat is constantly in the litter box but does not seem to be able to pass urine. Why would you advise an immediate consultation with the veterinary surgeon?
    It is possible that the cat's urethra may be blocked. This may cause the bladder to distend and rupture. Uraemia and peritonitis will result since the urine cannot drain from the body.
24. What is the difference between crystalluria and urolithiasis?
    Crystalluria is the presence of mineral crystals in the urine, whilst urolithiasis is the presence of calculi (stones) within the urinary tract which are made up of many crystals.
25. Define the following terms: anuria, dysuria, polyuria, haematuria and tenesmus.
    
    • Anuria - the failure of the kidneys to produce urine.
    • Dysuria - difficulty in urinating.
    • Polyuria - increased production of urine.
    • Haematuria - blood present in the urine.
    • Tenesmus - ineffectual or painful attempts to pass urine (or faeces).
26. What is the name of the disease often seen in middle-aged, unspayed bitches?
    Pyometra (infection of the womb).
27. What is the difference between a "closed" and "open" pyometra?
    Vulval discharge is not present in cases of closed pyometra, whilst an offensive smelling red-brown vulval discharge is commonly seen in cases of open pyometra. (The terms open and closed refer to the state of the cervix).
28. List symptoms common to cases of both closed and open pyometra.
    
    • Polydipsia.
    • Depression.
    • Pyrexia (fever).
    • Anorexia.
    • Vomiting.
    Bitches with an open pyometra may remain fairly bright and alert.
29. What treatment is necessary in cases of pyometra?
    
    • Ovariohysterectomy.
    • Antibiotic therapy.
    • Fluid therapy.
30. What is the name of the term used to describe increased lacrimation (tear production)?
    Epiphora.
31. What is blepharospasm?
    A spasm of the obicularis muscle of the eyelid, often as a result of a foreign body or injury to the cornea. The animal typically looks like it is screwing its eyelids up against the light.
32. A prolapsed eyeball must be replaced as soon as possible. Why is this?
    To prevent ulceration to the dry cornea and permanent damage to the optic nerve.
33. List 3 lubricants suitable for application to a prolapsed eyeball prior to its replacement.
    
    • Artificial tears (such as Lacrilube or Viscotears).
    • Sterile KY Jelly.
    • Liquid paraffin.
    • Olive oil.
34. In the case of a prolapsed eyeball, what would you do whilst waiting for the veterinary surgeon to arrive?
    
    • Keep the cornea well moistened with sterile saline or false tears.
    • Keep the animal warm and still.
35. What is the name of the disease that is characterised by symptoms including a marked head tilt, loss of balance and nystagmus (involuntary rapid movement of the eyeball)?
    Vestibular syndrome.
36. State 3 differences between stupor and coma?
    
    • An animal in a stupor may be roused (with difficulty), but a comatose animal is impossible to rouse.
    • The pupillary and palprebal reflexes remain present in stupefied animals, but are consistent with deep anaesthesia in comatose animals.
    • The pedal reflex is present in stupefied animals, but absent in comatose animals.
37. A client telephones the surgery. Her West Highland terrier is having a fit. He is not a known epileptic and this is the first incident of this nature. What advice would you give?
    
    • Try to keep as calm as possible.
    • Advise that she does not attempt to touch the dog until he has come out of the fit, since there is a risk of being bitten.
    • Move any objects away from the dog that may be injurious to him.
    • Turn off the lights/draw the curtains.
    • Ensure that any audio-visual equipment is switched off.
    • Make a note of the time and duration of the fit. Note any urination or defecation.
    • Once the fit is over, the dog should be allowed to recover in a quiet, dark environment with minimal tactile stimulation for several hours (it is not a good idea to whisk the him up to the surgery in the car immediately afterwards, unless he does not appear to have fully recovered).
    • Owners would have to bring the dog to the surgery if fitting continues for longer periods of time, or if multiple close fits occur.
    • Avoid offering food and water until the dog has completely recovered.
    • Suggest that the owner search the house/garden for possible causes of the fit (access to chemicals or poisons that may have been ingested) and ensure that these be removed from harm's way.
    • Advise that although the fit may be a one-off incident, it would be sensible for the dog to visit the practice the following day; blood tests may pinpoint a physiological reason for the fit (although they are rarely conclusive) and a thorough general health examination would be prudent.
    • Ensure that the owner keeps records of any further fits.
38. Can you give 2 other names for hypocalcaemia (reduced levels of blood calcium)?
    
    • Eclampsia.
    • Puerperal tetany.
39. Why is hypocalcaemia commonly seen in lactating animals with large litters?
    The demand for milk may be enormous and this subsequently drains calcium from the dam's body leaving her with a deficiency.
40. List 6 symptoms associated with hypocalcaemia.
    
    • Restlessness.
    • Reluctance to feed the litter.
    • Hyperpnoea (panting).
    • Muscle tremors/muscle weakness.
    • Hyperaesthesia (abnormally excitable responses to stimuli).
    • Convulsions and eventual collapse.
41. What medication would you prepare for the veterinary surgeon if you were expecting the imminent arrival of a bitch suffering from hypocalcaemia?
    10% Calcium Borogluconate injection (this is given intravenously).
42. What advice would you give to an owner whose puppy has been electrocuted after chewing through an electric cable?
    
    • Keep calm.
    • Switch off the electricity at the mains.
    • If the mains switch cannot be located quickly, advise standing on a dry, insulated surface such as a wooden board and use a dry, non-metallic implement such as a broom handle to push the puppy clear from any electrically active objects.
    • If the puppy is conscious, advise that the airway is kept clear, that it is kept warm and brought to the surgery immediately since it will be necessary for the veterinary surgeon to check for signs of electrical burns and meningeal oedema.
    • If the puppy is unconscious, the airway should be cleared and artificial resuscitation commenced (cardiac massage should be given if no heartbeat is felt).
      These procedures are described in Module 7 - if the owners are not happy to attempt them at home, advise that the pup be brought at once to the surgery or arrange for a veterinary surgeon/nurse to visit immediately.
    • If it has been possible to resuscitate the puppy, treatment for shock and burns will be necessary - sadly animals that suffer unconsciousness following an electric shock usually do not recover.