EXAMEN CLINIQUE

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Question n°1

A dog that has spent two years in Polynesia is brought for a consultation for “coughing, dyspnea, dejection, and unexplained weight loss”. After a full clinical examination, which further examination should you perform as a priority (to get an immediate result)?

  • Answer b), an echocardiograph: As the dog has come from a region where dirofilariosis is endemic, the echocardiograph (right parasternal access, supra-aortic short-axis section) can immediately pick up adults in the right pulmonary artery. But obviously a blood test (to detect microfilaria) and an X-ray (to evaluate the extent of pulmonary lesions) are indicated as a second priority.

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Question n°2

Which auscultation area would you give preference to in a young Golden Labrador with growth retardation and poor tolerance to effort?

  • Answer c), tricuspid area: in Europe, tricuspid valve dysplasia is currently the most widespread congenital cardiopathy in this breed (in which mitral valve dysplasia and sub-aortic stenosis may also be encountered).

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Question n°3

In a young dog with a chronic cough in which standard antibiotic/corticoid/antitussive treatments produce no effect, what disorder should you think of when you learn that the dog often plays with snails in the garden?

  • Answer d), angiostrongyliasis: the intermediate host of this parasitosis (currently in expandion in northern zones) is a gastropod (snail or slug).

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Question n°4

In a 12-year-old Yorkshire Terrier monitored for tracheal collapse and mitral regurgitation, which clinical aspect will allow you to say that the cough has become cardiogenic (pulmonary oedema due to left heart failure)?

  • Answers b) c) d) are all correct. For c), the tracheal collapse cough – loud and dry – becomes quiet and wet in the event of alveolar oedema.

  • Answers b) c) d) are all correct. For c), the tracheal collapse cough – loud and dry – becomes quiet and wet in the event of alveolar oedema.

  • Answers b) c) d) are all correct. For c), the tracheal collapse cough – loud and dry – becomes quiet and wet in the event of alveolar oedema.

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Question n°5

In a 2-year-old Leonberger suffering from apathy and seborrhoea, overweight and with a slow heartbeat (70/min) and with respiratory sinus arrhythmia (RSA), which supplementary examination offers the best chance of revealing the etiology?

  • Answer c), a thyroid function examination (Cholesterol, T4, TSH): this breed often suffers from severe primary hypothyroidism (T4 = 0). Having said that, as the results will not be immediate, an echocardiograph can immediately rule out dilated cardiomyopathy (DCM), also common in this breed but very unlikely in this case because symptomatic DCM cannot be accompanied by RSA at 70/min. An ECG may also be useful to highlight the anomalies encountered in hypothyroidism: sinus bradycardia, hypovoltage, and parasystole.

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Question n°6

In a 6-year-old Irish Wolfhound with a high (180/min) and irregular heart rate and a pulse deficit (90/min), which disorder should come to mind first?

  • Answers c) and d): the 1/2 pulse deficit is fairly characteristic of an atrial fibrillation which in this breed is most often primitive, but also sometimes secondary to a classical DCM. An ECG will confirm the AF and an echocardiograph will distinguish the IAF (normal shortening fraction) and the DCM (shortening fraction < 20%).

  • Answers c) and d): the 1/2 pulse deficit is fairly characteristic of an atrial fibrillation which in this breed is most often primitive, but also sometimes secondary to a classical DCM. An ECG will confirm the AF and an echocardiograph will distinguish the IAF (normal shortening fraction) and the DCM (shortening fraction < 20%).

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Question n°7

In a dog with a record of acute lameness brought in for sudden dejection, you detect hyperthermia (40°) and a strange heart murmur (left midthoracic, protodiastolic) which was not there in previous visits. Which further examination is a priority?

  • Answer a) an echocardiograph: this clinical picture is pathognomonic of endocarditis; the murmur characteristics evoke aortic failure which the echocardiograph will pick up immediately. In the dog it is the aortic valve that is most often affected, followed by the mitral valve. Of course, in the event of valve vegetation showing bacterial colonisation, a blood analysis (blood culture) should be done immediately.

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Question n°8

In a dog brought in for the sudden appearance of ascites without any other symptoms, the cardiac auscultation is perfectly normal. What supplementary examination should you perform as a priority?

  • Answer b), an abdominal scan: in the absence of heart murmurs, heart rate disorders and any respiratory symptoms, this ascites is unlikely to be the consequence of right heart failure. The origin should rather be sought in the abdomen: hepatic origin (cirrhosis or microvascular dysplasia), renal origin (nephritic syndrome, for example by amyloidosis), intestinal origin (lymphangiectasis with hypoproteinemia), tumoral origin (for example, a spleen tumor with hemoperitoneum). The echocardiograph is therefore first intention, followed if necessary by an echo-guided puncture of the ascites, or by a blood analysis (protein electrophoresis) if hypoproteinemia is suspected.

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