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ACVECC practice questions

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Question 1Veterinary Emergency and Critical Care

A dog with hemorrhagic shock is being resuscitated. Which parameter is the most sensitive indicator of inadequate tissue perfusion despite a normal arterial blood pressure?

  1. Packed cell volume
  2. Urine specific gravity
  3. Total plasma protein
  4. Serum lactate concentration Correct answer.

Explanation

Lactate rises when tissue oxygen delivery falls below metabolic demand and is a sensitive marker of hypoperfusion even when compensatory vasoconstriction maintains arterial pressure. Blood pressure can appear normal in compensated shock while lactate remains elevated.

Question 2Veterinary Emergency and Critical Care

Which fluid type is most appropriate as an initial resuscitation bolus in a cat with hypovolemic shock from acute vomiting and diarrhea?

  1. Hydroxyethyl starch
  2. Balanced isotonic crystalloid Correct answer.
  3. 5% dextrose in water
  4. Hypertonic saline alone

Explanation

Balanced isotonic crystalloids such as lactated Ringer's or Plasmalyte restore intravascular and interstitial volume and are first-line for most hypovolemic patients. They approximate extracellular composition and are safe for repeated boluses.

Question 3Veterinary Emergency and Critical Care

A dog presents with acute collapse, pale mucous membranes, and a heart rate of 220/min. Which category of shock best fits this presentation?

  1. Obstructive
  2. Cardiogenic
  3. Distributive
  4. Hypovolemic Correct answer.

Explanation

Tachycardia with pale membranes and acute collapse most commonly reflects loss of intravascular volume, as with hemorrhage or severe dehydration. Distributive, cardiogenic, and obstructive shock typically have different physical findings such as bounding pulses, hypothermia with bradycardia, or muffled heart sounds.

Question 4Veterinary Emergency and Critical Care

What is the recommended initial dose of epinephrine for cardiopulmonary resuscitation in a dog?

  1. 1 mg/kg IV
  2. 10 mg/kg IV
  3. 0.1 mg/kg IV
  4. 0.01 mg/kg IV Correct answer.

Explanation

The standard low-dose epinephrine regimen for canine CPR is 0.01 mg/kg IV every 3 to 5 minutes. Higher doses do not improve outcome and may worsen post-resuscitation myocardial dysfunction.

Question 5Veterinary Emergency and Critical Care

Which finding is most consistent with a diagnosis of sepsis in a critically ill dog?

  1. Polycythemia with hypoproteinemia
  2. Hypoglycemia with hyperkalemia only
  3. Bradycardia with hypertension
  4. Hyperlactatemia with hypotension and fever Correct answer.

Explanation

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection, commonly manifesting as fever or hypothermia, tachycardia, hypotension, and elevated lactate. Combinations of perfusion deficits and inflammatory signs support the diagnosis.

Question 6Veterinary Emergency and Critical Care

A dog with a known seizure disorder arrives in status epilepticus. Which first-line medication should be administered?

  1. Propofol CRI
  2. Levetiracetam PO
  3. Phenobarbital IM
  4. Midazolam IV Correct answer.

Explanation

Benzodiazepines such as midazolam or diazepam are first-line for terminating status epilepticus because they rapidly enhance GABA-mediated inhibition. They can be given IV, intranasal, or intramuscular when venous access is delayed.

Question 7Veterinary Emergency and Critical Care

Which electrolyte abnormality is most commonly associated with acute adrenal crisis in a dog?

  1. Hypernatremia and hypokalemia
  2. Hypocalcemia and hyperphosphatemia
  3. Hyperkalemia and hyponatremia Correct answer.
  4. Hypercalcemia and hypophosphatemia

Explanation

Aldosterone deficiency impairs renal sodium retention and potassium excretion, producing hyponatremia and hyperkalemia. These changes, together with hypovolemia and hypoglycemia, characterize Addisonian crisis.

Question 8Veterinary Emergency and Critical Care

Which parameter is used to calculate the shock index in a bleeding trauma patient?

  1. Heart rate divided by systolic blood pressure Correct answer.
  2. Systolic blood pressure divided by heart rate
  3. Packed cell volume divided by total protein
  4. Lactate multiplied by base deficit

Explanation

The shock index is heart rate divided by systolic arterial pressure and rises as compensatory tachycardia outpaces pressure maintenance. A value above roughly 0.9 to 1.0 suggests significant hypoperfusion and need for intervention.

Question 9Veterinary Emergency and Critical Care

A dog with severe hemorrhage is receiving a massive transfusion. Which complication should be anticipated and monitored for?

  1. Hyperglycemia and hyperalbuminemia
  2. Metabolic alkalosis and polycythemia
  3. Hyperkalemia and hypocalcemia Correct answer.
  4. Hypernatremia and hypercalcemia

Explanation

Stored red cells leak potassium and contain citrate that chelates ionized calcium, so massive transfusion can cause hyperkalemia and ionized hypocalcemia. Monitoring electrolytes and calcium is essential during large-volume transfusion.

Question 10Veterinary Emergency and Critical Care

Which acid-base disturbance is most consistent with a dog that has been vomiting for several days and has a high bicarbonate with low chloride?

  1. Respiratory acidosis
  2. High anion gap acidosis
  3. Metabolic alkalosis Correct answer.
  4. Metabolic acidosis

Explanation

Prolonged vomiting loses gastric hydrochloric acid, generating a hypochloremic metabolic alkalosis with compensatory hypoventilation. Elevated bicarbonate with low chloride supports this pattern.

Question 11Veterinary Emergency and Critical Care

A cat with urethral obstruction has a potassium of 8.5 mEq/L and bradycardia. Which intervention is most appropriate to stabilize the myocardium while definitive therapy proceeds?

  1. Sodium bicarbonate IV
  2. Furosemide IV
  3. Regular insulin with dextrose
  4. Calcium gluconate IV Correct answer.

Explanation

Calcium gluconate antagonizes the membrane effects of hyperkalemia on the myocardium within minutes, stabilizing the heart while therapies to shift or remove potassium take effect. It does not lower serum potassium.

Question 12Veterinary Emergency and Critical Care

A dog in respiratory distress has a PaO2 of 55 mmHg while breathing room air. How is this best classified?

  1. Normal oxygenation
  2. Severe hypoxemia Correct answer.
  3. Hyperoxemia
  4. Hypercapnia

Explanation

A PaO2 of 55 mmHg on room air is well below the expected value of roughly 90 to 100 mmHg and indicates significant hypoxemia requiring oxygen supplementation and investigation. Hypercapnia refers to elevated CO2, not low oxygen.

Question 13Veterinary Emergency and Critical Care

A dog with severe acute pancreatitis develops hypotension and oliguria. Which monitoring approach best assesses volume responsiveness after a fluid bolus?

  1. Single central venous pressure reading
  2. Serial urine specific gravity
  3. Dynamic measures such as pulse pressure variation Correct answer.
  4. Daily body weight alone

Explanation

Dynamic indices reflecting stroke volume variation with respiration better predict fluid responsiveness than static pressures. A single CVP value correlates poorly with volume status.

Question 14Veterinary Emergency and Critical Care

Which finding suggests that a dog with trauma has developed a tension pneumothorax requiring immediate decompression?

  1. Progressive respiratory distress with absent lung sounds and cardiovascular collapse Correct answer.
  2. Mild tachypnea with normal oxygenation
  3. Bilateral crackles with fever
  4. Subcutaneous emphysema alone

Explanation

Tension pneumothorax causes progressive air accumulation with rising intrathoracic pressure, collapsing venous return and producing shock. Absent lung sounds on the affected side with worsening distress and hypotension warrant immediate thoracocentesis.

Question 15Veterinary Emergency and Critical Care

A dog with acute kidney injury is oliguric despite adequate fluid resuscitation. Which intervention is most appropriate to address the oliguria after volume status is optimized?

  1. Additional rapid crystalloid boluses
  2. Dopamine infusion at renal dose
  3. Hypertonic saline bolus
  4. Furosemide as a constant rate infusion Correct answer.

Explanation

Once euvolemia is achieved, loop diuretics such as furosemide can be used to promote urine output and manage fluid balance in oliguric renal failure. Low-dose dopamine has not been shown to improve renal outcomes.

Question 16Veterinary Emergency and Critical Care

Which clinical sign most strongly suggests upper airway obstruction rather than lower airway or parenchymal disease?

  1. Inspiratory stridor Correct answer.
  2. Productive cough
  3. Crackles on auscultation
  4. Expiratory wheeze

Explanation

Upper airway obstruction produces turbulent airflow during inspiration, generating stridor. Lower airway and parenchymal disease more often produce expiratory wheeze or crackles.

Question 17Veterinary Emergency and Critical Care

A dog with immune-mediated hemolytic anemia has a PCV of 12% and is dyspneic. Which transfusion product is most appropriate?

  1. Platelet concentrate
  2. Cryoprecipitate
  3. Packed red blood cells Correct answer.
  4. Fresh frozen plasma

Explanation

Symptomatic anemia with a low PCV is best addressed with packed red blood cells to restore oxygen-carrying capacity with minimal volume load. Plasma and cryoprecipitate do not increase red cell mass.

Question 18Veterinary Emergency and Critical Care

Which parameter is used to calculate the corrected anion gap when assessing a metabolic acidosis?

  1. Sodium plus potassium minus chloride
  2. Bicarbonate minus lactate
  3. Sodium minus chloride plus bicarbonate Correct answer.
  4. Chloride minus bicarbonate

Explanation

The anion gap is calculated as sodium minus the sum of chloride and bicarbonate, representing unmeasured anions. An elevated gap suggests accumulation of organic acids such as lactate or ketones.

Question 19Veterinary Emergency and Critical Care

A cat with hypertrophic cardiomyopathy presents with acute hindlimb paralysis and cold limbs. Which treatment is most appropriate initially?

  1. High-dose furosemide
  2. Corticosteroid administration
  3. Analgesia with an opioid and supportive care Correct answer.
  4. Vasodilator infusion

Explanation

Aortic thromboembolism causes severe ischemic pain, and analgesia is a cornerstone of initial management along with supportive care and treatment of underlying heart disease. Furosemide is reserved for congestive heart failure, and vasodilators can worsen hypotension.

Question 20Veterinary Emergency and Critical Care

A dog with traumatic brain injury has a declining level of consciousness. Which intervention best supports cerebral perfusion?

  1. Maintain normotension and normocapnia Correct answer.
  2. Permit permissive hypotension
  3. Hyperventilate to a PaCO2 of 20 mmHg
  4. Administer hypotonic fluids

Explanation

Cerebral perfusion depends on mean arterial pressure minus intracranial pressure, so maintaining normotension and normal CO2 supports perfusion without excessive vasoconstriction. Hyperventilation is reserved for brief use in impending herniation.

Question 21Veterinary Emergency and Critical Care

Which finding is most consistent with feline arterial thromboembolism on physical examination?

  1. Bilateral jugular distension
  2. Muffled heart sounds
  3. Bounding pulses in all limbs
  4. Absent femoral pulse with firm painful muscles Correct answer.

Explanation

An arterial thromboembolus typically lodges at the aortic trifurcation, producing absent or weak femoral pulses, cold limbs, and firm painful muscles. This reflects acute limb ischemia.

Question 22Veterinary Emergency and Critical Care

A dog with parvovirus is being managed with aggressive fluid therapy. Which parameter best reflects adequate resuscitation?

  1. A falling urine output
  2. A rising PCV
  3. Improving mentation and lactate clearance Correct answer.
  4. Increasing heart rate

Explanation

Perfusion is assessed by mentation, capillary refill, urine output, and lactate clearance, which together indicate restored tissue oxygen delivery. A falling lactate and improving mentation are reassuring.

Question 23Veterinary Emergency and Critical Care

Which drug is used to reverse opioid-induced respiratory depression in a critically ill dog?

  1. Flumazenil
  2. N-acetylcysteine
  3. Naloxone Correct answer.
  4. Atropine

Explanation

Naloxone is a competitive opioid receptor antagonist that rapidly reverses opioid-induced respiratory depression and sedation. It should be titrated to effect to avoid precipitating pain and catecholamine surge.

Question 24Veterinary Emergency and Critical Care

A dog ingests a large amount of dark chocolate. Which clinical sign is most consistent with theobromine toxicity?

  1. Tachyarrhythmia and hyperactivity Correct answer.
  2. Oliguria and hyperkalemia
  3. Bradycardia and hyporeflexia
  4. Coagulopathy and petechiae

Explanation

Theobromine and caffeine in chocolate are methylxanthines that cause catecholamine release, producing tachycardia, arrhythmias, hyperactivity, and vomiting. Severe cases can develop seizures and cardiac arrest.

Question 25Veterinary Emergency and Critical Care

A dog with septic peritonitis has a lactate of 6 mmol/L and a mean arterial pressure of 55 mmHg despite 60 mL/kg of crystalloid. Which next step is most appropriate?

  1. Administer additional crystalloid boluses indefinitely
  2. Initiate a vasopressor such as norepinephrine Correct answer.
  3. Start a beta-blocker
  4. Give a loop diuretic

Explanation

When hypotension persists despite adequate fluid resuscitation, vasopressors are indicated to restore mean arterial pressure and organ perfusion. Norepinephrine is commonly used in vasodilatory septic shock.

Question 26Veterinary Emergency and Critical Care

A dog is presented with severe respiratory distress and cyanosis. Which condition is most likely to cause cyanosis?

  1. Methemoglobinemia
  2. Severe anemia
  3. Carbon monoxide poisoning
  4. Hypoxemia from pulmonary disease Correct answer.

Explanation

Cyanosis is a bluish discoloration of mucous membranes due to increased deoxygenated hemoglobin, typically from hypoxemia caused by pulmonary disease or right-to-left shunting. Severe anemia may not produce cyanosis because there is insufficient hemoglobin to desaturate. Carbon monoxide poisoning and methemoglobinemia cause characteristic color changes (cherry red and chocolate brown, respectively) rather than typical cyanosis.

Question 27Veterinary Emergency and Critical Care

A cat is presented with acute onset of open-mouth breathing and increased respiratory effort. Thoracic radiographs show pulmonary edema. Which underlying condition is most commonly associated with this presentation?

  1. Pleural effusion
  2. Asthma
  3. Pneumothorax
  4. Hypertrophic cardiomyopathy Correct answer.

Explanation

Hypertrophic cardiomyopathy is a common cause of left-sided congestive heart failure in cats, leading to cardiogenic pulmonary edema and respiratory distress. Asthma typically causes bronchoconstriction and airway inflammation without pulmonary edema. Pleural effusion and pneumothorax cause pleural space disease and may cause respiratory distress, but they do not typically produce pulmonary edema.

Question 28Veterinary Emergency and Critical Care

A dog with severe vomiting and diarrhea is presented with signs of hypovolemic shock. Which fluid type is most appropriate for initial resuscitation?

  1. 5% dextrose in water
  2. 0.45% NaCl with 2.5% dextrose
  3. Lactated Ringer's solution Correct answer.
  4. Hypertonic saline (7.2%)

Explanation

Isotonic crystalloids such as Lactated Ringer's solution are the first-line choice for volume resuscitation in most cases of hypovolemic shock because they expand the extracellular fluid compartment. Hypotonic fluids like 0.45% NaCl with dextrose are not appropriate for resuscitation. 5% dextrose in water provides free water and no effective volume expansion. Hypertonic saline is used in specific situations (e.g., head trauma) but is not the initial fluid of choice for general hypovolemia.

Question 29Veterinary Emergency and Critical Care

A dog is presented after being hit by a car. The dog has a fractured femur and is bleeding from a skin wound. Which parameter is most useful for initially assessing perfusion?

  1. Mentation
  2. All of the above Correct answer.
  3. Heart rate
  4. Blood pressure

Explanation

Perfusion is assessed using multiple parameters including heart rate, blood pressure, mentation, mucous membrane color, capillary refill time, and lactate. No single parameter is sufficient. Therefore, all of the listed parameters are useful for initial assessment.

Question 30Veterinary Emergency and Critical Care

A dog with a known history of hypoadrenocorticism is presented with weakness and vomiting. Which electrolyte abnormality is most characteristic of this condition?

  1. Hypokalemia and hypernatremia
  2. Hyperkalemia and hyponatremia Correct answer.
  3. Hyperkalemia and hypernatremia
  4. Hypokalemia and hyponatremia

Explanation

Hypoadrenocorticism (Addison's disease) is characterized by aldosterone deficiency, leading to sodium loss and potassium retention. This results in hyponatremia and hyperkalemia. The other combinations are not typical of Addison's disease.

Question 31Veterinary Emergency and Critical Care

A dog is presented with a suspected narcotic overdose and has a respiratory rate of 6 breaths per minute. Which drug should be administered?

  1. Flumazenil
  2. Doxapram
  3. Atropine
  4. Naloxone Correct answer.

Explanation

Naloxone is a competitive opioid receptor antagonist used to reverse opioid-induced respiratory depression. Flumazenil reverses benzodiazepines, not opioids. Atropine is an anticholinergic used for bradycardia. Doxapram is a respiratory stimulant but is not the specific antidote for opioid overdose.

Question 32Veterinary Emergency and Critical Care

A cat is presented with a urethral obstruction and has a heart rate of 40 beats per minute. Which electrolyte abnormality is most likely present?

  1. Hyperkalemia Correct answer.
  2. Hypokalemia
  3. Hypocalcemia
  4. Hypercalcemia

Explanation

Urethral obstruction in cats commonly leads to hyperkalemia due to decreased renal excretion of potassium. Hyperkalemia can cause bradycardia and other cardiac arrhythmias. Hypokalemia, hypercalcemia, and hypocalcemia are not typically associated with urethral obstruction.

Question 33Veterinary Emergency and Critical Care

A dog with a history of seizures is presented in status epilepticus. Which medication is considered first-line for immediate control of seizures?

  1. Diazepam Correct answer.
  2. Propofol
  3. Phenobarbital
  4. Levetiracetam

Explanation

Benzodiazepines such as diazepam are the first-line treatment for status epilepticus because of their rapid onset of action. Phenobarbital and levetiracetam are used for maintenance or as adjuncts. Propofol is used for refractory seizures but is not first-line.

Question 34Veterinary Emergency and Critical Care

A dog is presented with severe acute pancreatitis and is showing signs of hypovolemic shock. Which fluid therapy approach is most appropriate initially?

  1. Aggressive crystalloid boluses Correct answer.
  2. Maintenance crystalloid therapy
  3. Colloid boluses alone
  4. Hypertonic saline

Explanation

Hypovolemic shock requires rapid volume expansion with isotonic crystalloid boluses. Maintenance therapy is insufficient for shock. Colloids may be used as an adjunct but are not first-line alone. Hypertonic saline is not typically used for pancreatitis-associated shock.

Question 35Veterinary Emergency and Critical Care

A dog with immune-mediated hemolytic anemia has a packed cell volume of 12% and is dyspneic. Which blood product is most appropriate for transfusion?

  1. Fresh frozen plasma
  2. Platelet-rich plasma
  3. Packed red blood cells Correct answer.
  4. Cryoprecipitate

Explanation

Packed red blood cells are indicated to improve oxygen-carrying capacity in severe anemia with clinical signs of hypoxia. Fresh frozen plasma provides clotting factors but does not increase red cell mass. Platelet-rich plasma and cryoprecipitate are used for specific clotting factor deficiencies.

Question 36Veterinary Emergency and Critical Care

A dog with a history of trauma is presented with tachypnea and decreased breath sounds on the right side. Thoracocentesis yields air. Which condition is most likely?

  1. Pneumothorax Correct answer.
  2. Pleural effusion
  3. Pulmonary contusion
  4. Diaphragmatic hernia

Explanation

Pneumothorax is characterized by air in the pleural space, leading to decreased breath sounds and respiratory distress. Thoracocentesis yielding air confirms pneumothorax. Pleural effusion would yield fluid. Pulmonary contusion and diaphragmatic hernia do not typically yield air on thoracocentesis.

Question 37Veterinary Emergency and Critical Care

A dog with acute kidney injury is oliguric despite adequate fluid resuscitation. Which intervention is most appropriate to manage oliguria?

  1. Administration of mannitol
  2. Administration of hypertonic saline
  3. Administration of dopamine
  4. Administration of furosemide Correct answer.

Explanation

Furosemide is a loop diuretic that can be used to promote urine output in oliguric acute kidney injury after volume status has been optimized. Dopamine is not recommended for renal protection. Mannitol is used for specific indications like cerebral edema, not typically for oliguria. Hypertonic saline is not indicated for oliguria.

Question 38Veterinary Emergency and Critical Care

A dog is presented with severe respiratory distress and stridor. Which condition is most likely?

  1. Pneumonia
  2. Pleural effusion
  3. Pulmonary edema
  4. Laryngeal paralysis Correct answer.

Explanation

Stridor is a high-pitched inspiratory sound indicating upper airway obstruction, commonly caused by laryngeal paralysis. Pulmonary edema, pleural effusion, and pneumonia typically cause lower airway or parenchymal signs such as crackles or wheezes, not stridor.

Question 39Veterinary Emergency and Critical Care

A dog with a history of vomiting for several days has a high bicarbonate on blood gas analysis. Which acid-base disturbance is most likely?

  1. Respiratory acidosis
  2. Metabolic alkalosis Correct answer.
  3. Respiratory alkalosis
  4. Metabolic acidosis

Explanation

Prolonged vomiting leads to loss of gastric acid (HCl), resulting in metabolic alkalosis characterized by elevated bicarbonate. Metabolic acidosis would show low bicarbonate. Respiratory alkalosis and acidosis are primarily driven by changes in carbon dioxide, not bicarbonate.

Question 40Veterinary Emergency and Critical Care

A dog with severe hemorrhage is receiving a massive transfusion. Which complication should be monitored for?

  1. Hypernatremia
  2. Hypoglycemia
  3. Hyperkalemia
  4. Hypocalcemia Correct answer.

Explanation

Massive transfusion can cause citrate toxicity, leading to hypocalcemia because citrate chelates calcium. Hyperkalemia can occur with stored blood but is less common with massive transfusion. Hypernatremia and hypoglycemia are not typical complications.

Question 41Veterinary Emergency and Critical Care

A dog with a known seizure disorder is in status epilepticus and has not responded to initial benzodiazepine therapy. Which medication is most appropriate next?

  1. Diazepam
  2. Propofol
  3. Phenobarbital Correct answer.
  4. Levetiracetam

Explanation

Phenobarbital is commonly used as a second-line agent for status epilepticus after benzodiazepines. Propofol is used for refractory cases. Levetiracetam is an adjunct. Additional diazepam is unlikely to be effective after initial failure.

Question 42Veterinary Emergency and Critical Care

A dog with a history of trauma has a pneumothorax and is showing signs of tension. Which finding is most consistent with tension pneumothorax?

  1. Hypertension
  2. Tracheal deviation Correct answer.
  3. Increased breath sounds
  4. Bradycardia

Explanation

Tension pneumothorax causes mediastinal shift, leading to tracheal deviation away from the affected side. Breath sounds are decreased on the affected side. Tachycardia and hypotension are more common than bradycardia and hypertension.

Question 43Veterinary Emergency and Critical Care

A cat with hypertrophic cardiomyopathy presents with acute hindlimb paralysis and cold limbs. Which treatment is most appropriate?

  1. Surgical embolectomy
  2. Anticoagulant therapy alone
  3. Thrombolytic therapy
  4. Analgesia and supportive care Correct answer.

Explanation

Feline arterial thromboembolism often has a poor prognosis, and treatment is primarily supportive with analgesia and management of underlying heart disease. Thrombolytic therapy and surgical embolectomy are rarely performed due to high risk and limited availability. Anticoagulants are used for prevention, not acute treatment.

Question 44Veterinary Emergency and Critical Care

A dog with parvovirus is receiving aggressive fluid therapy. Which parameter best reflects adequate resuscitation?

  1. Heart rate of 160 beats per minute
  2. Urine output of 1-2 mL/kg/hr Correct answer.
  3. Blood glucose of 60 mg/dL
  4. PCV of 60%

Explanation

Urine output of 1-2 mL/kg/hr indicates adequate renal perfusion and resuscitation. Tachycardia may persist for other reasons. A PCV of 60% indicates hemoconcentration and inadequate resuscitation. Hypoglycemia indicates inadequate glucose supply, not resuscitation.

Question 45Veterinary Emergency and Critical Care

A dog with septic peritonitis has a lactate of 6 mmol/L and a mean arterial pressure of 55 mmHg despite 60 mL/kg of crystalloids. Which intervention is most appropriate next?

  1. Administer more crystalloids
  2. Administer vasopressors Correct answer.
  3. Administer corticosteroids
  4. Administer hypertonic saline

Explanation

In septic shock refractory to fluid resuscitation, vasopressors such as norepinephrine are indicated to maintain blood pressure. Additional crystalloids may worsen edema. Hypertonic saline is not first-line. Corticosteroids may be considered in refractory shock but are not the immediate next step.

Question 46Veterinary Emergency and Critical Care

A dog with a history of eating dark chocolate is presented with vomiting and hyperactivity. Which clinical sign is most consistent with theobromine toxicity?

  1. Hypothermia
  2. Bradycardia
  3. Tachycardia Correct answer.
  4. Hypotension

Explanation

Theobromine is a methylxanthine that causes sympathetic stimulation, leading to tachycardia, hyperactivity, and vomiting. Bradycardia, hypotension, and hypothermia are not typical; instead, hypertension and hyperthermia may occur.

Question 47Veterinary Emergency and Critical Care

A dog with severe acute pancreatitis develops hypotension and oliguria. Which monitoring approach best assesses volume responsiveness?

  1. Central venous pressure Correct answer.
  2. Urine output
  3. Heart rate
  4. Blood pressure

Explanation

Central venous pressure is used to estimate volume status and guide fluid therapy, although it is not a perfect measure. Blood pressure, urine output, and heart rate are important but do not directly assess volume responsiveness.

Question 48Veterinary Emergency and Critical Care

A dog with a history of trauma is presented with severe hemorrhage and a shock index of 1.2. Which parameter is used to calculate the shock index?

  1. Diastolic blood pressure divided by heart rate
  2. Systolic blood pressure divided by heart rate
  3. Heart rate multiplied by systolic blood pressure
  4. Heart rate divided by systolic blood pressure Correct answer.

Explanation

The shock index is calculated as heart rate divided by systolic blood pressure. An elevated shock index indicates inadequate perfusion and is useful in triaging trauma patients. The other formulas are incorrect.

Question 49Veterinary Emergency and Critical Care

A dog with severe metabolic acidosis has a pH of 7.2, PaCO2 of 30 mmHg, and bicarbonate of 12 mEq/L. Which compensatory response is expected?

  1. Hyperventilation Correct answer.
  2. Hypoventilation
  3. Decreased renal hydrogen ion excretion
  4. Increased renal bicarbonate excretion

Explanation

Metabolic acidosis stimulates hyperventilation to reduce PaCO2 and partially compensate for the acidosis. Hypoventilation would worsen acidosis. Increased renal bicarbonate excretion and decreased hydrogen ion excretion would also worsen acidosis; instead, the kidneys would retain bicarbonate and excrete hydrogen ions.

Question 50Veterinary Emergency and Critical Care

A dog with a history of trauma has a suspected diaphragmatic hernia. Which diagnostic finding is most consistent with this condition?

  1. Intestinal loops visible in the thoracic cavity on radiographs Correct answer.
  2. Pleural effusion
  3. Increased lung opacity
  4. Pneumothorax

Explanation

Diaphragmatic hernia is diagnosed by visualizing abdominal organs, such as intestinal loops, within the thoracic cavity on radiographs or ultrasound. Increased lung opacity, pleural effusion, and pneumothorax can occur with other conditions and are not specific for diaphragmatic hernia.