BCSE (Basic & Clinical Sciences Examination) · USA / Canada · ICVA; administered through CVMA-NEB and AVMA-ECFVG
Original practice questions written to the published syllabus · not past papersDrugs acting on the central nervous system: sedatives, tranquillisers, alpha-2 agonists, general and local anaesthetics, opioids, anticonvulsants and muscle relaxants.
In the exams: ICAR AICE-JRF core group 07; ICAR AIEEA-PG 13 (Pharmacology & Toxicology); BCSE anaesthesia 20-23 items
NAVLE / BCSE / ECFVG (North America)
Clinical choices by species and patient: sedation for a cardiac or shocked patient, cats and NSAIDs or paracetamol, ABCB1 dogs, equine and bovine alpha-2 dosing differences, status epilepticus protocol, local anaesthetic toxicity, and dose-volume and infusion calculations. BCSE allots about 20–23 items to anaesthesia.
How our questions for BCSE spread across the units of Veterinary Neuropharmacology. Difficulty: 3 easy, 21 medium, 7 hard.
| Principles of CNS pharmacology | 4 | |
| Injectable general anaesthetics | 4 | |
| Inhalant general anaesthetics | 4 | |
| Local anaesthetics | 4 | |
| Sedatives and tranquillisers | 3 | |
| Alpha-2 adrenergic agonists | 3 | |
| Opioid analgesics | 3 | |
| Anticonvulsants | 3 | |
| Muscle relaxants | 3 |
Choose an answer, then open the working. Each explanation says why the right answer is right and why the others are not.
Oral diazepam given daily to cats has been associated with which serious idiosyncratic adverse effect?
A. Acute hepatic necrosis
Idiosyncratic fulminant hepatic necrosis has been reported in cats given oral diazepam. Heinz bodies are linked to repeated propofol or paracetamol; eosinophilic airway disease to bromide in cats.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
A 20 kg dog was sedated intramuscularly with 0.2 mL of medetomidine 1 mg/mL. Atipamezole 5 mg/mL is to be given intramuscularly at five times the medetomidine dose by mass. What volume of atipamezole is given?
B. 0.2 mL
Medetomidine given = 0.2 mL × 1 mg/mL = 0.2 mg. Atipamezole = 5 × 0.2 = 1.0 mg; 1.0 mg ÷ 5 mg/mL = 0.2 mL, the same volume. 1.0 mL confuses the mass (1 mg) with volume; 0.04 mL divides instead of multiplying; 0.4 mL uses the tenfold mass ratio meant for dexmedetomidine (2 mg ÷ 5 mg/mL).
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
Which feature is characteristic of ketamine anaesthesia?
D. Eyes open and central with palpebral reflex present, increased muscle tone
Dissociative anaesthesia leaves eyes open and central with reflexes, increases muscle tone and stimulates the sympathetic system. Airway reflexes are partly kept, although they cannot be relied on to protect the airway.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
A 20 kg premedicated dog is to be induced with propofol at 4 mg/kg as written in the anaesthetic protocol. The emulsion is 10 mg/mL. What is the maximum volume drawn up?
C. 8 mL
Dose = 20 × 4 = 80 mg; 80 ÷ 10 mg/mL = 8 mL, given to effect. 80 mL confuses mg with mL; 0.8 mL is a decimal slip; 2 mL would result from dividing body weight by the concentration (20 ÷ 10).
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
A cat is anaesthetised with propofol on five consecutive days for wound management. Which adverse effect is most expected?
A. Heinz body formation and slower recoveries
Cats have limited glucuronidation of phenols; repeated daily propofol produces oxidative red cell injury (Heinz bodies) and prolonged recovery.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
Recovery from ketamine is expected to be prolonged in a cat with urethral obstruction mainly because:
B. Cats excrete ketamine and its active metabolite norketamine largely in urine
In cats a large fraction of ketamine and active norketamine is renally excreted, so obstruction or renal failure prolongs effect.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
A dog is maintained on isoflurane, whose MAC in this species is taken as 1.3%. The anaesthetist wants 1.3 MAC. What end-tidal isoflurane concentration is targeted?
C. 1.69%
1.3 MAC × 1.3% = 1.69%. 1.30% is only 1 MAC; 2.60% is 2 MAC, deep enough to cause marked cardiovascular depression; 1.00% is below MAC.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
Which local anaesthetic should never be used for intravenous regional anaesthesia or given intravenously because of cardiotoxicity?
C. Bupivacaine
Bupivacaine dissociates slowly from cardiac sodium channels, causing refractory arrhythmias and arrest. Lidocaine without adrenaline is the drug for IV regional blocks.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
A dog stable on potassium bromide starts having seizures again after the owner changes to a high-salt diet. Why?
D. Chloride competes with bromide for renal reabsorption, so bromide excretion increases
Bromide and chloride share renal tubular handling; more chloride means more bromide is excreted and serum concentration falls. Bromide is not hepatically metabolised.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
Why is phenytoin not used as a maintenance anticonvulsant in dogs or cats?
B. It is cleared too fast in dogs to keep levels up and too slowly in cats, risking toxicity
Dogs have a very short phenytoin half-life, while cats have a very long one, so neither can be dosed safely and effectively.
Further reading: Riviere & Papich, Veterinary Pharmacology and Therapeutics, 10th ed.; Lumb and Jones' Veterinary Anesthesia and Analgesia, 6th ed.
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