RCVS Statutory Membership Examination (SME) · UK · Royal College of Veterinary Surgeons
Original practice questions written to the published syllabus · not past papersThe production diseases of high-yielding animals and the mineral and vitamin deficiencies: milk fever, ketosis, grass tetany, downer cow and their relatives.
In the exams: ICAR AICE-JRF core group 07 (Medicine); China comprehensive paper cattle; a recurring topic across Indian PG, PhD and state PSC syllabi
How our questions for RCVS Statutory Membership Examination spread across the units of Veterinary Clinical Medicine II: Metabolic, Production and Deficiency Diseases. Difficulty: 12 easy, 44 medium, 13 hard.
| Endocrine disorders of dogs and cats (diabetes mellitus and DKA, hypo- and hyperadrenocorticism, thyroid disease) | 13 | |
| Milk fever | 7 | |
| Ketosis | 7 | |
| Trace mineral deficiencies | 6 | |
| Hypomagnesaemia | 5 | |
| Fatty liver syndrome | 5 | |
| Rickets, osteomalacia and osteodystrophy | 5 | |
| Vitamin deficiencies | 5 | |
| Metabolic profile testing | 4 | |
| Downer cow syndrome | 4 | |
| Post-parturient haemoglobinuria | 4 | |
| Azoturia | 4 |
Choose an answer, then open the working. Each explanation says why the right answer is right and why the others are not.
A 7-year-old Jersey cow calved 12 hours ago. She is in sternal recumbency with her head turned into her flank, cold ears, dilated pupils, a dry muzzle, ruminal stasis, a rectal temperature of 37.4 °C and a weak, rapid pulse. What is the most appropriate first treatment?
D. Calcium solution given slowly intravenously while auscultating the heart
These are classic signs of stage 2 milk fever, and slow intravenous calcium is the treatment of choice; auscultation detects arrhythmias caused by too-fast infusion. A sternal cow with poor swallowing risks aspiration if drenched. Rapid IV magnesium is dangerous, and dextrose does not correct hypocalcaemia.
Further reading: Constable et al., Veterinary Medicine 11th ed.; Goff 2008; Oetzel 2004; Suttle, Mineral Nutrition of Livestock 4th ed.
Which description best fits type II ketosis in dairy cows?
A. Onset 1 to 2 weeks after calving in over-conditioned cows, with insulin resistance and fatty liver
Type II ketosis is associated with fat cows, heavy fat mobilisation and fatty liver early in lactation, and responds less well to treatment. Type I (underfeeding) ketosis occurs at 3 to 6 weeks near peak yield. Butyric silage causes alimentary ketosis.
Further reading: Constable et al., Veterinary Medicine 11th ed.; Goff 2008; Oetzel 2004; Suttle, Mineral Nutrition of Livestock 4th ed.
A cow 10 days after calving has a reduced appetite, falling milk yield, strongly positive urine ketones, and a high-pitched ping on simultaneous percussion and auscultation over the left 9th to 13th ribs. What is the best interpretation?
D. Left displaced abomasum with secondary ketosis; correct the LDA and support energy
A ping over the left 9th to 13th ribs in an early-lactation cow is typical of left displaced abomasum. Reduced intake causes secondary ketosis, which will not resolve until the displacement is corrected. A rumen ping is usually lower and more dorsal and caudal; right displacement pings on the right.
Further reading: Constable et al., Veterinary Medicine 11th ed.; Goff 2008; Oetzel 2004; Suttle, Mineral Nutrition of Livestock 4th ed.
A donkey's serum triglyceride is reported as 620 mg/dL. Using a factor of 0.01129, what is it in mmol/L, and does it exceed the commonly used hyperlipaemia threshold of about 5.6 mmol/L?
A. 7.0 mmol/L; yes
Working: 620 x 0.01129 = 7.00 mmol/L, above 5.6. The factor 0.0259 (16.1) applies to cholesterol, not triglyceride, and a misplaced decimal in the factor gives 70 or 0.70.
Further reading: Reed, Bayly & Sellon, Equine Internal Medicine 4th ed.; Constable et al. 11th ed.
A horse with stiff, painful hindquarters after exercise passes dark urine. The urine dipstick is strongly positive for blood, but no red cells are seen on microscopy of the sediment. This indicates:
A. Myoglobinuria
Dipsticks react with the haem group of both haemoglobin and myoglobin. No red cells excludes haematuria, and the history of exercise-associated muscle pain points to myoglobin. The myoglobin comes from exercise-associated muscle damage.
Further reading: Reed, Bayly & Sellon, Equine Internal Medicine 4th ed.; Constable et al. 11th ed.
Beef cattle on phosphorus-deficient range are seen chewing bones of old carcasses. Which disease is this behaviour classically linked with?
C. Botulism
Osteophagia (bone chewing) from phosphorus deficiency leads cattle to eat carcass material containing Clostridium botulinum toxin, as described in southern Africa (lamziekte). Phosphorus supplementation and vaccination are used for control.
Further reading: Constable et al., Veterinary Medicine 11th ed.; Goff 2008; Oetzel 2004; Suttle, Mineral Nutrition of Livestock 4th ed.
A horse is fed mostly wheat bran with grass hay; its total ration contains 0.25% calcium and 0.75% phosphorus of dry matter. What is the Ca:P ratio and the expected problem?
B. 0.33:1; nutritional secondary hyperparathyroidism (big head)
Working: 0.25 / 0.75 = 0.33, so the ratio is about 0.33:1 (inverted, 1:3). With more phosphorus than calcium, PTH stays high and facial bones are replaced by fibrous tissue. Most species need about 1:1 to 2:1. Inverting gives 3:1, which describes the opposite ratio.
Further reading: Reed, Bayly & Sellon, Equine Internal Medicine 4th ed.; Constable et al. 11th ed.
A bone lesion shows reduced bone mass, but what bone is present is normally mineralised. This is:
D. Osteoporosis
Osteoporosis is too little bone of normal composition (for example from starvation, copper deficiency or disuse). Osteomalacia and rickets are failures of mineralisation, and osteodystrophia fibrosa is fibrous replacement under PTH.
Further reading: Constable et al., Veterinary Medicine 11th ed.; Goff 2008; Oetzel 2004; Suttle, Mineral Nutrition of Livestock 4th ed.
Cattle fed mouldy sweet clover hay bleed excessively after dehorning. The correct specific treatment is:
A. Vitamin K1 (phytonadione)
Mouldy sweet clover contains dicoumarol, a vitamin K antagonist that prevents activation of clotting factors II, VII, IX and X. Vitamin K1 is the effective antidote; vitamin K3 is much less effective as treatment. Blood transfusion may be needed in severe cases.
Further reading: Constable et al., Veterinary Medicine 11th ed.; Goff 2008; Oetzel 2004; Suttle, Mineral Nutrition of Livestock 4th ed.
An elderly hyperthyroid cat has normal serum creatinine before treatment. After T4 is returned to normal with an anti-thyroid drug, creatinine rises above the reference range. What is the best explanation?
B. Hyperthyroidism had raised GFR, masking pre-existing chronic kidney disease
Thyroid hormone increases renal blood flow and GFR and reduces muscle mass, so creatinine can be falsely reassuring in hyperthyroid cats. Treatment reveals underlying chronic kidney disease, which is why renal function is rechecked after treatment and a reversible trial of medical therapy is often used before permanent treatment.
Further reading: Feldman et al., Canine and Feline Endocrinology 4th ed.; Ettinger, Feldman & Côté 8th ed.
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