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Labrador with changed appearance (view source)
Revision as of 18:11, 4 October 2012
, 18:11, 4 October 2012no edit summary
<center><WikiQuiz
<b><big>
<u>Signalment</u>:
:9-year-old male neutered Labrador Retriever
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<u>Chief complaint</u>:
:For the last three months he had not been eating well at home and would not eat dry food so the clients had changed him to tinned food. Two weeks ago the clients noticed the change in him that led to this consultation.
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<center><WikiQuiz
questionnumber="1"
questionnumber="1"
{| class="mw-collapsible mw-collapsed wikitable"
{| class="mw-collapsible mw-collapsed wikitable"
! Histopathlogy report
! Histopathology report
|-
|-
| Stratified squamous epithelium covering the tissue is ulcerated. The epithelial tissue is proliferative and contiguous in places with a mass present below. The underlying collagen is infiltrated by a solid mass of proliferating squamous epithelial tissue. The epithelial tissue occurs as masses, trabeculae or nests with minimal stromal tissue. The epithelial cells are variable in size; they have large nuclei with prominent nucleoli; mitotic figures are frequent.
| Stratified squamous epithelium covering the tissue is ulcerated. The epithelial tissue is proliferative and contiguous in places with a mass present below. The underlying collagen is infiltrated by a solid mass of proliferating squamous epithelial tissue. The epithelial tissue occurs as masses, trabeculae or nests with minimal stromal tissue. The epithelial cells are variable in size; they have large nuclei with prominent nucleoli; mitotic figures are frequent.
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<center><WikiQuiz
<center><WikiQuiz
questionnumber="10"
questionnumber="10"
question=""
question="It was decided to go ahead with a course of neoadjuvant radiotherapy with the goal of shrinking the tumour to reduce surgical dose. Before starting treatment however it is important to complete staging. What is required to stage this patient fully?"
choice1=""
choice1="Thoracic radiographs or CT scan"
choice2=""
choice2="Lymph node aspirate/excisional biopsy"
choice3=""
choice3="Both thoracic radiographs/CT scan and lymph node aspirate/excisional biopsy "
choice4=""
choice4="No staging is required because this tumour does not metastasize. "
choice5=""
choice5=""
correctchoice="3"
correctchoice="3"
feedback1=""
feedback1="'''Incorrect'''. An additional diagnostic procedure is required in this case. Choose again. "
feedback2=""
feedback2="'''Incorrect'''. An additional diagnostic procedure is required in this case. Choose again."
feedback3=""
feedback3="'''Correct'''. A CT scan was performed and a lymph node biopsy was negative."
feedback4=""
feedback4="'''Incorrect'''. Your client wants the very best for his dog and so decides to take him to another veterinary surgeon. Choose again."
feedback5=""
feedback5="Choose again."
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<center><WikiQuiz
questionnumber="11"
question="You now review the contrast-enhanced thoracic CT scan. Based on the image, what do you tell your client?"
choice1="The CT scan is normal and there are no visible secondaries in the lungs. "
choice2="There are metastatic nodules throughout the lungs and nothing further can be done. "
choice3="There are metastatic nodules in the lungs but they will grow slowly so treatment for the oral tumour should go ahead anyway. "
choice4="There are metastatic nodules in the lungs but they will be treated with chemotherapy."
choice5="The scan shows evidence of pulmonary fibrosis so the patient has a second serious medical problem. "
correctchoice="1"
feedback1="'''Correct.'''"
feedback2="'''Incorrect'''. Unfortunately your client takes your advice and euthanizes his dog. "
feedback3="'''Incorrect'''. Your client is concerned that he would be putting the animal through a lot but wouldn’t have very long because of the metastasis and so decides on euthanasia."
feedback4="'''Incorrect'''. Your client is concerned that he would be putting the animal through a lot but wouldn’t have very long because of the metastasis and so decides on euthanasia."
feedback5="'''Incorrect'''. Your client is concerned that he would be putting the animal through a lot but wouldn’t have very long because of the metastasis and so decides on euthanasia. "
image= "File:Case 12-image for Q11-image 4.jpg">
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<center><WikiQuiz
questionnumber="12"
question="Why would an excisional lymph node biopsy of the submandibular lymph node be superior to a fine-needle aspirate?"
choice1="A. Squamous cell carcinoma often causes local inflammation resulting in enlarged lymph nodes; it is important to rule out reactive versus neoplastic."
choice2="B. It is unlikely that the lymph node would be positive so it doesn’t really make any difference. "
choice3="C. A biopsy is always more accurate because early metastatic cells can be missed on cytology. "
choice4="D. Both A and C are correct "
choice5="E. Neither would be appropriate because the sentinel node in this location would be the retropharyngeal node. "
correctchoice="4"
feedback1="'''Incorrect'''. Choose again."
feedback2="'''Incorrect'''."
feedback3="'''Incorrect'''. Choose again."
feedback4="'''Correct'''."
feedback5="'''Incorrect'''. Choose again."
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questionnumber="13"
question="Radiotherapy went well and the tumour shrank, permitting a reduced surgical dose. The patient underwent a caudal mandibulectomy. What is the most common acute side-effect of irradiating the oral cavity?"
choice1="Vomiting"
choice2="Tooth decay "
choice3="Mucositis "
choice4="Fibrosis "
choice5="Thinning of cortical bone "
correctchoice="3"
feedback1="'''Incorrect'''. Choose again."
feedback2="'''Incorrect'''. Choose again."
feedback3="Correct"
feedback4="'''Incorrect'''. Choose again."
feedback5="'''Incorrect'''. Choose again."
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questionnumber="14"
question="What is the most common delayed effect of irradiating the oral cavity?"
choice1="Bone necrosis"
choice2="Gingival recession"
choice3="Tooth loss "
choice4="Fibrosis of the tongue "
choice5="Skin necrosis "
correctchoice="2"
feedback1="'''Incorrect'''. Choose again."
feedback2="Correct"
feedback3="'''Incorrect'''. Choose again."
feedback4="'''Incorrect'''. Choose again."
feedback5="'''Incorrect'''. Choose again."
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questionnumber="15"
question="In view of the successful elimination of the primary, what do you consider the patient’s long-term prognosis to be?"
choice1="Excellent - he should be cured. "
choice2="Very good - the risk of local recurrence or metastatic spread is low. "
choice3="Good - he may develop metastatic spread, but not for years. "
choice4="Fair - this was a large tumour that had been present for months before detection so recurrence or metastatic spread is still a possibility. "
choice5="Poor - he would be unlikely to live more than 6 months. "
correctchoice="4"
feedback1="'''Incorrect'''. This is what we would hope but local recurrence or metastatic spread is still a possibility."
feedback2="'''Incorrect'''. This is what we would hope but local recurrence or metastatic spread is still a possibility."
feedback3="'''Incorrect'''. This is what we would hope but local recurrence or metastatic spread is still a possibility."
feedback4="'''Correct'''."
feedback5="'''Incorrect'''. He should have a better prospect than 6 months."
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</WikiQuiz></center>
<center><WikiQuiz
questionnumber="16"
question="Your client had a cat that had exactly the same problem and he wants to know if she could have had the same treatment. What do you tell your client about oral squamous cell carcinoma in the cat?"
choice1="The cat could have had neoadjuvant radiation followed by a caudal mandibulectomy with the same outcome. "
choice2="We never perform mandibulectomies on cats because they will not tolerate them. "
choice3="Oral squamous cell carcinoma of the mandible of the cat is very sensitive to radiation so radiation is the sole treatment. "
choice4="Oral squamous cell carcinoma of the cat does not respond well to radiation and the results have been poor with conventional protocols. "
choice5="Cats do not get mandibular squamous cell carcinoma; it is always sublingual. "
correctchoice="4"
feedback1="'''Incorrect'''. Review oral squamous cell carcinoma in the cat."
feedback2="'''Incorrect'''. Review oral squamous cell carcinoma in the cat."
feedback3="'''Incorrect'''. Review oral squamous cell carcinoma in the cat."
feedback4="'''Correct'''."
feedback5="'''Incorrect'''. Review oral squamous cell carcinoma in the cat."
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questionnumber="17"
question="Currently, what is the treatment of choice for cats with oral squamous cell carcinoma?"
choice1="Early detection while surgery is still an option "
choice2="Mitoxantrone chemotherapy "
choice3="Approved NSAID"
choice4="Prednisolone"
choice5="Cisplatin chemotherapy"
correctchoice="1"
feedback1="'''Correct'''."
feedback2="'''Incorrect'''. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient."
feedback3="'''Incorrect'''. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient."
feedback4="'''Incorrect'''. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient."
feedback5="'''Incorrect'''. Q15&17 are general knowledge questions and do not relate to your ability to manage your patient."
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<br><br>
{{Elsevier
|url = http://www.elsevierhealth.co.uk/product.jsp?isbn=9780702042508
|book = North and Banks, Small Animal Oncology
|image = North and Banks SA Oncology.jpg
}}
[[Category:Case-based Quizzes]]