Ceefer Case Presentation
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Questions and Answers

Which of the following is true regarding the abortive classification of infection?

  • Replicating virus is positive in whole blood.
  • Anti-FeLV antibodies may show variable titers. (correct)
  • Proviral FeLV DNA is positive.
  • Viral RNA is positive in whole blood.

In the regressive/latent classification, what is typically true about the Anti-FeLV antibodies?

  • They are low or absent during reactivation.
  • They are always negative.
  • They are positive only during transient viremia.
  • They are present in high titres. (correct)

For the progressive infection classification, which of the following statements is accurate?

  • Replicating virus is positive in whole blood. (correct)
  • Anti-FeLV antibodies are typically present at high titres.
  • IFA is negative initially.
  • Viral RNA is negative in whole blood.

Which of the following is a potential diagnostic differential for feline hypercalcemia?

<p>Hyperparathyroidism (C)</p> Signup and view all the answers

In the updated problem list, which symptom is most directly associated with FeLV Snap positivity?

<p>Decreased appetite (A)</p> Signup and view all the answers

What is the chief complaint for Ceefer, the cat?

<p>Weight loss (B)</p> Signup and view all the answers

What type of oral examination findings were observed in Ceefer?

<p>Gingiva erythematous with multiple focal oral ulcers (D)</p> Signup and view all the answers

During the physical examination, which of the following vital signs indicated a possible health issue?

<p>Heart rate of 180 bpm (D)</p> Signup and view all the answers

What lifestyle detail was noted regarding Ceefer?

<p>Indoor/Outdoor (B)</p> Signup and view all the answers

Which symptom suggests that Ceefer may be experiencing dehydration?

<p>Tacky mucous membranes (A)</p> Signup and view all the answers

What was a significant finding during the abdominal palpation of Ceefer?

<p>Both kidneys feel irregular on palpation (A)</p> Signup and view all the answers

Which of the following conditions is included in the differential diagnosis for Ceefer?

<p>Neoplasia (B)</p> Signup and view all the answers

What type of diagnostic tests should be considered for Ceefer's evaluation?

<p>Urine analysis and complete blood count (A)</p> Signup and view all the answers

Which patient samples are acceptable for conducting an FeLV test?

<p>Whole Blood, Serum, Plasma (B)</p> Signup and view all the answers

What is the primary function of the snap test?

<p>To detect soluble p27 viral antigen (B)</p> Signup and view all the answers

What does a positive FeLV snap test indicate?

<p>Confirmation tests are required (B)</p> Signup and view all the answers

Which classification of FeLV infection indicates that the cat is contagious during transient viremia?

<p>Regressive/Latent (A)</p> Signup and view all the answers

What is the prognosis for cats with progressive FeLV infection?

<p>Poor prognosis (C)</p> Signup and view all the answers

Which of the following is a possible reason for discordant test results, such as an ELISA snap positive but IFA negative?

<p>Lab error (A)</p> Signup and view all the answers

What is a key characteristic of abortive FeLV infection?

<p>Viral replication is terminated by immune response (D)</p> Signup and view all the answers

What should be done if a patient tests positive for FeLV but appears healthy?

<p>Retest in 3 months (D)</p> Signup and view all the answers

What diagnostic tests are used to differentiate neoplasia from infection in this clinical scenario?

<p>Fine Needle Aspiration (FNA) and Cytology (B)</p> Signup and view all the answers

What percentage of cats with progressive FeLV infections develop lymphoid malignancies such as lymphoma?

<p>30% (A)</p> Signup and view all the answers

Which of the following cellular genes is commonly observed with viral insertion in feline lymphoma?

<p>c-myc (D)</p> Signup and view all the answers

What condition is characterized by increased band neutrophils and monocytosis in the updated problem list?

<p>Infection (D)</p> Signup and view all the answers

Which of the following best describes the role of FeLV in cancer development?

<p>FeLV participates in a complex process leading to cancer (D)</p> Signup and view all the answers

Which systemic cancer treatment approach is generally applied?

<p>Chemotherapy or immunotherapy (C)</p> Signup and view all the answers

How has the percentage of cats with lymphoma that were FeLV positive changed from before the 1980s to 2003?

<p>Decreased from over 70% to around 15% (B)</p> Signup and view all the answers

What is a common clinical presentation associated with FeLV positive cats at risk for lymphoma?

<p>Lethargy and weight loss (B)</p> Signup and view all the answers

Flashcards

Decreased Appetite

A reduction in the desire or ability to eat.

Weight Loss

A decrease in body mass.

Decreased Activity Level

A reduction in the normal level of physical activity.

Oral Ulcers

Sores or lesions within the mouth.

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Irregular Kidneys

Kidney abnormalities detected during physical examination (palpation).

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Tachycardia (HR 180)

A fast heart rate, more than the normal range.

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Increased Bronchovesicular Sounds

Abnormal lung sounds indicating possible inflammation or disease in the lungs.

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Differential Diagnosis

A list of possible diagnoses to be considered to find the cause of the illness, in this case for the cat.

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Abortive FeLV Infection

An FeLV infection where the virus doesn't replicate actively and doesn't cause apparent disease.

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Regressive/Latent FeLV Infection

FeLV infection where the virus is present, but not actively replicating, causing no noticeable signs.

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Progressive FeLV Infection

An FeLV infection that is actively replicating, and typically leading to disease.

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FeLV Proviral DNA (PCR)

A test that detects the presence of FeLV viral DNA in cells.

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Hypercalcemia in Feline Patients

An elevated level of calcium in the blood of a cat.

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FeLV/FIV Snap Test

An ELISA used to detect FeLV and FIV antigens in blood samples.

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Positive Snap Test

Means the test detected viral antigen; further testing is needed to confirm.

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Confirmation Test (IFA)

Immunofluorescent Assay that detects viral antigens within white blood cells.

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Regressive/Latent FeLV

Cats are initially contagious but eventually clear the virus. Often negative on antigen tests after initial infection.

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Progressive FeLV

Persistent viral infection causing various diseases; cats are contagious for a long time.

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Abortive FeLV

Viral replication stopped by the immune system; rarely observed.

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Discordant Test Results

Inconsistent results: e.g., positive snap test but negative IFA. Suggests possible causes.

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FeLV Testing Samples

Whole blood, serum, and plasma can be used for FeLV tests.

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What imaging modalities can help to differentiate neoplasia from infection?

Thoracic radiographs and abdominal ultrasound are imaging modalities that can help to differentiate neoplasia from infection. They can reveal abnormalities like masses or enlarged lymph nodes suggestive of neoplasia. However, additional diagnostic tests are often needed to confirm the diagnosis.

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Fine needle aspiration (FNA)

A minimally invasive procedure to obtain a sample of cells from a suspicious mass for cytological examination.

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Cytology

The microscopic examination of cells to determine their structure, organization, and any abnormalities.

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What is the relationship between FeLV and Lymphoma?

FeLV infection significantly increases the risk of developing lymphoma in cats. Approximately 30% of cats with progressive FeLV infections develop lymphoid malignancies, including lymphoma and leukemia. FeLV positive cats are 60 times more likely to develop lymphoma than FeLV negative cats. This increased risk is linked to the virus's ability to insert its genetic material into the host's DNA, potentially disrupting tumor suppressor genes or activating oncogenes.

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Insertional Mutagenesis

A process where a virus integrates its genetic material into the host's genome, potentially disrupting genes or activating oncogenes, increasing the risk of cancer.

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Viral Integration into Cellular Oncogene

The insertion of a virus's genetic material into a host's proto-oncogene, a gene that normally regulates cell growth and division, can lead to inappropriate activation of the oncogene and increased risk of cancer.

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How does FeLV contribute to Lymphoma development?

FeLV contributes to lymphoma development through insertional mutagenesis. The FeLV provirus integrates into the host's DNA, potentially disrupting tumor suppressor genes or activating proto-oncogenes, leading to uncontrolled cell growth and lymphoma.

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What is the connection between FeLV and the development of lymphoma?

FeLV (Feline Leukemia Virus) increases the risk of developing lymphoma in cats. The virus can insert its genetic material (provirus) into the host's DNA, potentially disrupting tumor suppressor genes or activating oncogenes, leading to uncontrolled cell growth and lymphoma.

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Study Notes

Ceefer Case Presentation

  • Ceefer is a Domestic Shorthair (DSH) cat, female, spayed, and a young adult.
  • Chief complaints include decreased appetite, weight loss, and decreased activity level.
  • Ceefer was found as a stray about 6 months prior to the presentation.
  • Ceefer has 5 other cats, 2 indoor/outdoor dogs, and 4 horses as pets.
  • Ceefer was vaccinated about 3 months ago for panleukopenia, calicivirus, herpes-1, and rabies.
  • Ceefer's retroviral status is unknown/never tested.
  • Ceefer is an indoor/outdoor cat.
  • Ceefer weighs 4.8kg.

Further History

  • Ceefer has had decreased appetite for a month, gradually worsening.
  • No history of diarrhea.
  • She does sometimes go outside.
  • No increased drinking or urinating, no decrease.
  • Occasional sneezing previously.
  • No vomiting.
  • Currently, she consumes Fancy Feast dry, some wet food.

Physical Examination

  • Demeanor: Quiet, alert, and responsive.
  • Heart rate: 180. No murmur or arrhythmia.
  • Respiratory rate: 28. Increased bronchovesicular sounds.
  • Temperature: 101.2°F. Normal stool on thermometer,
  • Oral Exam: Mucous membranes pale pink and tacky; CRT 2-3 seconds. Gingiva erythematous, with multiple oral ulcers.
  • Abdominal Palpation: Comfortably responsive, not nauseous. Both kidneys felt irregular on palpation, but appeared normal to slightly enlarged in size.

Problem List

  • Decreased appetite
  • Weight loss
  • Lethargy
  • Mild dehydration (tachy MM, longer CRT)
  • Oral ulcers/stomatitis
  • Abnormal lung sounds
  • Irregular kidneys

Differential Diagnosis

  • Degenerative
  • Anomalous
  • Metabolic
  • Neoplasia
  • Inflammatory/infections/immune-mediated
  • Trauma/toxin
  • Vascular
  • Infectious
  • Congenital
  • Autoimmune
  • Toxin/trauma
  • Endocrine/metabolic

Diagnostic Tests

  • CBC
  • Chemistry profile (Chem)
  • Urinalysis
  • FeLV testing
  • FIV testing

Hematology Results

  • Some hematology values are elevated, potentially indicating underlying issues like anemia or infection.
  • Review specific values for details.

Chemistry Results

  • Some chemistry values are elevated, potentially indicating kidney dysfunction or dehydration.
  • Review specific values for details.
  • Potasium is high, indicating a possible issue.

Urinalysis Results

  • Clear urine is observed with a normal specific gravity.
  • Normal protein, Glucose, and Ketones, but bilirubin is elevated, which could indicate a problem with the liver.

FeLV/FIV Snap Test Results

  • Review specific results for details, looking for positive or negative indicators.

Patient Sample Type

  • Whole blood, Serum, or Plasma are used for the FeLV test.

Snap Test

  • The snap test is an ELISA for antigen.
  • It determines the presence of soluble p27 viral antigen.

Confirming Positive Snap Results

  • Confirm positive results with an IFA (immunofluorescent assay).
  • The IFA detects FeLV antigen within leukocytes.

Alternative Option for a Routine Wellness Exam

  • Retest in 3 months if the results are part of a routine wellness exam and the patient is otherwise healthy.

Consequences of FeLV Infection

  • Abortive: Viral replication ends due to effective immune response, does not cause significant problems.
  • Regressive/Latent: Early after exposure, may become undetectable, then potentially reactivate.
  • Progressive: Persistent infection causing severe problems over time.

How to Explain Discordant Results

  • Early signs of infection, lab errors, or cleared disease

Updated Problem List (updated after diagnosis)

  • Decreased appetite
  • Weight loss
  • Lethargy
  • Dehydration
  • Oral ulcers
  • Abnormal lung sounds
  • Irregular kidneys
  • Left caudal lung lobe mass
  • Bilateral renal masses
  • Left shift (increased band neutrophils)
  • Monocytosis
  • Hyperglobulinemia
  • Hypercalcemia
  • FeLV-positive

Updated Differential Diagnosis

  • Neoplasia (lymphoma, carcinoma)
  • Infection (pneumonia, renal abscesses)

Cytology Smear Evaluation

  • Kidney sample analysis showing lymphocytes, possibly a high-grade lymphoma, and inflammation.

Treatment/Prognosis

  • Chemotherapy (CHOP protocol) may provide the best chance for successful remission.
  • FeLV positive status might decrease the duration and success of the therapy.

Patient Outcome

  • Ceefer is undergoing chemotherapy and responding well.

Questions/Further Investigation

  • Additional questions may be needed, specific to the diagnosis.

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Description

This quiz explores the case of Ceefer, a young adult Domestic Shorthair cat presenting with decreased appetite, weight loss, and activity level changes. We delve into her medical history, vaccinations, and current health status to analyze potential health issues. Perfect for veterinary students and animal care professionals.

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