Small Animal Medicine I

• Course Director: Talia Guttin, VMD, DACVIM (SAIM), Associate Professor
  • Email: tguttin@sgu.edu; Zoom appointments available by request.
• Executive Secretary SAMS Department: Ms. Emmanuel, femmanuel@sgu.edu. Lecturers in this course:
• Anne Corrigan, DVM, MS, DACVIM (SAIM), Professor, acorrigan@sgu.edu; Bob Kennis, DVM, DACVD, Visiting Professor, kennira@auburn.edu; Melissa Bain, DVM, DACVB, Visiting Professor, mjbain@ucdavis.edu.
• Class Office Hours via Zoom: TBD with class reps. One-on-one office hours available upon request.

This course will consist of pre-recorded lectures and mandatory live sessions using Zoom for remote students, and classroom Ray and Jan Sis 2, as well as the online teaching tool TopHat.

Students will need a functional laptop and reliable internet connection.

Panopto lecture slides and/or lecture notes will be provided as pdf files. The slides will be accessible for digital notes. For certain lessons, scientific articles, videos, or other references will be assigned and will be provided via Sakai or TopHat.

All lectures will be recorded and distributed via Panopto and SAKAI orTopHat. The main references for this course are:

Textbook of Veterinary Internal Medicine, Editor Ettinger, Publisher Saunders, 8th edition.

Small Animal Critical Care Medicine, Editors Silverstein & Hopper, Publisher Elsevier, 2nd edition.

Fletcher, et al. RECOVER CPCR Guidelines. Journal of Emergency and Critical Care, 22(S1); 2012: S102-131.

Videos and articles will be posted on MyCourses.

1. Students who need accommodations should contact Student Accessibility and Accommodations Services (SAAS), located in the Welcome Center, inside the International Students Office.
2. Information can be found at mycampus.sgu.edu/group/saas

None.

This course is the first in a 2-set series of Small Animal Internal Medicine courses. These courses will cover the clinical presentation, diagnostic evaluation, and current therapies in small animal medicine. This course, the first of the 2-set series, covers the following systems and topics: infectious diseases, renal and urinary diseases, respiratory diseases, dermatology, hematology, immune mediated diseases, and emergency and critical care. The focus of the course is evidence-based medicine, and the problem-based approach, starting with a problem list, developing a differential diagnosis list, followed by a diagnostic plan, and treatment plan, for diseases within each system or topic.

Upon successful completion of this course, the student will be able to:

1. Apply knowledge of the pathophysiologic basis of disease to obtain accurate patient histories, describe clinical signs, identify breed predispositions, and utilize correct medical terminology for common diseases in the main organ systems.
2. Create differential diagnosis lists based on patient clinical data for conditions in specific organ systems.
3. Based on clinical data and differential diagnosis lists, develop diagnostic plans and interpret appropriate diagnostic testing for common diseases in major organ systems.
4. Integrate clinical data and knowledge of pharmacology to design treatment plans for diseases in specific organ systems, considering EBVM and antimicrobial stewardship.
5. Recognize emergency presentations and considerations for specific organ systems.
6. Formulate appropriate verbal and/or written communication to clients and other veterinary professionals regarding history, diagnostic tests, referral, treatment, and prognosis.
7. Recognize zoonotic and contagious disease routes of transmission, associated risks in the workspace, and select patients for isolation.

Infectious Diseases:

1. Apply fundamentals of pharmacology and antimicrobial stewardship to select, adjust and critique therapy for a variety of infectious diseases, considering the infecting microbe, the host, and the drug.
2. Compare and contrast simple vs. complicated infections and determine appropriate treatment protocols and prognosis.
3. Describe toxicities and side effects for commonly used antimicrobials.
4. Review and explain breed predispositions, historical data, presenting complaints, and clinical signs of a variety of fungal diseases.
5. Design, implement, and critique diagnostic plans, treatment plans, and prognosticate for fungal infections in both stable and emergent patients.
6. Review and explain breed predispositions, historical data, presenting complaints, and clinical signs of a variety of viral diseases in both the dog and cat.
7. Design, implement, and critique diagnostic plans, treatment plans, and prognosticate for viral infections.
8. Review and explain breed predispositions, historical data, presenting complaints, and clinical signs of a variety of bacterial/parasitic/mycoplasmal/and protozoal diseases in both the dog and cat.
9. Design, implement, and critique diagnostic plans, treatment plans, and prognosticate for bacterial/parasitic/mycoplasmal/and protozoal diseases in both the dog and cat.
10. Formulate appropriate communications for both veterinarians and owners.
11. Promote preventative medicine and discuss appropriate vaccination protocols and benefits of vector prevention.
12. IN CLASS: model teamwork and communications skills, utilize the TARGET app to assist in case discussions.

Respiratory Diseases:

1. Review and explain relevant anatomy, physiology, and pathophysiology of common respiratory conditions and be able to create differential lists for presenting cases of respiratory disease.
2. Review and explain breed predispositions, historical data, presenting complaints, and clinical signs of a variety of respiratory diseases.
3. Design, implement, and critique diagnostic plans, treatment plans, and prognosticate for respiratory diseases in both stable and emergent patients.
4. Compare and contrast different airway wash techniques.
5. Utilize current research and resources to assist in disease classifications and treatment.
6. Be able to calculate the A-a gradient and interpret venous and arterial blood gas evaluation.
7. Review emergency procedures for patient stabilization and diagnostics.
8. Formulate appropriate communications for both veterinarians and owners.
9. IN CLASS: Model teamwork and professional communications.

Hematologic and Immune Mediated Diseases:

1. Classify anemias as regenerative or non-regenerative, and whole blood loss vs. increased destruction vs. decreased production.
2. Formulate a differential list and diagnostic plan for each category of anemia.
3. Classify thrombocytopenias as: consumptive vs. destruction vs. decreased production
4. Formulate a differential list and diagnostic plan for each category of thrombocytopenia.
5. Extrapolate similarities and differences between all the immune mediated diseases as far as diagnostic plan, underlying triggers, treatment, and prognosis.
6. Distinguish primary vs. secondary immune mediated diseases, and make a diagnostic plan for the common triggers of the immune system and the immune mediated disease.
7. Practice verbal and/or written client communication regarding the prognosis, treatment, and risk of relapse for immune mediated diseases.
8. Discuss the treatment, side effects, and prognosis of immune mediated diseases.
9. Review and explain relevant physiology and pathophysiology of the coagulation cascade and be able to create differential lists for animals presenting with coagulation disorders.
10. Review and explain breed predispositions, historical data, presenting complaints, and clinical signs of a variety of coagulation disorders.
11. Design, implement, and critique diagnostic plans, treatment plans, and prognosticate for patients with coagulation disorders.
12. Compare and contrast primary vs. secondary hemostasis; including the proteins necessary for hemostasis and the organization of the cell-based model of hemostasis
13. IN CLASS: Model teamwork and professional communications.

Renal and Urinary Diseases:

1. Distinguish lower urinary tract signs and upper urinary tract signs via targeted history questions, physical exam, and clinical signs.
2. Develop a differential diagnosis list based on clinical data and localization to the upper or lower urinary tract.
3. Create a diagnostic plan based on the differential list for cases of: acute kidney injury (AKI), chronic kidney disease (CKD), glomerular disease, urolithiasis, urinary tract infection (UTI), prostatic disease, Feline Idiopathic Cystitis (FIC), urinary neoplasia, and micturition disorders.
4. Compare and contrast acute kidney injury from chronic kidney disease.
5. Select and/or interpret diagnostic testing for upper and lower urinary tract diseases.
6. Compare the diagnosis, monitoring, treatment, and prognosis for glomerular diseases to other kidney diseases.
7. Discuss treatment for the common renal diseases, considering EBVM (ACVIM consensus statements, IRIS staging and treatment guidelines).
8. Discuss treatment and prevention for the common lower urinary tract diseases, considering EBVM.
9. Select nutrition plans for various renal and urinary diseases based on the patient’s specific needs.
10. Identify the indications for renal and urinary system surgery and describe the commonly used surgical techniques for renal, ureteral, and urethral diseases.
11. Discuss the indications for referral for dialysis, the prognosis, and the different types of dialysis.
12. Identify the indications for referral to a specialist for diagnostics, or medical, non- invasive, or surgical treatment of renal and urinary diseases.
13. Prognosticate for the common upper and lower urinary tract diseases.
14. Recognize when isolation protocols for infectious and zoonotic diseases should be implemented, and how to discuss zoonotic diseases with owners.
15. Practice verbal and/or written client communication regarding renal and urinary case history, etiology, prognosis, and treatment.
16. IN CLASS: Model teamwork and professional communications.

Behavior:

1. Distinguish inappropriate toileting from urine marking behavior.
2. Create and critique treatment plans for inappropriate toileting in cats.
3. Practice verbal and/or written client communication about the treatment and prognosis for inappropriate toileting in cats.

Emergency/CPR:

1. Compare and contrast BLS and ALS in CPR.
2. Describe and critique appropriate monitoring and stabilization of emergent patients.
3. Compare and contrast chest compression techniques.
4. Understand emergency drugs/therapeutics and how and when to administer including medications, defibrillation and open chest CPR.
5. Utilize current research and resources to assist in disease classifications and treatment.

Dermatology:

1. Understand and utilize appropriate dermatology terminology and define primary and secondary dermatologic lesions.
2. Develop targeted history questions for the dermatologic patient.
3. Identify breed predispositions in dermatologic diseases.
4. Based on presenting complaint, history, and PE findings, create a differential diagnosis list for dermatologic patients.
5. Select and interpret diagnostic tests for common dermatologic diseases.
6. Describe how a definitive diagnosis of the common dermatologic diseases is made: pyoderma, demodicosis, dermatophytosis, scabies, Malassezia, atopy, food allergy, flea allergy, endocrine dermatopathies, DLE, cutaneous lymphoma, uveodermatologic syndrome, juvenile cellulitis, vasculitis, erythema multiforme, toxic epidermal necrolysis, and hepatocutaneous syndrome.
7. Review the pharmacology of therapeutic options of common skin diseases and appropriate use, including antimicrobial stewardship.
8. Develop a treatment plan for the common dermatologic diseases including management and prevention.
9. Explain the prognosis for the common dermatologic diseases.
10. Review nutritional aspects of skin disorders including therapeutic nutritional supplementation.
11. Describe the anatomic structures of the canine ear and the related pathophysiology of otitis externa/media/interna.
12. Define the “3 Ps” (predisposing, primary, perpetuating) and their contribution to the work-up and management of otitis.
13. Recognize when isolation protocols for infectious and zoonotic diseases should be implemented, and how to discuss zoonotic diseases with owners.
14. Practice verbal and/or written client communication regarding dermatology case history, etiology, prognosis, and treatment.

CLOS: Upon successful completion of this course, the student will be able to:

1. Apply knowledge of the pathophysiologic basis of disease to obtain accurate patient histories, describe clinical signs, identify breed predispositions, and utilize correct medical terminology for common diseases in the main organ systems.
2. Create differential diagnosis lists based on patient clinical data for conditions in specific organ systems.
3. Based on clinical data and differential diagnosis lists, develop diagnostic plans and interpret appropriate diagnostic testing for common diseases in major organ systems.
4. Integrate clinical data and knowledge of pharmacology to design treatment plans for diseases in specific organ systems, considering EBVM and antimicrobial stewardship.
5. Recognize emergency presentations and considerations for specific organ systems.
6. Formulate appropriate verbal and/or written communication to clients and other veterinary professionals regarding history, diagnostic tests, referral, treatment, and prognosis.
7. Recognize zoonotic and contagious disease routes of transmission, associated risks in the workspace, and select patients for isolation.

Note: *= pre-recorded Panopto lecture; **= mandatory live session (yellow)

Grading scale complies with SGU and SVM assessment guidelines:

Total grade in the course will be based on 100 points:

• Midterm Exam (17 lectures)= 35 points
• Final Exam (non-cumulative, 26 lectures)= 55 points
• Professionalism = 10 points
  • Please see Professionalism Rubric, Appendix XXI
  • If a score of 0-6 in professionalism is obtained, the student will automatically be brought to CAPPS.
• Note: Sakai/TopHat review questions: participation is monitored and graded, but points for correctness do not contribute to your grade. In other words, we will monitor your progress through the lectures and quiz questions, and you must watch all the lectures and go through the review questions, but review question scores are for you to monitor your learning, and do not count towards your grade.

Any excuses for mandatory In-person/Zoom sessions must be submitted excuses via the Dean of Students (Dr. Bhaiyat) and he will notify the course director.

For ExamSoft/ExamMonitor exams:

A grade reduction of 5% will be applied to that exam if students do not observe the parameters listed in the Assessment Policy for Students.

The material in this course will be integrating much of what you have learned in other courses, so get out your old course material and refer back to it for best learning. Other tips:

• Office hours attendance and participation are recommended.
• After each class, summarizing and making an outline of the lecture’s most important points.
• Working through cases that are provided in lecture on your own, by formulating a problem list, differential diagnosis list, and diagnostic plan, prior to seeing the lecturer’s slides with that information, is encouraged.
• Use the Learning Objectives for each section/lecture, and “Talia’s Tips” main points, to guide studying.
• Refer to the Internal Medicine textbook.

Students are expected to watch all lectures and complete the review questions prior to the mandatory live In-person/Zoom sessions. Content questions will be answered on Sakai/TopHat and at office hours, but not at the live sessions, as other activities are planned for this time.

Students attending St. George’s University are expected to conduct themselves with integrity, dignity, and courtesy, according to a code of conduct that defines the interests, reputation, and stature of the University community. Learning experiences at St. George’s University are not only meant to develop strong academic skills, but also to cultivate students with positive professional attributes, who are well adjusted to the norms of social graces and good social behavior.

The Code of Conduct includes student comportment and the honor code, as well as those actions that warrant disciplinary action. The University reserves the right to take any action that is sees fit to protect the rights of the student body, as well as the reputation of the University.

Abuses of this Code, outlined in the student manual, will result in disciplinary action, which may include suspension or dismissal. It is the responsibility of all students to know the University Code of Conduct. It is required that all students abide by the terms of the University Code of Conduct.

Students are expected to be available during the standard 8:30am-5:20pm AST school day, to attend, engage with in-person/online content, and participate in all classes and clinical rotations for which they have registered. Employment is not an excusable absence. Although attendance, engagement, and participation may not be recorded at every academic activity, attendance, engagement, and participation is graded for mandatory sessions. Students’ lack of attendance, engagement, and participation may adversely affect their academic status as specified in the grading policy.

If failure to attend, engage, or participate in individual classes, examinations, and online activities, or from the University itself is anticipated, or occurs spontaneously due to illness or other extenuating circumstances, proper notification procedures must be followed.

Students who fail to attend an examination or submit an assignment by the deadline without a valid reason (see student manual: SGUSVM POLICY ON AN EXCUSED ABSENCE (EA) FOR STUDENTS) will receive a score of “0” points for the examination. Students who have technical issues during examinations MUST inform the course director (tguttin@sgu.edu) and IT (tellexaminationservices@sgu.edu OR support@sgu.edu OR call 1-631-665-8500 ext. 4444 (US, NU, International) OR 1-473-439-2000 ext. 4444 (Grenada), AND Dean of Students (DOS@sgu.edu) during the open period for the examination. Failure to do so immediately will result in the student receiving a score of “0” points for the examination.

Scheduling of examinations (regular, re-sit, completion, comprehensive, or exemption) is at the discretion of the University. Completion exams will be scheduled within 7 days of the original exam date. Re-sit examination will be scheduled in the first week of the following term

All students are responsible for knowing and complying with the University’s Code of Conduct and the guidelines. Students must read and then sign the Honor Code statement at the start of examinations to indicate that they will comply with the University Code of Conduct.

Prior to Exam Day

1. Each student is required to have a laptop for the purpose of taking computer- based examinations (e-Exams) at SGU. Students must ensure that their laptops meet the current minimum system requirements prior to exam day:
2. Examinees must use their MY SGU Member Center username and password to access the Custom Home Page (www.examsoft.com/sgu) created by ExamSoft for the University.
3. Examinees are responsible for downloading and registering the latest version of Examplify on their laptop prior to exam day. Once Examplify has been successfully downloaded, examinees are strongly encouraged to familiarize themselves with the software by downloading and taking practice exams.
4. Examinees are responsible for setting their laptop up for ExamMonitor prior to the exam (see links below).
5. Examinees will be notified via MyCourses, of all exam related information. Email notifications will also be sent from ExamSoft Support to examinees, notifying them of examinations available for downloading.
6. Examinees experiencing difficulties with their laptop are encouraged to visit the IT department for assistance prior to exam day. Examinees needing a laptop must visit the Office of Institutional Advancement (OIA) to request an exam loaner.
7. Examinees should visit the following information to familiarize themselves with the online proctored exam format and set up their baseline photo.
   1. A Examsoft/ExamID quick guide for students (Please note that the current Examplify version is 2.3.8)
   2. The Examsoft student perspective video 30mins
   3. The Examsoft/ExamID FAQ
   4. Examsoft information page
   5. The general Reminders/Guidelines

The materials (such as slides, handouts and audio/video recordings) provided to students who are taking courses at St. George’s University (SGU) are the intellectual property of the Faculty and/or Administration of SGU. Students are free to use these materials solely for the purpose of group or individual study. Reproduction in whole or in part is prohibited.