• Anatomy & Physiology - species comparisons, organ systems
• Pharmacology - drug dosages, mechanisms, species-specific considerations
• Pathology - disease mechanisms, lesions, histopathology
• Clinical Medicine - diagnosis, treatment protocols
• Microbiology & Parasitology - pathogens, life cycles, zoonoses
• Surgery - procedures, anesthesia
• Exam prep - NAVLE, finals, case-based questions

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BVS415-VMC: Internal Medicine II - Exam Prediction & Study Guide

FREQUENCY ANALYSIS OF PAST QUESTIONS

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TOP 8 PREDICTED QUESTIONS WITH FULL ANSWERS

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🔴 1. MILK FEVER IN COW (Parturient Hypocalcaemia)

• Caused by a sudden, sharp drop in blood calcium (hypocalcaemia) around parturition
• Serum Ca falls from ~10 mg/dL to below 5 mg/dL
• High-producing dairy cows (Holstein, Jersey) aged 5-10 years most affected
• Occurs within 72 hours of calving (most cases within 24 hours)
• Reason: large demand for Ca in colostrum/milk exceeds absorption from intestine and bone mobilization

• At parturition, Ca suddenly drains into colostrum
• The cow's parathyroid hormone (PTH) response is delayed or insufficient
• Low Ca → impaired neuromuscular transmission → flaccid paralysis
• Low Ca also reduces smooth muscle contractility → GI stasis, bladder atony

• Stage I (Hypersensitivity): Excitement, hypersensitivity, staggering, tetany - lasts 1 hour
• Stage II (Sternal recumbency): Cow lies sternally, S-shaped neck curve, cold extremities, dry muzzle, subnormal temperature (36-37.5°C), weak heart sounds, "tucked up" appearance - most common presentation
• Stage III (Lateral recumbency): Complete lateral recumbency, coma, bloat, death if untreated

• Clinical signs + history (recently calved dairy cow)
• Serum Ca < 5 mg/dL (normal 8.5-10.5 mg/dL)
• Rapid response to Ca treatment confirms diagnosis

• IV Calcium borogluconate 400 mL of 25% solution given slowly over 10-20 minutes
• Monitor heart rate during infusion (bradycardia = slow down)
• Also give calcium subcutaneously to provide sustained release
• Phosphorus and Magnesium may also be supplemented

• Low Ca diet 2-3 weeks prepartum (DCAD diet) to stimulate PTH response
• Vitamin D administration before calving
• Oral Ca gels at calving

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🔴 2. KETOSIS IN COW (Acetonaemia)

• Occurs in high-producing dairy cows in early lactation (first 6 weeks post-calving)
• Negative energy balance: the cow cannot eat enough to meet energy demands of high milk production
• Body mobilizes fat → incomplete oxidation of fatty acids → accumulation of ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone)
• Predisposed by: obesity at calving, poor dry cow management

• Low blood glucose → high fat mobilization (NEFA)
• NEFA → liver → ketone bodies when oxaloacetate is depleted
• Ketone bodies rise in blood, urine, milk, breath

• Type I (Wasting form): Most common; cow loses weight rapidly, reduced milk production, inappetence, sweet acetone smell on breath/urine/milk
• Type II (Nervous form): Licking, bellowing, circling, aggression, star-gazing - due to neurotoxic effect of ketones
• General: Dull, dehydrated, firm dry feces

• Rothera's test on urine or milk (purple color = positive for ketones)
• Blood BHBA > 1.4 mmol/L (subclinical), > 3 mmol/L (clinical)
• Blood glucose < 40 mg/dL (hypoglycaemia)

• IV 50% Dextrose solution 500 mL - immediate glucose
• Propylene glycol 250-500 mL orally BID for 3-5 days (gluconeogenic precursor)
• Glucocorticoids (Dexamethasone 20 mg IM) - stimulates gluconeogenesis
• Correct underlying diet; increase energy intake

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🔴 3. AZOTURIA IN HORSE (Tying-Up / Exertional Rhabdomyolysis)

• Occurs when a horse fed high-grain diet is rested for 1-2 days then exercised suddenly
• Also called "Monday Morning Disease" (heavy draft horses rested over weekend)
• Excessive glycogen accumulation in muscle → rapid breakdown on exercise → lactic acid accumulation → muscle damage

• Excess glycogen stored in muscle during rest
• On exercise, rapid anaerobic glycolysis → lactic acid
• Lactic acid + high carbohydrate → muscle necrosis (rhabdomyolysis)
• Release of myoglobin → myoglobinuria → dark reddish-brown urine
• Myoglobin can cause renal tubular damage

• Occurs shortly after starting exercise
• Muscle stiffness and pain (especially hindquarters - gluteal, lumbar muscles)
• Sweating, anxiety
• Dark red/brown urine (myoglobinuria) - characteristic sign
• Reluctance to move, may refuse to move
• Rapid breathing, elevated heart rate
• Severe cases: horse may go down and be unable to rise

• History + characteristic dark urine
• Elevated serum CK (creatine kinase) and AST
• Myoglobin in urine
• Muscle biopsy in chronic cases

• Stop exercise immediately, keep horse warm and calm
• Do NOT walk the horse (walking worsens muscle damage)
• IV fluids (saline/lactated Ringer's) to protect kidneys and clear myoglobin
• NSAIDs (phenylbutazone, flunixin) for pain and inflammation
• Muscle relaxants (methocarbamol)
• Vitamin E and Selenium supplementation
• Sodium bicarbonate for acidosis

• Reduce grain rations on rest days
• Regular exercise schedule (no sudden rest-then-work pattern)

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🔴 4. DOWNER'S COW SYNDROME

• Most commonly follows unresolved or complicated milk fever
• Prolonged recumbency causes ischemic muscle and nerve damage
• Damage to sciatic nerve, obturator nerve, or femoral nerve during calving
• Hypophosphataemia, hypokalaemia may contribute

• Cow is alert, eating, drinking but cannot stand
• "Frog-legged" posture (hind limbs splayed out)
• Good appetite and vital signs unlike typical Ca-deficient cow
• Muscles of hindlimbs are swollen, painful on palpation
• Continues to decline if not managed

• Calcium, phosphorus, magnesium supplementation (rule out metabolic causes)
• Flotation tank (hydrotherapy) - cow floated in water to allow weight-bearing, promotes recovery
• Regular turning (every 2-4 hours) to prevent pressure sores and further ischemia
• Deep, clean, soft bedding
• Anti-inflammatory drugs (dexamethasone)
• Assisted standing with hip lifters/slings
• Good nursing care is essential

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🔴 5. HYPOMAGNESEMIC TETANY (Grass Tetany / Hypomagnesaemia)

• Sudden drop in blood Mg below 1.5 mg/dL (normal 1.8-3.2 mg/dL)
• Most common in lactating beef/dairy cows grazing lush green pastures in spring
• Young lush grass is low in Mg and high in K and N (which inhibit Mg absorption)
• Lactation increases Mg demand
• Also called Grass Staggers or Lactation Tetany

• Low Mg → impaired neuromuscular inhibition → hyperexcitability
• Mg normally blocks excessive nerve impulses at neuromuscular junction
• Unlike Ca, Mg has no hormonal homeostatic mechanism - directly dietary dependent

• Acute form: Sudden excitement, hypersensitivity to touch/sound, muscle tremors, tetanic convulsions, opisthotonos, paddling limbs, death within hours
• Subacute form: Reduced appetite, reduced milk, staggering gait, facial twitching

• Serum Mg < 1.5 mg/dL
• CSF Mg also low
• History of grazing lush pasture

• 200-400 mL of 50% Magnesium sulphate SC (gives slow sustained release)
• IV 25% Calcium-Magnesium borogluconate (combined Ca-Mg solution) for rapid effect
• Sedate if convulsing first (pentobarbitone or chloral hydrate)
• Move off lush pasture

• Mg supplementation as licks/boluses/top-dressed on pasture
• Calcined magnesite (MgO) in feed at 60 g/day during risk period

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🟠 6. VITAMIN DEFICIENCY - A, D, E (High value 8-mark question)

• Source: Green fodder, yellow maize, fish oils (beta-carotene precursor)
• Functions: Vision (rhodopsin), epithelial integrity, reproduction, immune function
• Deficiency signs: Night blindness (first sign), xerophthalmia, keratinization of epithelia, reproductive failure, diarrhoea, CNS signs in calves
• Treatment: Vitamin A injection (retinyl palmitate)

• Source: Sunlight (UV on skin), sun-cured hay
• Functions: Calcium and phosphorus absorption from intestine, bone mineralization
• Deficiency signs: Rickets in young (soft bones, enlarged joints, bowed limbs), Osteomalacia in adults (soft painful bones), milk fever predisposition
• Treatment: Vitamin D3 injection, sunlight exposure

• Source: Green fodder, wheat germ
• Functions: Antioxidant, protects cell membranes, works with Se
• Deficiency signs: White Muscle Disease (nutritional muscular dystrophy) in calves/lambs - white streaking of skeletal and cardiac muscle, sudden death, stiff gait
• Treatment: Vitamin E + Selenium injection (e.g., Dystosel)

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🟠 7. ECLAMPSIA IN BITCH (Puerperal Hypocalcaemia)

• Severe calcium drain through milk production
• Small breeds (Chihuahua, Toy Poodle, Dachshund) most at risk
• Usually occurs 1-4 weeks post-whelping, rarely in late pregnancy
• Poor diet during pregnancy, calcium supplementation during pregnancy paradoxically worsens it by suppressing PTH

• Restlessness, panting, muscle tremors
• Tetanic convulsions - rigid limbs, facial muscle spasms
• Hyperthermia (due to muscle activity)
• Ataxia, weakness
• Can be fatal if untreated

• Serum Ca < 6.5 mg/dL (critical)
• History + clinical signs

• IV 10% calcium gluconate, 0.5-1.5 mL/kg slowly - monitor heart rate
• Cool the animal (hyperthermia)
• Remove puppies temporarily, then gradually reintroduce
• Oral calcium supplementation after stabilization
• Wean puppies early and supplement them

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🟠 8. ETHNO-VETERINARY MEDICINE

• Cost-effective in rural/resource-limited settings
• Accessible to farmers without nearby veterinary services
• Some practices have scientific backing
• Integrated with modern veterinary practice in many developing countries including Nepal and India

• Neem (Azadirachta indica) leaves/oil: antibacterial, antifungal, antiparasitic
• Turmeric (Curcuma longa): anti-inflammatory, wound healing
• Garlic (Allium sativum): anthelminthic, antimicrobial
• Aloe vera: wound healing, skin diseases
• Mustard oil: skin conditions, external parasites
• Cow dung/urine: applied for wounds (traditional practice in South Asian context)

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QUICK SHORT NOTE TOPICS TO PREPARE

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EXAM STRATEGY

1. Q. No. 6 (Compulsory) in Purbanchal exams is always short notes - prepare at least 6 short note topics
2. Milk Fever, Ketosis, Azoturia - write these in full ETIOLOGY + PATHOGENESIS + CLINICAL SIGNS + DIAGNOSIS + TREATMENT format (8 marks each)
3. Downer's Cow and Hypomagnesaemia - very likely to appear as full 8-mark questions
4. Vitamin deficiency (especially A, D, E) appeared in the 2025 final - strong chance of repeat
5. The syllabus includes Diabetes mellitus in dogs and Hypothyroidism - these have NOT appeared yet, so they carry a moderate chance of appearing as a "new" question

1. Milk Fever in Cow
2. Ketosis in Cow
3. Azoturia in Horse
4. Downer's Cow Syndrome
5. Hypomagnesemic Tetany

• Diabetes mellitus/insipidus in dogs
• Hypothyroidism in dogs
• Mineral deficiencies (iron, copper, zinc, selenium)