Royal College of Veterinary Surgeons Membership Exam (RCVS) Companion Animal Medicine and Surgery Syllabus

Give the diagnostic criteria framework for canine IMHA (signs of immune destruction).

Requires evidence of immune-mediated destruction (≥2 of: spherocytosis, positive saline agglutination, positive Coombs) PLUS evidence of haemolysis (≥1 of: hyperbilirubinaemia/icterus, haemoglobinaemia, haemoglobinuria, ghost cells).

What infectious agent causes feline infectious peritonitis, and what differentiates the effusion in the 'wet' form?

A mutated feline coronavirus. Wet/effusive FIP yields a high-protein, straw-yellow, viscous exudate with low cellularity and a high albumin:globulin inversion (A:G $<0.4$ supports FIP); Rivalta test is typically positive.

Compare primary vs secondary immune-mediated thrombocytopenia and the platelet count at which spontaneous bleeding occurs.

Primary (idiopathic) IMTP is a diagnosis of exclusion; secondary follows infection, neoplasia, or drugs. Spontaneous mucosal/petechial haemorrhage typically occurs when platelets fall below $\sim 30\text{--}50 \times 10^{9}/\text{L}$.

Localise a lesion causing UMN vs LMN signs in the pelvic limbs based on spinal cord segment.

T3–L3 lesions cause UMN signs to the pelvic limbs (increased tone/reflexes, intact-to-exaggerated withdrawal). L4–S3 lesions cause LMN signs (decreased tone/reflexes, reduced withdrawal, muscle atrophy).

Describe the Modified Frankel / neurological grading concept for thoracolumbar IVDD and the prognostic significance of deep pain.

Grades run from grade 1 (pain only) through paresis, paralysis, to loss of deep pain perception (grade 5). Presence of deep (nociceptive) pain perception is the single most important positive prognostic indicator for recovery after surgery.

What is the signalment and pathophysiology of Hansen type I vs type II intervertebral disc disease?

Type I: chondrodystrophic breeds (Dachshund), acute nucleus pulposus extrusion from chondroid degeneration. Type II: non-chondrodystrophic older dogs, gradual annulus fibrosus protrusion (fibroid degeneration) with chronic compression.

List the cardinal signs of myasthenia gravis in the dog and the confirmatory test.

Appendicular and oesophageal weakness with fatigability, regurgitation from megaoesophagus, and a positive edrophonium (Tensilon) response. Confirmed by elevated serum acetylcholine receptor antibody titre.

Define the Halsted principles of surgery.

Gentle tissue handling, meticulous haemostasis, preservation of blood supply, strict aseptic technique, minimal tension on tissues, careful tissue apposition, and obliteration of dead space.

Classify surgical wounds by contamination and give expected infection rates.

Clean ($<5\%$), clean-contaminated (entry into a viscus with controlled contamination, $\sim5\text{--}10\%$), contaminated (gross spillage/fresh trauma, $\sim15\text{--}20\%$), and dirty/infected (established infection, $>20\text{--}40\%$).

What is the recommended timing of prophylactic antibiotics for surgery and the duration consideration?

Administer IV within 30–60 minutes before the skin incision to achieve tissue concentrations at incision; redose intra-operatively every ~90–120 minutes (or 2 half-lives). Prophylaxis is generally discontinued within 24 hours post-op.

State Lister/asepsis principles distinguishing sterilisation, disinfection and antisepsis.

Sterilisation destroys all microorganisms including spores (e.g., autoclave at $121\,^{\circ}\text{C}$, $103\,\text{kPa}$, 15 min). Disinfection kills most pathogens on inanimate surfaces. Antisepsis is microbial reduction on living tissue (e.g., chlorhexidine skin prep).

Describe the layers of a routine gastrointestinal (enterotomy/intestinal) closure and the preferred suture pattern.

A single-layer approximating closure incorporating the submucosa (the holding layer of intestine) using a simple interrupted or simple continuous pattern with monofilament absorbable suture (e.g., polydioxanone). The submucosa provides the suture-holding strength.

Compare the four stages of secondary-intention wound healing.

Inflammatory (haemostasis and debridement, 0–5 days), debridement (overlaps, leukocyte influx), proliferative/repair (granulation, angiogenesis, epithelialisation, fibroplasia, ~5–20 days), and maturation/remodelling (collagen reorganisation, weeks–months, regaining ~80% tensile strength).

Define the moist wound healing types of dressing and when to transition from debridement to a dressing promoting granulation.

Adherent (wet-to-dry) or hydrophilic dressings for the debridement phase; transition to non-adherent moisture-retentive dressings (hydrogels, hydrocolloids, foams) once a healthy granulation bed forms to support epithelialisation and contraction.

What is the difference between an advancement flap, an axial pattern flap and a free graft in reconstruction?

Advancement/subdermal plexus flaps rely on the random subdermal plexus and have limited length. Axial pattern flaps include a direct cutaneous artery/vein, allowing larger robust flaps. Free skin grafts are detached tissue dependent on recipient-bed revascularisation (imbibition then inosculation).

Classify fractures using the Salter-Harris system for physeal injuries.

Type I: through the physis. II: physis + metaphysis (most common). III: physis + epiphysis (into joint). IV: epiphysis through physis into metaphysis. V: crushing/compression of the physis (worst prognosis for growth).

State the AO/ASIF principles of fracture fixation.

Anatomic reduction (especially articular), stable fixation appropriate to the fracture (absolute vs relative stability), preservation of blood supply to bone and soft tissue, and early active mobilisation of the limb and patient.

Differentiate primary (direct) from secondary (indirect) bone healing.

Primary/direct healing occurs under absolute stability with anatomic reduction—no callus, via cutting cones/Haversian remodelling. Secondary/indirect healing occurs with relative stability and micromotion, proceeding through callus (endochondral and intramembranous ossification).

Outline a structured approach to lameness localisation and grading.

Observe gait (weight-bearing vs non-weight-bearing), grade lameness 0–5 (0 = sound, 5 = non-weight-bearing), then systematic palpation/manipulation distal-to-proximal for pain, swelling, crepitus and instability; localise before imaging.

What is the cranial drawer and tibial compression test diagnosing, and what is the most common cause in dogs?

Cranial cruciate ligament (CrCL) rupture—the stifle's most common orthopaedic disease in dogs. Cranial drawer demonstrates cranial tibial translation; tibial thrust/compression test reproduces it dynamically. Often associated with a medial meniscal tear.

Compare osteoarthritis radiographic and joint-fluid findings with immune-mediated polyarthritis.

Osteoarthritis: osteophytes, subchondral sclerosis, joint effusion; synovial fluid has low cell counts with mononuclear cells. Immune-mediated polyarthritis: multiple joints, synovial fluid with high non-degenerate neutrophil counts and negative culture.

Define ASA physical status classification and its purpose in anaesthesia.

A 5-grade scale of patient health: I (normal healthy), II (mild systemic disease), III (severe systemic disease), IV (severe disease that is a constant threat to life), V (moribund, not expected to survive without surgery); E suffix for emergency. It standardises peri-anaesthetic risk assessment.

List the components and rationale of balanced/multimodal anaesthesia.

Combining premedication (sedation + analgesia), induction, maintenance (inhalant/TIVA), and analgesia (opioids, local blocks, NSAIDs) so each drug is used at lower doses—maximising benefit while minimising the dose-dependent cardiorespiratory depression of any single agent.

Compare the cardiovascular effects of propofol, alfaxalone and ketamine for induction.

Propofol: dose-dependent vasodilation, hypotension, apnoea on rapid injection. Alfaxalone: similar but wider margin, less cumulative. Ketamine: sympathomimetic, maintains/raises heart rate and blood pressure (good for shock) but is contraindicated with raised intracranial/intraocular pressure and avoided in HCM cats.

State the minimum alveolar concentration (MAC) concept and approximate MAC of isoflurane and sevoflurane in dogs.

MAC is the alveolar inhalant concentration preventing movement in 50% of subjects to a noxious stimulus—an index of potency. Isoflurane MAC $\approx 1.3\%$ and sevoflurane MAC $\approx 2.3\text{--}2.4\%$ in dogs. Opioids and other agents lower MAC.

What are the five core parameters monitored under anaesthesia and one device for each?

Oxygenation (pulse oximetry, $\text{SpO}_2$), ventilation (capnography, $\text{ETCO}_2$), circulation (ECG, blood pressure—Doppler/oscillometric), temperature (oesophageal probe), and anaesthetic depth (eye position, jaw tone, palpebral reflex).

Define normal capnograph values and the significance of a sudden drop in ETCO2 to near zero.

Normal $\text{ETCO}_2$ is $35\text{--}45\,\text{mmHg}$. A sudden fall toward zero indicates a catastrophic event—oesophageal intubation, airway disconnection/obstruction, or cardiac arrest (no pulmonary perfusion)—and demands immediate action.

List common intra-anaesthetic complications and first-line responses for hypotension and hypothermia.

Hypotension (MAP $<60\,\text{mmHg}$): reduce inhalant, give a fluid bolus, then a positive inotrope/vasopressor (e.g., dopamine, dobutamine, ephedrine). Hypothermia: active warming (forced-air blanket), warmed fluids—it prolongs recovery and reduces MAC.

Describe how to recognise acute pain in dogs and cats and one validated scale for each.

Behavioural and physiological cues: guarding, altered posture, reluctance to move, tachycardia, and (cats) facial grimace. Validated tools include the Glasgow Composite Measure Pain Scale (canine) and the Feline Grimace Scale / Glasgow feline scale.

Explain the WHO-style analgesic ladder/multimodal approach and which receptor classes are targeted.

Combine agents acting at different sites: opioids (mu/kappa receptors), NSAIDs (COX/prostaglandin inhibition), local anaesthetics (sodium-channel blockade), and adjuncts (ketamine—NMDA antagonist; alpha-2 agonists; gabapentin). Pre-emptive and multimodal dosing reduces central sensitisation and total drug doses.

State the components of a primary survey in emergency triage (the ABCs) for veterinary patients.

Airway, Breathing, Circulation, then Disability (neurological) and Examination/Exposure. Identify and treat immediately life-threatening problems (haemorrhage, airway obstruction, shock) before a full secondary survey.

Define the shock fluid resuscitation 'bolus' approach for dogs and cats with hypovolaemic shock.

Isotonic crystalloid in incremental boluses—dogs roughly $10\text{--}20\,\text{mL/kg}$ (up to a full 'shock dose' of $\sim80\text{--}90\,\text{mL/kg}$ titrated), cats more conservatively $5\text{--}10\,\text{mL/kg}$ (shock dose $\sim40\text{--}60\,\text{mL/kg}$)—reassessing perfusion endpoints after each bolus.

Describe gastric dilatation-volvulus (GDV): signalment, key radiograph sign and treatment priorities.

Large/giant deep-chested breeds; the right-lateral radiograph shows a 'double bubble' / compartmentalised 'Popeye/smurf hat' gas-filled stomach. Priorities: aggressive shock fluids and gastric decompression first, then surgical derotation and gastropexy to prevent recurrence.

Compare the lesion distribution of flea allergy dermatitis, atopic dermatitis and sarcoptic mange in the dog.

Flea allergy: dorsal lumbosacral/tail-base and caudal thighs. Atopic dermatitis: face, ears, paws, ventrum, axillae (often pruritus before lesions). Sarcoptic mange: ear margins, elbows, hocks, ventral abdomen with intense pruritus and a positive pinnal-pedal scratch reflex.

What is the diagnostic value of cytology of skin/ear: cocci vs rods vs Malassezia, and treatment implication?

Cocci suggest Staphylococcus (often respond to first-line topical/systemic antibacterials); rods suggest Gram-negative (e.g., Pseudomonas—needs culture and targeted therapy); peanut/footprint-shaped Malassezia yeast indicate antifungal therapy. Cytology guides empirical treatment.

List the components of the Schirmer tear test and ophthalmic emergency triage for a red, painful eye.

The Schirmer tear test I measures aqueous tear production over 1 minute; normal $\geq 15\,\text{mm/min}$, with KCS (dry eye) typically $<10\,\text{mm/min}$. A red painful eye demands ruling out glaucoma (tonometry), corneal ulcer (fluorescein) and uveitis before any steroid is applied.

Differentiate the fluorescein and Seidel test interpretations in corneal disease.

Fluorescein stains exposed corneal stroma green, confirming an ulcer; it does not adhere to intact epithelium or to Descemet's membrane (so a descemetocele shows a clear centre with stained rim). A positive Seidel test (stream of dilution of dye) indicates a perforating leak of aqueous.

State the canine and feline normal intraocular pressure range and the glaucoma threshold.

Normal IOP by applanation/rebound tonometry is approximately $10\text{--}25\,\text{mmHg}$. Sustained IOP $>25\text{--}30\,\text{mmHg}$ indicates glaucoma; acute glaucoma with vision threat is an emergency requiring rapid IOP reduction (e.g., mannitol, topical agents).

Describe the modified Triadan numbering and how to identify a tooth (e.g., tooth 108 / 204).

Triadan uses three digits: first digit is the quadrant (1 = right maxilla, 2 = left maxilla, 3 = left mandible, 4 = right mandible for permanent teeth; 5–8 for deciduous), and the last two digits number the tooth from midline. Thus 108 = right maxillary 4th premolar (carnassial); 204 = left maxillary canine.

List the stages of periodontal disease and the principal radiographic feature used for staging.

Stages 0–4 based on attachment loss: 0 normal, 1 gingivitis only, 2 early (<25% attachment loss), 3 moderate (25–50%), 4 advanced (>50%). Dental radiography quantifies alveolar bone loss, the key staging determinant.

State the principles of oncological surgery and define surgical margins (marginal, wide, radical).

Achieve complete excision with appropriate margins guided by tumour type and grade. Marginal: through the pseudocapsule (risk of residual tumour). Wide: a cuff of normal tissue (e.g., 2–3 cm lateral and one fascial plane deep for soft tissue sarcoma/mast cell). Radical: removal of the entire compartment/structure.

Explain the TNM classification used in veterinary oncology.

T = primary tumour size/extent, N = regional lymph node involvement, M = distant metastasis. It standardises clinical staging to guide prognosis and treatment, supplemented by histological grading for tumours like mast cell tumours and soft tissue sarcomas.

Compare grading and prognosis of cutaneous mast cell tumours (Patnaik and Kiupel systems).

Patnaik is a 3-tier system (grade I well-differentiated/good, II intermediate, III poorly differentiated/poor). The Kiupel 2-tier system (low vs high grade) improves consistency—high-grade tumours have higher metastatic risk and shorter survival; mitotic count and KIT/Ki-67 refine prognosis.

Differentiate core from non-core vaccines for dogs in the UK and the recommended primary course.

Core (WSAVA): canine distemper virus, canine adenovirus, canine parvovirus (DHP), with leptospirosis treated as core in the UK due to endemicity. Primary course of two-to-three doses finishing at ~16 weeks, a booster at ~6–12 months, then core revaccination typically every 3 years (lepto annually).

List feline core vaccines and the immunological reason for finishing kitten vaccination at ~16 weeks.

Feline panleukopenia (FPV), feline herpesvirus-1 (FHV-1) and feline calicivirus (FCV) are core; rabies where relevant. The final dose at ~16 weeks ensures maternally derived antibody has waned enough not to block the kitten's active immune response.

Outline a comprehensive parasite control approach covering endo- and ectoparasites.

Risk-based protocol: routine roundworm/tapeworm treatment (e.g., monthly–quarterly), Angiostrongylus vasorum prevention in endemic areas, flea control year-round, and tick prevention. Tailor to lifestyle, travel (PETS scheme requires tapeworm treatment for Echinococcus) and zoonotic risk.

Compare the lifecycle and zoonotic significance of Toxocara canis vs Echinococcus granulosus.

Toxocara canis: ascarid with transplacental/transmammary transmission; zoonotic causing visceral/ocular larva migrans in children. Echinococcus granulosus: small tapeworm in dogs (definitive host) with sheep intermediate hosts; human ingestion of eggs causes hydatid cyst disease—hence mandatory tapeworm treatment for pet travel.

List three important companion-animal zoonoses and their public health control measures.

Rabies (vaccination, quarantine/PETS controls), leptospirosis (vaccination, rodent control, PPE), and dermatophytosis/ringworm (Microsporum canis—hygiene, isolation, treatment). Toxoplasma gondii from cat faeces also matters for immunocompromised and pregnant people.

State the resting energy requirement (RER) formula and how maintenance energy is derived.

$\text{RER} = 70 \times (\text{body weight in kg})^{0.75}$ kcal/day; a linear approximation for 2–45 kg is $\text{RER} = 30 \times \text{BW} + 70$. Maintenance energy requirement is RER multiplied by a life-stage/activity factor (e.g., $1.2\text{--}1.6$ for neutered adults).

Describe body condition scoring (BCS) and the relationship between BCS and ideal weight for a weight-loss plan.

BCS uses a 9-point scale where 4–5/9 is ideal; each point above 5 represents roughly $10\text{--}15\%$ over ideal weight. Feed RER (or ~80% of RER for ideal weight) of a calorie-restricted, high-protein diet and reassess every 2–4 weeks targeting $\sim1\text{--}2\%$ body-weight loss per week.