True-false
Given Smoky’s clinical signs, decide for each step if it would be an appropriate action. Think about how you would work through your remaining differentials for Smoky.
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True
Feedback: A repeat physical examination is warranted and would provide additional information on the clinical status of the animal and progression of clinical signs. In terms of serological identification of infectious disease processes, other infectious disease differentials will be able to be tested for using the previously collected samples. It is recommended that the laboratory is contacted directly to discuss further testing.
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True
Feedback: This is a great idea but you need to know what you want to ask for!
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False
Feedback: It's complicated. The role RRV plays in neurological disease in horses remains uncertain. It is probably worth talking with the lab before requesting this test.
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True
Feedback: This is the best option as it fits with the clinical picture of this horse and may also be responsible for your colleague’s case. A single positive IgM titre in a horse with neurological signs is suggestive of Flavivirus involvement in development of myeloencephalopathy
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False
Feedback: While ABLV should still be on your list of differentials at this stage, ante-mortem testing is very difficult. Serological testing is not appropriate. If the clinical presentation of the case continues in line with ABLV and without any alternate diagnosis, despite continued effort, and ABLV is suspected you should notify the EAD hotline 1800 675 888.
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False
Feedback: It's complicated. While EHV1 myeloencephalopathy may remain a differential diagnosis in this case, a negative titre will rule out disease but a single positive titre is of no diagnostic use as exposure is widespread in horses and is not necessarily associated with disease. You could request molecular testing of nasal swabs and bloody lymphocytes from previously submitted samples.