Level A. Review your pharmacology notes on NSAIDs and/or try this quick knowledge check. Many questions have two parts and all have a feedback section. If you go too fast, you will miss part II and the feedback.
Level B. Challenge yourself!
Zoey, a 15 year old TB mare presents with mild signs of colic 3 days after foaling. She has been off feed and won’t eat her grain and is only picking at her hay. The colt is alive and is nursing frequently but isn’t putting on much weight. The mare has chronic knee (carpal) issues from being on the track and has seemed reluctant to get up so the owners have been giving her phenylbutazone. She was on 2 grams of bute once daily in the last month due to the extra weight of the foal and they have increased it to twice daily after foaling. It doesn’t seem to make much difference; she still lies down a lot. She has major medical insurance.
On physical examination she is quiet and depressed. You observe small dry fecal balls in the stall. Her mucous membranes are tacky and pale. Her udder is fairly empty but not inflamed or sore on palpation.
HR : 64bpm
RR: 30 bpm
GI sounds quiet. No reflux on nasogastric intubation. Vaginal exam shows bruising but you do not identify any tears. On rectal examination it seems that the intestines are higher in the abdominal cavity than normal and there is some ingesta in the pelvic flexure but not a huge amount. Her uterus seems to be involuting normally. Abdominal ultrasound shows large quantities of free fluid. Abdominal tap results in large quantities of light yellow fluid with low protein and low cellularity. Creatinine of the fluid is off the high end of your test capability (~8 mg/dL is the limit of the test).