Well, here we are at Zuku's NAVLE® Prep Accelerator Hoot Camp. It'll be me talking about study strategies and Dr. Linnea Tracy there, who will be speaking about poultry. Dr. Tracy, feel free to turn off your video if you don't want to watch, but you're welcome to watch. It's up to you. 

For today's talk, we'll start as we always do with the weekly warmup. We'll be going through a short review of some of the questions we've seen in previous sessions, which is a good way to improve your retrieval skills. For poultry classic cases today, Dr. Linnea is gonna go through not one, but two really useful poultry diseases you might wanna know about. And she's available for Q&A in the Q&A box. Study strategies will be me and I'll be talking about not studying for success and things you can do that are not studying that help you perform better. That'll be a fun and easy talk. Finally, as always, we'll reinforce what we learned today with a low stakes quiz and then I'll give you a short assignment for Tuesday on Dog and Cat. My favorite chicken picture. 

It's time for the weekly warmup, everybody. As I said, we always like to warm up with a few questions from before. This habit of quizzing yourself on stuff you saw a couple days ago, I wanna encourage you to have that habit in your own prep for the NAVLE®. That could be what you do during independent study on your notes, but it should also be something you can have the system in Zuku help you do is seeing those questions you miss, trying them again and getting them right. This practice of actively pulling information out of your head, they call it retrieval practice, it actually reinforces your knowledge and you're literally opening the doors, opening the paths between your brain where the information might lie and your fingertips and that's what we're trying to do our entire study plan. 

So here's question number one based on last week's topic. A six-year-old Great Dane presents with acute non-productive retching, abdominal distension, and signs of hypovolemic shock. On physical exam, the abdomen is tympanic and firm. What is the most appropriate next diagnostic step to confirm your leading diagnosis? So they're asking what what do you want to do diagnostically? Here come your options. Do a CT scan of the abdomen? AFAST scan? Abdominal radiographs? Exploratory surgery? Abdominocentesis and fluid cytology? So if you want to weigh in in the chat box, feel free. We'll give everybody a minute or two to look at that and then I'll go to the next. Checking the chat box here. Excellent. I see lots of good choices here, very good. So most people remember this one from Dr. Mahon's talk. So what are we going to do? We want something that almost any clinic can do. It's a common thing. We're gonna go for abdominal radiographs. If I can get it to come up. There we go, the color change. It's very easy to see the gas bubble, whether it's partial rotation or full rotation, but that's what you do because you suspect what disease? Yeah, a GDV. 

Which clinical finding most strongly supports a diagnosis of GDV over other causes of an acute abdomen? So we're looking for a clinical finding here. Is it retching with a firm tympanic abdomen? Hyperdynamic pulses with abdominal pain? A fluid wave on abdominal palpation? Hypotension plus pale mucus membranes? Vomiting and abdominal pain? All right, so which one of these clinical findings most strongly supports your diagnosis, your provisional diagnosis of GDV over other possible acute abdomen abdominal problems? All right, people are weighing in quickly. Okay, we've got a couple choices starting to pop up. I like to see that. Remember folks, as we say here all the time, you don't need to get 100 to pass your NAVLE®. If you get this one right, good for you. But if you got it wrong, also good for you because you learn from the ones you miss. And the name of the game is not to freak out about the questions you miss, just say, well, I missed that one, what's the answer? Oh, okay. And then you remember it for next time. Okay, that's how we learn. We learn from the ones we miss the most. Here we go. Here is your answer. It seems like it wants me to click it twice. There we go. So, you know, retching, a non-productive retching, nothing much is coming up and a firm tympanic abdomen, that's a big concern for GDV. Tympani, you remember we're talking about this. What's the disease we compare this to in other species? We think of a DA in a cow, you might get tympani in colic in a horse. 

Okay, we're going to go back a little further to our equine topics of a week or so ago. It's always good to not just do the most recent stuff, but continue to do your retrieval practice for other diseases. A 12-year-old Morgan Mare presents in the spring in Pennsylvania with a short strided gait, reluctance to turn, and increased digital pulses in the forelimbs. She alternates lifting her feet, but is not lame at the walk. Hoof testers elicit pain at the toe. Which diagnostic is most appropriate to localize this lameness? A Palmar digital nerve block? Distal limb radiographs? Low four-point nerve block? Abaxial nerve block? Endocrine testing? So think about this. This is a good example of a NAVLE® format third order question where they give you a scenario, a case scenario. They expect you can get in the ballpark of what you think your differential diagnosis is, and then they're asking you how do you confirm it. Okay, let's see how people look in the chat room. Very nice, I see several different kinds of choices. This is excellent, I'm glad to see this. You guys are remembering some of the stuff we talked about. And here comes your answer. So remember, what is our big differential diagnosis we're concerned about in this horse? It's laminitis. You know, pain in the toe, they're not particularly lame at the walk, but they're clearly lame from something. The pain in toe suggests we probably got a laminitis. It's one of the more common problems we worry about and an abaxial nerve block is the one you want to pick. If you give the abaxil nerve block and the pain goes away, that helps it be more diagnostic. 

All right, back to doggies. A seven-year-old male neutered doberman presents after collapsing at home. The owner reports non-productive retching and progressive abdominal bloating over the past few hours. On exam, the dog is tachycardic, hypotensive, has a distended tympanic abdomen. You suspect GDV and prepare for fluid resuscitation. I think that means fluids and resuscitation. Which vein is the most appropriate for IV catheter placement in this patient? So here comes your options. Lateral saphenous? Cephalic? Dorsalpedal? Jugular? And I can't see it. Femoral? So which vein are we looking for here? I see pretty much people are all on the same page on this one. Very good, very good. Okay, in three, two, one, here comes your answer. And it's the cephalic vein, okay? Remember these guys can be shocky, hypotensive, we need to have fluid support. 

You're treating a shocky, painful dog with GDV, and you choose to trocarize to quickly reduce abdominal distension and improve preload. How do you decide where to insert the catheter? They're talking about using the catheters like a trocar to let the pressure off, okay? They're not talking about a venous catheter that you put in a blood vessel. You put the trocar always on the left side to avoid the spleen? You put the trocar on the midline, cranial to the umbilicus? On the right side, caudal to the last rib? This dog is too sick to trocarize? Put it in the most tympanic area? So I've got my owl cup, Dr. Tracy, do you have a chicken cup? 

I'm through with my coffee for this morning so I don't have my chicken cup out. 

Okay. Alright guys, let's see how we did. Where do we put that trocar? We put it in the most tympanic area because you don't know quite where the peak of the expansion is going to be so you're just looking for the top of that bubble so there's not much tissue between you and the gas inside the gastric mucosa. Good job, everybody. Now, remember, if you didn't get that right, not a reason to feel bad. We all miss questions. That's why we call it practice, okay? The point is not to try to get 100. The point to try learn from your mistakes and get better. 

All right, folks, thank you so much for joining us this morning and for your patience getting this up and going. So my name is Dr. Linnea Tracy. I'm a boarded poultry veterinarian and I work here in the US across the country, mostly with laying hens and a little bit with broilers and turkeys too. So today we're going to go over some classic cases, two for one disease special for hoot camp in some major areas of poultry disease. This is often an area that people stress about for the NAVLE®, but don't worry. Poultry is a minority topic there and the cases are fun, and so hopefully you'll be able to feel more confident after this presentation. 

Let's go to the first case. This is going to be your classic case number one, and it's going to a history. You get a call to your office in the spring. You go out to see this flock and you see that they are a multi-age backyard flock of chickens and turkeys. There's about 50 birds in this flock. They're being ranged out in someone's big backyard with pasture. Typically, this block has no mortality. They're very healthy. They've been doing well for a while now, but they have lost seven birds out of 50 this week. So that's a pretty high percentage. Five of those losses were yesterday and two were the day before. There were no obvious clinical signs reported to you. They're not sure why they died. They couldn't see any signs of trauma or anything else. 

So you go out to examine them of course because it's a puzzle and you need to go and check out the animals. Before you're even able to drive there two more birds die and your owner tells you that when you arrive. When you do get there you see that members of the flock are lethargic so they're hesitating to move around they're feeling slower than usual. The mortality that the owner has saved is cyanotic so remember that's a classic word it shows up in a lot different disease presentations in poultry and otherwise. Just means coloration blue or purpling. In poultry, you'll mostly see this around the face. So on the waddles, on the comb, on the non-feathered areas. So you see blue combs here. You decide to open up a couple of these, taking good care and make sure you're wearing gloves and all of that. And you notice that they have petechial hemorrhages over the heart. At the proventricular-ventricular junction, which is the area between the chemical and the manual stomach of the bird, and then they also have a mottled liver appearance. This makes you really suspicious, so you go ahead and you obtain choanal swabs of all dead and lethargic birds. And the photo here is to show you what that looks like. Choanal cleft is the cleft on the hard pallet of birds. And those swabs are the best diagnostic methodology from a lot of respiratory diseases. You send those swabs to the state lab for PCR and you call your state vet and you make sure that none of those birds leave the premises. So for this, what is your top differential here? Give you a couple of minutes. There's some good clues here. Cyanosis, petechial hemorrhages, rapid mortality. You're calling your state vet. Remember to think of the one that comes most obvious to mind, not a zebra. Okay, so we're seeing a couple of different ones come in. Lots of good guesses here. Okay, let's go to the next slide. 

Top differential here is avian influenza. So I wanna give an extra shout out to those people that also said virulent Newcastle disease. So that is something that you would also worry about, hard to differentiate. The keys here to give you a clue into this case question were that they were outdoor birds and it was during the spring. So that's kind of a clue in terms of how this disease gets into your flock in terms of question writing. So let's jump into how the background of that disease and how you might figure that out. So avian influenza, it is an influenza A virus. So if you're a virology nerd, that's family Orthomyxoviridae. This is traditionally spread by migratory waterfowl. This is, again, that spring question. If you have geese, ducks, joining your backyard flock from the outside as they migrate, this is a big concern for disease spread. There's a lot of different types of avian influenza. We classify them by two antigens, so hemaglutinin or H-types and neuraminidase N-types. The ones that we're really concerned about are H types 5 and 7, because they have the genetic potential to become highly pathogenic strains. So highly pathogenic means that it just has a way larger impact on those birds. It's very virulent. It causes a lot of disease. So H5 and H7 highly pathogenic strains are known as HPAI, highly pathogenic avian influenza, and they're what is known in the old literature and sometimes still in test questions as fowl plague because it kills up to 100% of the birds it infects. Often very, very rapidly in the case of just a couple few days. So we are actually experiencing in the U.S. and most of the world right now an outbreak of highly pathogenic avian influenza caused by H5N1. In the U S it's been going on since 2022 to current which makes this kind of a hot topic right now in poultry disease. So it has been spread by waterfowl but you're read it being hosted in other mammals and other birds more frequently now than it used to be. Primarily because that outbreak has been going on for a bit longer than we expected. You're also sometimes gonna see low pathogenic avian influenza. So that would be subtypes H1 or H3 most commonly. These, however, would be a mild respiratory disease. No clinical signs, kind of like the common cold for poultry, they are gonna come through on a similar seasonal basis, but they're not gonna cause big mortality. It's good to know here that most bird types are susceptible to avian influenza and some strains are zoonotic. So not always and often not very strongly, but you do need to take precautions to make sure especially as you going out to see sick flocks are not being exposed unduly. 

Okay, so in a presentation of avian influenza, what are you most commonly going to see? The number one clinical sign here is sudden heavy mortality. And in many cases, if you have the misfortune of seeing this disease in real life, you will see nothing more than sudden heavy mortality. You may just get a call and say, I don't know what happened, doc, half the flock is dead. We didn't do anything wrong. And this might be the cause. Other things you might see if it's sort of sneaking into the flock and having a slower presentation, you're going to see an acute decrease in laying if they're an egg layer flock. You're going see a drop in feed and water intake because those birds aren't feeling well and they're not going to be doing their daily activities. If you're in the flock, you're gonna see depression, lethargy, and you'll see neurologic signs sometimes too. So torticollis, twisting of the neck, incoordination, kind of like bumbling, fumbling, falling over movements. Classic ones here are, again, cyanosis, that's what we talked about in that case, and bruised shank appearance. And that's because this is a virus that attacks the endothelium, so the lining of the blood vessels, which means you're gonna have some blood leakage in those areas. And that why we also see petechial hemorrhages in certain areas of the bird. So you can see photos of what a cyanotic chicken looks like, normal versus turning blue in photo number two on the right. A little bit of mild cyanosis on the top, number one photograph, and that bruised shank appearance in photo number three. Over time, you're going to see increased respiratory effort and rales, so like that strong wheezing respiratory noise. Facial edema can be common. You can also see that in photo one. Diarrhea, and then of course, this is a highly virulent disease, so you're going to have high morbidity. It's going to spread really fast. You're going have a high mortality. It's very pathogenic. So with highly pathogenic strains, you'll often see 100% mortality if you don't get in there and prevent it being exposed to your flock. 

Okay. So, again, kudos to the folks that put in Newcastle disease into that question answer because that was a really good guess. You are correct. You cannot rule out just on presentation virulent Newcastles disease that looks very, very similar. However, if you see a question like this and you hear about migratory waterfowl being involved, that's going to be your clue that avian influenza is gonna be the top differential. In some cases, infectious laryngotracheitis can appear as heavy mortality, doubling mortality. And then often in real life, if there's a management error or some type of toxicosis, that can affect a lot of birds in a flock simultaneously and that can mimic the presentation of a highly pathogenic virus. 

Okay. To diagnose avian influenza, what are you going to be looking at? So gross lesions when you're in the field, hemorrhages at mucosal junctions. So again, that proventricular ventricular margin is a classic lesion. Organ surface petechiae, multifocal organ necrosis. Again, think of it, this is an endothelial virus, so it's attacking your blood vessels. What would that look like in your patients? You might see hemorrhargic GALT, so GI-associated lymphoid tissue again because the virus is breaking down those vessels. And then you might also see shellless or misshapen eggs as the bird starts shutting down non-essential processes like egg laying. So diagnosis here is a tricky topic. So you can have a very strong clinical suspicion, but the only agency in the US that can make a definitive diagnosis of Avian influenza, especially highly pathogenic avian influenza, is a federal lab, so the USDA. So for you guys in the field, if you're sending in samples to the state lab, you'll be sending in maybe serology, so serum from blood draws. They can use this to check ELISA or auger gel immunodiffusion assays, which is a photo on the right of the slide, to see whether the birds have any antibodies in their blood to avian flu. The presumption here is that there There's no exposure to avian flu because we have done really good biosecurity and we're excluding it from our flocks. Typically, that's a very good assumption. So if you do see a serologic positive and you're seeing mortality, you might go back and take choanal cleft swabs for PCR. I always encourage you to take both if you're out on a farm and you have the opportunity. So for PCR, you're gonna swab the choanal cleft because it's an access into the respiratory system or tracheal swabs. If you're doing ducks, you're going to go for the cloaca so the other end of the bird. Once those are run at the lab, the state lab, they'll have to send those samples over to the USDA and they're gonna rerun those tests just to be absolutely sure because this disease does have regulatory implications for the entire country. So we're not allowed personally to say, oh yes, this is definitely HPAI. 

So treatment and prevention. Unfortunately here, we're talking about a viral illness, so we don't have any treatments available. Because this is a regulated disease under USDA guidelines, if we find highly pathogenic avian influenza in a flock, we are required and the USDA will coordinate to do this to eliminate the flock through euthanasia because we cannot allow this virus to spread and cause havoc in other birds. To prevent it though, it's really important, we're gonna embrace biosecurity as strongly as possible. So downtime between farms. If you're placing birds, we wanna make sure that coop is clean and there's been nothing in there for a while before we put another flock in there. No wild bird contact. So as much as possible, try to scare off those ducks from your pastures. Eliminate fomites. This is really important as a vet if you're visiting flocks. You don't wanna be bringing in disease to your patients. So making sure your boots are clean, you're using personal protective equipment and you're cleaning and disinfecting everything you use. Do not intermingle flocks or move sick animals. That's just a general rule of thumb for all of us as veterinarians. Very important though here. And there are no vaccines available in the U.S. For H5 and H7. They do exist. We're just not legally allowed to use them again per USDA guidelines. However, if you're a turkey vet, there are vaccines available for low path strains. So again, like those common cold strains, H1s and H3s, there are vaccines. When you are preventing them, the key points of takeaways here to prevent HPAI is do not allow wild birds to mingle with your poultry flocks. Do not grow your poultry close to swine. Swine love to put out a lot of different viruses and let them mingle. Seeing a pop-up here. And also, always report suspicious mortality. This is very important, because again, one of those key clinical signs in some of these big scary diseases are fast, rapid mortality. So make sure you always report those to the state vet. They're there to support you and to figure out what's going on with your cases just as much as you are. 

Let's move to a new case. We're going to do background here as well. This is gonna be a backyard flock again. This is a client of yours and they're in their fourth year of backyard chicken keeping so you feel like they have a pretty good handle on things. They have been buying commercial chicks but they also trade for birds locally. So this is pretty common, swap meets and Facebook marketplace buying chickens. They called you up because they had a bird that has a recent onset of hind limb paresis in young birds. So. They bought chicks, who knows where they came from. They've been mixed in with a couple of different sources. And now you're seeing them kind of splay-legged, draggy, progressive lameness. Nothing's really been working. They seem to otherwise be doing just fine. What is your top differential diagnosis here? So again, hind limb paresis, splay leg, multi-source chicken flock, different ages all mixed together. I can tell folks have been studying their poultry diseases. It's looking good. OK. Top differential, of course, is Marek's disease here. Your key notes here were the splayed leg appearance, the onset of paresis, the mixed poultry flock origin. Some keen observer also noted we had Marek's disease in the photo caption. So good on you if you noticed that. Means you're being very observant. 

Okay, so Marek's disease is our second disease of the day. What is the etiology here? We're actually looking at a herpes virus, an alpha herpesvirus, number two specifically. What happens when Marek's disease gets into the birds, that it actually causes immune cell apoptosis and transforms T cells into neoplasia. So this is the source of the most common lymphomas of poultry. So it's the most common lymphoproliferative disease. In poultry textbooks, you'll call this, you'll hear this referred to as leukosis. It's not as common elsewhere. Chickens are the most susceptible birds to this, although you can see it in other species more rarely. So if you're seeing a Marek's disease question on the NAVLE®, it's going to probably be in chickens. The way this gets into the birds is they inhale infectious particles. Viruses actually shed in the feather dander, which means it's very important to clean out those coops because any leftover feather dander or dirt can transmit it to the next birds. This is a ubiquitous disease agent. So essentially all chicks are exposed at the time of the hatch in their hatchery or at farm placement. So if you have had birds on your land for like this case had for four years, there was definitely Marek's disease that had come there one way or another. So by about this time, she was looking at some Marek's pressure in that flock. You can see that in this photo, that splayed stance in the young bird, that's characteristic of Marek's. They do have s progressive paresis to hind limb paralysis, and that is irreversible because it's being caused by lymphomas in the nerves and in the surrounding tissues, putting pressure on nerves as well. 

Okay, so presentation. Often these clinical signs can be nonspecific, although they usually are in young birds, so before they actually go into lay or very early lay, so before, they're about half a year old. Onset here will vary by environmental viral load and the virulence of the strain involved, but most often here in the U.S., we see about the same level of virulence, so it's mostly environmental load. Is your coop fully cleaned out? Is there a lot of leftover feather dander? Was there Marek's in the previous flock so we know there was a lot shed? Things you might see would be transient or flaccid paralysis. So if those birds feel like they're just lying down and they're not doing much and then they get up all of a sudden, they look just fine, that might be Marek's. Asymmetric paresis is really common and ataxia. Again, we're looking for things that are just unusual nervous signs in the periphery. You can also see mild central neurologic signs like blindness and hand tremors. It's a little less common. But again, look for those nonspecific signs in some of these cases too, like dehydration, weight loss, depression. Birds are very good at hiding that they're feeling ill, so looking for some of this signs is very important. Some of these birds outwardly may look clinically normal, and then you'll open them up on necropsy and they will be full of tumors. It can surprise you. One of the most classic nonsspecific ways to look for this in a flock is if you find birds that are a little bit less body condition than you would hope. So if you're seeing kind of a thin flock or an ununiform body weight appearance in that flock, this is something you might look for on necropsy. The mortality here might be variable. They may die because of tumors, but they may also die because they're paralyzed and they're unable to pursue food and water. And then again, not all infections progress to neoplasia. Some of them may just remain latent and that was a lucky bird and she just goes along through her life and sheds a little bit into the environment. 

So differentials here. There are other viral tumors of poultry. So avian leukosis virus is a classic one. So you can't rule that out without further diagnostics. You could have just an idiopathic neoplasia. So just bad luck, you had a tumor form in your birds. Although ovarian carcinomas are probably the most common type of idiopathic neoplaisia. So if you're seeing any type of tumor in an old laying hen, I would think ovarian carcinoma over Marek's disease. Again, old versus young. You could see a management error or toxicity lead to neurologic signs. In very young poultry, so seven days, 14 days or younger, you could actually see aspergillosis, so a infectious fungal disease that's common in poorly sanitized hatchery environments. Finally, mycobacterium can also cause appearance of tumor-like lesions, which are actually just lumps of infection. So you can see on this photo, this is a severely swollen sciatic nerve. This is one of the lesions we're gonna look for on your necropsies of mortality because it's swollen because it has been fully invaded with transformed T-cell. 

So the classic lesions that you're going to look for on the NAVLE® are going to be iridic monocytosis. So this is the photo you're seeing on the slide. A normal eye of a chicken is on the left and the infected eye is on the right. This is, I must say, incredibly rare. It's spectacularly rare. I think I only know one colleague who's currently alive who has seen this in practice in the U.S. However, if you do see it, this is pathognomonic slam dunk. It may appear on your NAVLE® because it is so pathognomonic. The reason the iris changes appearance in this certain way, turns gray, it turns a little cloudy and it tightens, is because that tissue is being invaded by T-cells. Again, it's a lymphoma presentation. You might also see those swollen edematous peripheral nerves that we saw on the last slide. There's a loss of the cross striations you may usually see on those nerves in a normal bird. Again, because they're being swollen and pushed out with fluid and T- cells. You'll often see visceral lymphomas, very clear distension of those organs. You might see cutaneous lymphomas, especially at feather follicles, so little skin lumps. And then in some cases, you might see a reddened leg appearance, erythematous legs. And the shanks we're talking about are from the ankle up to about the knee of the bird on that scaly skin. And that's called Alabama red leg, if you see it. 

So the next slide here, microscopic lesions are the best way to rule out the other viral diseases of tumor causing origin in poultry versus Marek's disease. Nerves, eyes and brain are great. You can also put in a bunch of other tissues and send them out for a histopath to get a very definitive diagnosis. You can see perivascular cuffing in brain microscopically. 

Alrighty, this last case we're going to do today is also we're moving into egg laying birds in a commercial setting. So this one is going to be a commercial multi-age egg farm and it has multiple houses of hens. This is very normal. All those hens are different ages. So one house maybe a year old, second house maybe half a year old, etc. This farm does vaccinate as a policy. There's no vaccination errors noted. That's very normal for a commercial flock to be vaccinated fully for all the things that they would be concerned about in their area. This, however, you're called out because you see a 24-week-old flock that is failing to meet egg production expectations. There's a standard amount of eggs per hen house that we expect, and we track that as one of the clinical measures of large flocks. You also see in this house when you're visiting that numerous hens are in poor body condition. This isn't what you're seeing in the other houses on the farm, so you're fairly confident it's not because of a feeding issue. Mortality has increased, and so because you have mortality on hand, you're gonna do a necropsy, and you note a bunch of visceral lymphomas in these birds. So in this case, again, we were just talking about it, what would be your top differential? Probably have a pretty good clue here, but what I want you to focus on is for Marek's disease, what is the top reason this flock's vaccination was not more effective? So it was fully vaccinated. It's showing clinical signs of Marek's disease. We did talk about what might be an issue in larger flocks. How is Marek's disease transmitted? Why is it important to make sure we have vaccine on hand? What might be occurring here? Okay, so I see a couple excellent good thoughts. Good, good thinking. Okay, let me go to the next slide. So here, we're looking at overwhelming challenge. So if you said biosecurity, if you said lack of clean out, if you said feather dander, you would be right. So in the case of vaccine failure in commercial settings, the most often the reason we see is that there was just too much virus in the environment. And we know that in any viral vaccine, if you have too much challenge virus, you're certainly going to overwhelm your vaccine. So most commonly, if young birds are exposed to a huge amount of virus, the challenge virus can out-compete the vaccine virus and take its place. So when we vaccinate for Marek's disease, we're vaccinating with a live attenuated virus. The challenge viruses are hotter. They're going to win if there's too much of a battle between them. In poorly cleaned pullet barns, so in the houses that we keep young chickens in before we move them to lay, this is most likely, the cause is too much feather dander, poor clean out, poor biosecurity. So in this case, I would go back to wherever the pullets were placed from chicks up until about 16, 17 weeks of age and ask them, what were you doing to clean and disinfect? How can we improve this process? So overwhelming challenge. 

Diagnosis and treatment, so we talked about that. Diagnosis, gross lesions can be suggestive in many cases. They can be pathognomonic if you see that iritic lesion, so gross lesion like these visceral lymphomas we're seeing in the photo. Histopathology and immunohistochemistry can help you differentiate between the different viral diseases of lymphomas in poultry. Molecular diagnostics and virus isolation are often non-diagnostic because we expect there to be Marek's in almost all poultry environments. So if you're taking a swab and you're saying, wow, I found Marek's here, slam dunk, not necessarily the case. Again, we're looking at a viral disease here so we don't have a treatment, unfortunately. This is a progressive viral disease. Once these birds start seeing clinical signs, you have a very grave prognosis. So a lot of those birds that are latent, like we talked about, get lucky, they're doing fine, they might live out their life totally well without any issues. However, once they start getting paresis, splayed leg paralysis, they start losing body condition, they stop laying eggs, those are the birds unfortunately that have a very grave prognosis. 

Okay, so to prevent them, vaccination as much as we can, we need to administer vaccine prior to exposure though because we want that vaccine to take the place of what the Marek's virus would do in the field. So this means we need do that in ovo, so in the egg before the birds are hatched, this is commonly done in commercial settings, or at the hatcheries if you're buying smaller portions of chicks for a backyard or small flocks. Many small hatcheries don't have Marek's vaccination. You can ask for it and you should push for it if they have any option for it, but because the live vaccines do require liquid nitrogen storage, a lot of the small places just aren't able to handle that. Live vaccines displace more pathogenic wild strains over time, so it's a good idea just to put them into your environment so that you don't encounter something that was from the environment causing disease without vaccination on board. Also, control that viral load. Clean out your poultry housing. Viruses shed in feather dander. Clean out your backyard flocks. Clean out your commercial housing. Vaccination will limit the shed of wild strain infections and therefore viral shed overall. But it will also be present in the environment no matter what. 

All right. All right, folks, well here we are to talk about the study strategy section for today. This is gonna be a fun one because it's short and it's easy and it really does help. We're gonna briefly cover the things you can do outside of study that really help your performance on the test and they help you cope with the stresses of getting ready, they help cope with the normal stresses of veterinary school and life, and they help you learn better, and they're not studying, okay? And they may seem, you know, common sense, but these are things that I think can make a real difference. And Linnae you might want to hide your video so we don't see you there. Okay, great. So here we go. Let me get my. 

So the main things you can do outside of study is simply keep a routine. Remember when we talked about study strategies and study plans? Having a few simple habits is one of the very best things you could do. Just having a habit of, you know, I may not know what I'm, you know I may, I might not learn everything, but I know what am gonna do today. I have my habit. I'm gonna study for what? Maybe an hour, do practice tests, then we'll take a little break. And then I'm gonna do independent study for 20 or 30 minutes, and then, I'm going to quiz myself. And day in, day out, habits like that are what gets you over the finish line with NAVLE®, okay? Having the habit of guessing strategically. Here are some habits you can have, which will help you cope with the very normal stresses and anxieties of getting ready for a big exam, and also of being a veterinary student or a new graduate. They basically boil down to the things we would expect. Exercise, sleep, particularly before a big test day, eat some breakfast to get your blood sugar up. Do take breaks and don't give up. So now we'll talk about those one by one. 

I want to encourage everyone to have some kind of habit of moving your bodies, exercise in whatever way works for you. It might be running, it might be swimming. For me, I walk a lot. I like to walk and my wife and I are learning salsa, so salsa keeps us active. Walk your dog, walk your wombat, whatever it might, but find a way to take a break and go exercise. Studies suggest that people who exercise tend to cope better with stress. It's a way to counteract some of the health issues that we all get from hunching over laptops all the time. But it makes you feel better in your body. And if you feel in your better body and you cope better with stress you're going to tend to learn better when you study and you're gonna tend to perform better when when you hit the big exam. 

Choose sleep. There are so many studies that have emerged where it's been shown that getting a good night's sleep is an integral part of your mental and emotional health. And there are studies that also suggest that if you get a good nights sleep, the stuff you studied yesterday will tend to stick a little better and the stuff that wasn't important will tend not to stick. Some of the studies that have come out have shown that there is a process that happens with a good deep night sleep where your brain is kind of processing the information of the day before and it's pruning out all the useless factoids and holding on to the good stuff. You'll find if you can prioritize sleep, you'll be fresher the next day as well when you study the next day. Remember, you're not going to learn everything today, you're not gonna learn everything tomorrow. You've got that habit, day in day out, of doing a little bit and making some headway. Getting sleep is part of it. 

To cram or not to cram? That is the question. If you're losing sleep because you're trying to cram for this test about everything, you're NOT helping yourself. You cannot cram for a test about everything. Don't even try, it's not worth it. Studies of, you know, that late night cramming that people do a day or so before a big test, what they show is you might have a very temporary increase in performance in some little area, but it fades away right away. Also, you're going to show up tired to the test, and if you want my opinion, the consequences of being tired on an all-day test are worse than getting a good night's sleep, maybe you didn't cram, and you can cope with those inevitable questions you don't know the answers to better because you're not sleeping, okay? So don't waste time cramming. Don't stay up late, especially right before the test. Prioritize exercise and sleep. You'll feel better and you'll cope better. And when you do study, things will stick better.

Apart from all that, yes, take breaks. Take short study breaks every 45 or 50 minutes, halfway through the day, take a longer break. Give yourself some time off from time to time. You cannot focus and study 24 hours of the day. You cannot focus and study seven days a week. You do deserve and need to take some breaks, something that's fun for you, so that you and come back fresh. This is a marathon, it's not a sprint, okay? And as important as it is, it's important that we do it well. And so doing it well means treating ourselves well, okay. So if that, if taking a break also happens to be exercise for you, awesome. If taking a break means tuning out because you wanna watch a movie, also awesome, okay, but do take breaks, short ones during the day as you study. And you know a longer one in the evening or a longer one maybe on the weekend but give yourself a little time off. 

Related to that, I'm just going to mention some interesting information that's out there about different ways of thinking. Focused versus diffuse thinking, modes of learning. There's been a lot of studies about different ways people learn and is it the only way and are you a visual thinker, are you a textual thinker or are you an auditory thinker. And as I understand it, what's emerged is We all learn in lots of different ways. Everybody, you know, might have preferences, but you can learn in almost any different way. But focused learning is when you're really paying attention, you're doing that independent study on some notes, you're focusing hard, you've got all the distractions tuned out, right? And you're trying to get it committed to memory. And that's a very common way we study, right. But you can't do it. 24-7. You can't do it seven days a week. If you are trying really hard to focus, you get exhausted. There's another kind of thinking that people have identified that is called diffuse thinking, and this is that experience you might have had. For example, I used to swim a lot. That was my exercise for a long time until I got lazy and didn't want get up early anymore. But I'd be on, you know, like an hour swim. And you're swimming, like your face is in the water most of the time, you can't really do much but swim and breathe. And what I found was after a while, you get into this sort of groove, this not thinking kind of groove. And many, many times I would start to get ideas kind of out of the blue. So a focused thinking is, A goes to B, goes to C, goes D. Diffuse thinking is more like creatively ideas pop up in your head and you make connections like oh, yeah there's a and then there's m and Then there's r and they're related to each other in these ways and it happens when you're loose It happens when your not thinking too hard. It's a creative way to make connections They're both legitimate and I'd encourage you to Find some time or make some space in your week. So you're not always focusing. There's a fun video you can find, this is probably I believe on YouTube is where I've seen it. It's Philip Oakley and Dr. Barbara Oakley, and they have some nice little videos on modes of learning. There's also a nice New York Times article if you want to look at it from 2017, but basically talk about learning how to learn. And they have some nice talks about, you know, your zombie brain and things like that. But it's kind of about this idea of focused versus diffuse learning. If you're always really clenched up and trying hard to focus, sometimes you, you can hold on too hard. So there's a balance to be found there. 

And finally, don't give up. You are not going to learn it all. And that is okay. Don't even try to learn at all. Just try to learn enough. You don't need 100 to pass NAVLE®, right? It's a pass fail test. You basically need about 75% correct of the 300 questions that count. And that means you can miss a lot of questions. That doesn't mean you should coast. You should not coast. But you should give yourself some leeway to miss some and not freak out. By the fact that there is some normal anxiety we all feel about a test like this, I want to encourage you to give yourself permission to feel that. Try not to invest a lot of emotion in your homework. You just say, well, I'm not gonna learn everything today, but I do know what I'm gonna do. I'm going to sit down and I'm going to spend an hour and a half doing some practice questions, a little break. Then I'm to do some independent study and i'm going to actively quiz myself. And I'm gonna do it again tomorrow, and I'm gonna do again the day after that. And when I sit down to study, I'm going to do the big stuff first. Dog, cat, horse, cow, pigs. You know, the big diseases first. And what are the big things I always want to know? Can I identify a classic case? How do I test for it? How do treat? Okay. So let's not invest a bunch of energy beating ourselves up over the things we did not do. Because there's always something more we might do. I would encourage you, don't beat yourself up over that. Give your best energy to what you can do and keep moving. All right, let me just check our chat room here and then we'll see how Dr. Tracy's doing. All right. I see we have Dr. Pettis saying when they opened the pool here in Virginia about a month ago, and I got the feeling that doing exercise helps a lot. It certainly helps me, these days I walk. Some people are asking questions, so we the panelists, we can see the questions. Feel free to drop us a line in Zuku at support@zukureview.com or info@zucureview.com. And if you've had issues, somebody's asking questions, what if I fail more than once? Drop us line and we'll do our best to help you out. 

So it's time for your low-stakes quiz. Low-stake quizzing of yourself, whether it's after independently studying some notes or anything you might've studied, that's good retrieval practice, so you wanna do it. So these are sample NAVLE® style questions tonight about chickens. Question one, which choice best describes the classic clinical presentation of avian influenza in a commercial poultry flock? Gradual onset of coughing and nasal discharge? Exudative sinusitis with low mortality? Sudden, high mortality, drop in egg production, neurologic signs, facial edema? Chronic weight loss, paralysis, and irregular iris pigmentation? Swollen joints, lameness, casius exudate, caseous exudates in the air sacs? Yellow diarrhea, enlarged liver, and high hatchery mortality? So which choice best describes the classical clinical presentation of avian influenza in a commercial poultry flock? Checking the list. Lots of people picking similar things. You guys are doing a great job tonight here. Good job. And the answer is... Sudden high mortality, drop in egg production, neurologic signs, and facial edema. Those are the classic clinical presentation for avian influenza. Lots and lots of suddenly dead birds. Good job. 

An outbreak of sudden, high mortality, and neurologic signs in a commercial flock raises suspicion for highly pathogenic avian influenza, HPAI, which statement regarding the diagnosis or prevention of HPAI is most accurate? Any licensed vet diagnostic lab can make definitive diagnosis? Cloacal swabs are the preferred diagnostic sample for all birds? Vaccination against H5 and H7 subtypes is common in the U.S. And Canadian commercial poultry operations? Biosecurity measures, especially restricting wild bird contact, are critical for prevention? I got to move my task bar here. ELISA and AGID are preferred tests for detecting active viral shedding? So which statement regarding the diagnosis or prevention of HPAI is most accurate? So looking in on chat, everybody agrees it looks like. Good job. Good job. And the answer is? Let's see, I think I have to click to get my answer to come. There it is. D, biosecurity measures especially restricting wild bird contact are critical for prevention. 

A young chicken presents with asymmetric leg paresis and mild head tremors. Necropsy reveals enlarged sciatic nerves and visceral lymphomas, which choice best describes the pathophysiologic mechanism of Marek's disease. Inhaled mycotoxins cause demyelination and immune suppression? Retrovirus integrates into host lymphocytes, triggering neoplasia and leukemia? Cell-associated herpesvirus causes immune cell apoptosis and T-cell transformation? Direct parasitic invasion of nerves results in lymphocytic infiltration and paralysis? A bacterial toxin induces peripheral nerve inflammation and edema? Chat room is very much agreeing, everybody agrees with the same thing, and the answer is... Remember, with Marek's disease, this is a cell-associated herpes virus which causes immune cell apoptosis and T-cell transformation. 

Which choice is the most effective strategy to prevent Marek's disease outbreaks in a commercial poultry operation? In ovo or day of hatch vaccination with strict hygiene? Routine antibiotic prophylaxis and vitamin supplementation? Delayed placement of chicks until two weeks of age? Isolation of infected birds and feather trimming to reduce dander? Use of coccidiostats in feed, and minimizing humidity? All right, I see most people agree on this one, too. Seems to me Dr. Tracy's done a very strong job. You guys are doing very well on chickens today. Well done. The answer is. A, in ovo or day of hatch vaccination with strict hygiene. Good job. Well done, everybody. Well done. 

All right, we have made it to the end of another Hoot Camp session. I wanna thank everybody for being here. Our next session will be on Tuesday. We'll be doing a dog and cat classic topic, heart worm. Okay, remember, one of the best things you can do between now and Tuesday is simply do a very quick review. Of Marek's and avian influenza. Just pop over to the Merck Manual, take a quick look, 10 minutes, five minutes per topic, and just remind yourself of some of the key points. Your tune-up topic for dog and cat for Tuesday heartworm, you really wanna be able to identify a classic case and they don't look the same in dogs and cats. What is your test of choice and what's your main treatment? And there's your link to the Merck Manual. I'll put this in chat as well. 

I wanna thank everybody for coming today. It's been great to see you. Thank you for coming out on the weekend. We had a few questions about, should I be getting 100% correct as I do tests in Zuku? Eventually, you're gonna correctly complete 100%, but nobody's getting 100 percent correct every time they take a test. That's not your goal. Eventually, by the time you're about one week from your NAVLE®, and you're doing timed tests every day, Yeah, you'd like to be hitting 75 or 80% correct on those, but that's months away. Today we're just practicing. Please tell Dr. Tracy how much you appreciate her in chat. Dr. Tracy, thank you so much for being here. We really appreciated your talk. Well done. 

Thank you, Steve. Everyone did a great job.