A HORSE IS PRESENTED TO YOUR CLINIC WITH A HISTORY OF SHIFTING LAMENESS, FIRM BONEY PROMINENCES AROUND THE FRONTONASAL SUTURES AND PAIN WHEN EATING.A horse is presented to your clinic with a history of shifting lameness, firm boneyprominences around the frontonasal sutures and pain when eating. The horse issuspected of having nutritional secondary hyperparathyroidism (NSH).Answer all parts of this question:a) Describe in detail the pathophysiology of NSH. You may use diagrams.(12.5 marks)b) Describe in detail the diagnosis of NSH. (12.5 marks)c) Describe the management of the case described above. (5 marks)6. Answer both parts of this question:a) List the clinical signs associated with hepatic insufficiency and failure in thehorse, and for each clinical sign, describe in detail the pathophysiologic basis ofthese manifestations. (20 marks)b) Discuss in detail the management of hepatic encephalopathy. (10 marks)Continued over pageEquine Medicine Paper 2 Page 7 of 87. A 450 kg two-year-old Thoroughbred colt was presented with acute onset severewatery diarrhoea. Pertinent findings from a thorough physical examination revealedmoderate signs of depression, significant tachycardia between 80–100 bpm, pyrexia of39.1°C, and dark injected mucous membranes with CRT of around 3 seconds. Smallpetechial haemorrhages were also noted on the lower lip mucous membranes. Thecolt’s peripheral pulses were mildly weak and his lower limbs felt cool to the touch.His digital pulses were not elevated at the time of presentation. The colt urinated asmall volume at presentation and the urine was thick with a dark red tinge.Stall side laboratory analysis performed on a venous sample at presentation yieldedthe abnormal results as below: