ACVS Board Exam Feb 2007 Flashcards
Calculate heart rate on an ECG
should give paper speed ie 50 mm/sec
Which fluid types have Calcium?
LRS and Plasmalyte 56
Which fluid types do not have Calcium?
Plasmalyte 148 and NormR
Calculate blood donor volume needed for cats
BW(50)(change in PCV desired/donor PCV
Tobias says 50 for cats, other texts say 66-70
Calculate blood donor volume needed for dogs
BW(90)(change in PCV desired/donor PCV)
Which colloid has an oncotic pressure of 30?
Hetastarch 200 (Elohast), COP 25 Hetastarch 450 (Hespan), COP 29-32
Duration of Hetastarch’s colloid effect?
12-24hr (Fossum)
Rough estimate of plasma omolarity?
2 X Na+
Globulins responsible for what % of COP?
20%
MOA Heparin
Potentiates antithrommbin (incr affinity by 10 000X) Low-molecular weight heparin inhibits fXa more than antithrombin
Can reharvest ACBG from prox humerus?
q 8 weeks
Clinical relevance of Swaim paper: wound healing - cats pull peripheral, dogs central VetSurg 2004 Nov-Dec;33(6):579-87
Surgeons should view the cat as a unique species, which presents its own special challenges in wound healing, and should take this into account when planning treatment of feline wounds, either by primary closure, or by second intention healing
Conclusion of Swaim paper: wound healing - cats pull peripheral, dogs central VetSurg 2004 Nov-Dec;33(6):579-87
Significant, previously unreported differences in cutaneous wound healing exist between cats & dogs. In general, cutaneous wounds in cats are slower to heal. Cats & dogs also appear to use different mechanisms o fsecond intention healing. In cats wounds close mainly by contraction of the wound edges, whereas dog wounds close more from central pull, and epithelialization
Definition Totipotent
unlimited, can form whole organism
Definition of Multipotent
(adult) can differentiate into multiple, but limited lineages
Definition of Pluripotent
(embryonic or iPS from adult stem cells) can differentiate into any of the 3 germ layers (endoderm, mesoderm, ectoderm)
TP of less than 2 g/dL will…
slow healing
Chlorhexidine: toxic to tissues at what concentration?
- At 0.05%, lethal to canine embryo fibroblasts (0.5% for povidone-iodine)
- May be ototoxic and neurotoxic
- Use in wounds < or =0.05%
- Use on skin 2-4%
Half life of albumin in a dog?
8 days
Minimum time that g-tube and e-tube must be left in?
7-10 days
Refeeding syndrome
hypophosphatemia
TPN – need central line due to?
osmolarity
Prophy ATBs ideal start time?
> 30 minutes & <60 min prior to incision
Readminister q 3 hours (ie. Two half lives of Cefazolin)
• Tobias=every 2 hours
Best atb’s for anaerobic infection
• Metronidazole, chloramphenicol, clavamox, clindamycin, ampicillin, tetracyclines, macrolides (aminoglycosides ineffective against anaerobes)
Open fracture grade 1-4 - definition
- I=wound smaller than 1 cm
- II=wound >1cm without extensive soft tissue damage
- IIIA=soft tissue damage but adequate coverage
- IIIB=extensive tissue loss, periosteal stripping, bone exposure, contamination
- IIIC=arterial injury requiring repair
Where anatomically do you transplant new kidney along aorta (cats)?
- Renal artery to caudal aorta, proximal to caudal mesenteric artery, end-to-side
- Vein to caudal vena cava, end to side
- If anastomose to iliac vessels, 12% pelvic limb complications
ETO effectiveness at what temp, conc, humidity, time of expo?
- Cycle time inversely related to concentration, temperature, humidity (Fossum)
- Time 2-5 hours
- Concentration 450-1200 mg/L
- Temperature 29-65C (84-149F)
- Humidity 45-85%
Why can you not ETO sterilize once radiated?
Releases toxic compounds
Conclusion of Mison Vet Surg – laser vs. Scalpel
Vet Surg. 2003 Mar-Apr;32(2):153-60.
The CO(2) laser provided better intraoperative hemostasis than CST. However, overall healing and increase in tensile strength of the skin-flap junction of the flaps created by the laser may be delayed during the first few weeks of wound healing.
Clinical relevance of Mison Vet Surg – laser vs. Scalpel
Vet Surg. 2003 Mar-Apr;32(2):153-60.
Skin flaps used to repair large skin defects in dogs can be created and elevated with a CO(2) laser. In areas of increased skin mobility or tension, skin flaps created with CO(2) laser may be more susceptible to complications such as dehiscence, and care should be taken to minimize these complications.
Surgical lasers – Argon vs. CO2 (effects, water absorption)
- Argon LASER (514 nm), energy absorbed by hemoglobin and melanin to heat
- Argon COAGULATION monopolar no touch, coagulation more uniform and shallower than electrosx, uses argon GAS (no water???)
- CO2 LASER(10600 nm), heats intracellular water to boiling, not absorbed by pigmented areas, not absorbed by blood-soaked areas, can’t use with scope, <0.6mm, less edema because CO2 seals lymphatics
Osteopromotion definition
- Results in enhancement of regenerating bone
- Tobias doesn’t state how it differs from osteoinduction
- Example : platelet-rich plasma
Ehrlos Danlos syndrome aka cutaneous asthenia – definition
• Inherited deficiency of type I or III collagen, Himalyan cats
Effect of steroids on wound healing
- Decreased protein synthesis, inhibits lysosomal enzymes, anti-inflammatory
- High doses limit capillary budding, inhibit fibroblasts epithelialization
Halsted’s principles
- Gentle tissue handling
- Hemostasis
- Preserving blood supply
- Aseptic technique
- Elimination of dead space
- Apposition of tissues
Local anesthetic + epinephrine – effect
- Epinephrine 0.1ml to 20 ml anesthetic
- Delays rate of vascular absorption of local anesthetic
- Increases intensity and prolonged anesthetic activity
Best way to administer Gentamicin IV (interval)
- 1-2 mg/lb q8h or 3 mg/lb q24h
- Q24 hrs (Boothe)
- Gentamycin better for staph, amikacin better for Pseudomonas
- Gentamycin more renal toxic than amikacin
Best dosing interval Fluoroquinolones
• Total daily dose once daily (Boothe)
Advantages and drawbacks of everting, inverting suture pattern
- Everting=increased strength across the wound, but may cause local ischemia
- Inverting=use largely replaced by appositional
Effect of hyperbaric chamber O2 on wound healing
- Improved outcome with deferoxamine
* May be detrimental to graft survival
Which mammary gland included in cr. superf. epigastric a.p. flap?
- Cr=glands 3 and 4
* Caudal=glands 2 to 5
Causes of skin graft failure
- Separation of graft from tissue bed (seroma, hematoma, exudation)
- Infection
- movement
4 processes of skin graft take
Adherence,Imbibition, Inosc, Vasc Ingrowth
Advantages of meshing a graft
- Allows drainage
- Covers larger defect
- Reconstruct irregular surfaces
Definition of pilonidal sinus (dermoid sinus)
• Pilonidal sinus=incomplete separation of ectodermal and neural tissue
Definition of nasal dermoid sinus cyst
• Nasal dermoid sinus cyst=same cause, but a canal called foramen cecum develops in the frontal bone, allowing outpouching of meninges into prenasal space and into contact with somatic ectoderm. Persistence of canal =draining sinus.
Prognostic factors for Canine Mammary Tumours
- Histologic type, tumor grade, invasiveness, LN
- Cell proliferation markers (AgNOR and ki67)
- 3cm (14 mo); >5cm or >6 mo (6 mo)
Definition of Burn classification 1-4
- 1.only epidermis effective
- 2.extends to dermis
- 3.extends to SQ
- 4.extends to muscle
- 5.extends to bone
Zones within a burn
• destruction (Tobias says coagulation), stasis, hyperemia
Approach for Fe and Ca thoracic duct
- Fe left 10th intercostal
* K9 right 10th intercostal
Methods to perform lymphagiogram
- Popliteal-limited approach recommended, either color or contrast injected, see contrast in 2-13 minutes,
- Intestinal-give cream 3-4 hrs before, efferent intestinal lymphatic vessel injected with color or contrast
Concentration of iohexol used for myelography
• 240 mg iodine/ml (Barone JAVMA 2007)
Side effects of myelography
- DaCosta JAVMA 2011- 3% seizures with iohexol
- Lexmaulova JVECC 2009, 14%, not significant but seizures occurred more commonly after caudal myelogram with iopamidol compared to iomeprol
Know key pregnancy dates – US, rads, teeth cats and dogs
- Fetal skeletons detected by day 42, pelvis by day 57
* HR on US by day 22-24
Innervation to the tongue (motor and sensory/taste)
- XII-motor
* VII- sensory to rostral tongue
Know CN VII and CN V functions
- VII- motor for facial expression, parasympathetic to lacrimal glands, sensory to rostral tongue
- V-motor to muscles of mastication, sensory to face
Blood supply to the rectum
- Dogs-cranial rectal artery (branch of caudal mesenteric)
* Cats-middle and caudal rectal artery (branch of internal pudendal)
Which urachal anomaly can regress spont. in cat?
Urachal diverticulum
pancreatic duct anatomy both spp
- In dogs, 68% have a larger Y duct that forms accessory duct and empties and minor duodenal papilla, and a smaller duct that empties adjacent to major duodenal papilla
- In cats, 80% have single pancreatic that joins cystic duct before major duodenal papilla
Secretion of parietal (acid), chief (pepsinogen), enterochromaffin and G cells
• G (gastric) cells produce gastrin, histamine, serotonin
• Enterochromaffin cells are in the colon
• Immune barrier of colon
o microfold (M)cells-lack microvilli, produce pro-inflammatory chemokines and cytokines
o dendritic (D)cells-migrate to mesenteric LNs, prime T-helper and B-cells
o intraepithelial lymphocytes- express CD8aa on T-cells
Somatostatin effects, produced by D cells in stomach, duod, pancreas
- Delta cells (wiggly D) of pancreas different than D cells of colon
- Delta cells produce somatostatin
- Somatostatin is a naturally occurring substance that has an extremely short half-life. It inhibits gastric, pancreatic, and biliary secretions (i.e., glucagon, insulin, gastric acid, amylase, lipase, and trypsin) and prolongs gastrointestinal transit time, decreases jejunal secretion, and stimulates gastrointestinal water absorption.
- Somatostatin also produced by pheochromocytoma (vasoactive substance) and analogue used to treat chylothorax
% of insulinoma patients with mets intraop?
50%
Crypts vs. villus – differences in function
- Crypts- At base of villus, non-dividing cells that produce fluid, differentiate into enterocytes as they pass up the crypt
- Villi- cells loose secretory function, digest and absorb
Clinical and lab findings with Short Bowel Syndrome
- Occurs when >50-85% of small intestines are resected
- Proximal resection better tolerated than distal
- cholesterol, and albumin were lowest 12 weeks after resection
- weight loss and watery diarrhea, oral contrast reaches colon in 5-12 min
- Tx with frequent highly digestable high fiber meals, fat-soluble vitamins, loperamide, abx for bacterial overgrowth
Most common oral neoplasia in dogs vs. cats
- Dogs- malignant melanoma, SCC>fibrosarcoma
* Cats-SCC (70-80%), fibrosarcoma
Blood supply to esophagus
- Cranial and caudal thyroid arteries
- bronchoesophageal artery
- esophageal branches of aorta and dorsal intercostals
- left gastric artery
Risk factors for GDV
- Large/giant breeds
- Increased thoracic depth to width ratio
- Hx in first degree relative
- Fewer meals, rapid eating, decreased food particle size
- Aggressive or fearful
- Increased hepatogastric ligament length
- Exercise or stress after a meal
Fentanyl CRI with Ketamine – characteristics
• Low doses of ketamine and CRI take advantage of this NMDA receptor binding. Ketamine helps with somatic more than visceral pain, but in a multimodal protocol with infusions that begin before surgery and last into the postoperative period, ketamine provides additional visceral analgesia over opioids alone
Pyloric muscle hypertrophy vs. Chronic hypertrophic pyloric gastropathy, as well as breed predilection
• Pyloric muscle hypertrophy
o Aka pyloric stenosis
o generally congenital, brachycephalics females
Radiographic dx of obstruction
• SI:L5 = 1.6/1, strongly suggestive if >2
Ileocecal intussuception: rate of recurrence and complications
• 6-27% recurrence
• Enteroplication of jejunum and ileum MAY reduce recurrence, but has side effects, maybe use of no cause is found
• Enteroplication causes Abd pain, vomiting, diarrhea, decreased appetite, constipation, obstruction, strangulation, perforation
• Burkitt JM J Am Vet Med Assoc. 2009 Mar 15;234(6):771
- intussusception in cats has a bimodal distribution (10 cats were < 1 yr; 9 cats were >=6 yrs)
- most were jejuno-jenunal, and 11/13 required R & A
- 7/8 older cats with histo had LSA or IBD
- 7/8 younger cats with histo had idiopathic
TA Stapler : staple height before and after compression, type of apposition ?
eversion
EEA Stapler : type of intestinal apposition ?
Inverted
LDS : describe staple shape post compression
curved
Three stages of laryngeal collapse and tx of choice ?
- Type I=laryngeal saccules
- Type II=cuneiform collapse
- Type III=corniculate collapse
- Treat primary causes of brachycephalic syndrome
- If persistent signs, permanent trach or tie-back
Monnet JAVMA “Massive Hepatocellular Carcinoma”- findings
- 61% of hepatocellular carcinomas
- Left lobe in 67% of cases
- 36% metastases vs 93% in nodular or diffuse forms
- MST 1460 days
Shunt fraction with scintigraphy
Normally <15%, usually really high with shunts
Uroliths – medical treatment
- Struvite- abx, acidifying diet
- Ca Oxalate- alkalinizing high moisture diet
- Urate- alkalinizing, low protein high moisture diet
- Cystine- 2,3 MPG
- Silicate- don’t eat hulls
Extent of tracheal R & A
- 50%-58% or 15-27 tracheal rings
- 20-25% in puppies
- Note- esophagus 50% thoracic, 20% cervical experimentally, clinically 3-5 cm
Function of surfactant
• A substance composed of lipoprotein that is secreted by the alveolar cells of the lung and serves to maintain the stability of pulmonary tissue by reducing the surface tension of fluids that coat the lung.
PEEP: positive and negative effects
- 5-10cmH20
- Eliminates cycling of alveoli by forced opening and closing
- May be necessary to maintain PaO2 in open thorax
- May cause decreased venous return and decreased cardiac output
Know EMG, positive sharp waves and fibrillation potentials – represent what?
- Denervation
* Destabilization of sarcolemma causes spontaneous firing myofibers
Effect of partial laryngectomy
- 83-90% success
* 20 cases of video-assisted, all improved, 10% pneumonia
Tracheal collapse grading system (viewed via endoscopy)
I-IV, 25-100%
Limit for bronchial mucosal loss that can be tolerated (1/3 circumference)
Trachea can tolerate 50-75% stenosis in Tobias
Extraluminal Treatment for Tracheal collapse
o MST 4.6 yrs
o 9% perioperative mortality
o 21% lar par, 24% lar collapse, no tracheal necrosis
o Becker Vet Sx 2012
Intraluminal Treatment for Tracheal collapse
o 75% 1 yr survival with various nitinol stents Sura JAVMA 2008
o 89% 1 yr survival with nitinol stent Durant Vet Sx 2012
o Complications- stent fracture, migration, tracheitis, collapse of other regions, obstruction by granulation tissue, tracheal rupture
Techniques for suturing trachea
• Split cartilage
o Less stenosis
• Annular ligament
• Landmark Demetriou (not in Tobias) says continuous has higher pullout strength than interrupted with horizontal mattress
Lung lobe torsion paper – which lobes, outcome in Pugs
- Left cranial
* Better in pugs, >90%
• Better in pugs, >90%
Pericardial effusion – tamponade pathophysiology
- Pericardial pressure first equilibrates with right ventricular filling pressure
- Then, with left ventricular filling pressure
- Decreased CO, increased venous pressure, body increased Na, H2O, catecholamines, increasing venous and portal pressures
- Jugular distention, liver congestion, ascites, edema
- Pulsus paradoxicus
Blood gases: A-a gradient, know normal values (at sea level), acid base balance
- A=alveolar, a=arteriolar
- A-a=pAO2-PaO2
- A-a=[150-(PaCO2X1.1)]-PaO2
- Normal A-a120, it’s normal
- (Cooper DACVECC, resident workshop)
ACT coag test: prolonged if plt decr (#) or coags (which) decr by 25%+
- ACT measures intrinsic, prolonged with PLT<10K
* Not sure about coags decreased to 25%+ but makes sense, maybe that’s why we don’t use ACT?
Dopaminergic - Beta – alpha effects of Dopamine at what dosages
- CRI Intermediate (2-10) or high (10-20 mcg/kg/min)
* Tobias chart pg 88
Innervation to the larynx, cricoarytenoid dorsalis muscle
- Cranial laryngeal nerve supplies cricothyroideus
* Caudal laryngeal nerve, a branch of the recurrent laryngeal, supplies the rest
Maximum recommended kvp for myelography
80 kvp
Cutaneous trunci spinal segment innervation
C8-T1
Horner’s syndrome – sympathetic innervation to the eye from which spinal c.s.
T1-T3
Paraneoplastic syndrome of hepatocell carcinoma
thrombocytosis
Pulsus paradoxicus
Pericardial effusion
Median Survival Time (MST) OSA appendicular
19.2 weeks
Suture patterns for tendon repair
- Far-near-near-far
- 3 loop pulley
- Locking loop
- Krakow
- Bunnel-meyer
String of normal synovial fluid
2.5 – 5 cm
Relationship between calcaneus and talus
Talocalcaneal joint
Full vascularization of autogenous cancellous bone graft
20 days
Bone graft cells stay alive in saline for how long?
up to 4-5 hours
Slipped cap fxs in cats – characteristics of species
- Capital physeal dysplasia- most commonly young, overweight castrated male cats
- More common if neutered before 6 months
- Histopathology-unusually wide physis containing clusters of chondrocytes and necrotic cartilage
Femoral neck and slipped cap fractures: dogs vs. cats
Capital>cervical in dogs, cervical 3-5X more than capital in cats
Dynamization : best time?
Starting at 6 weeks
Ideal diameter of femoral IM pin (alone)
60-70%
Direct bone healing e. Contact vs. gap
- Gap<1mm
* Contact=direct contact
Orton – Mitral Valve surgery paper JAVMA – outcome with replacement, complications
- Mechanical valve-11% operative mortality, 56% risk of thrombosis
- Bioprosthetic valve or valve repair recommended
Pulmonary artery banding
desired pressure distal to band < 30 mm Hg.
