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Diseases and Diagnosis > Block 3 +4 > Flashcards

Block 3 +4 Flashcards

1
Q

What needs to be done for extravasation of doxorubicin?

A

Cold compress
Zineguard (dexrazoxane)

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2
Q

What is the primary downside to doxorubicin?

A

Cardio issues
Toxic does is additive

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3
Q

What is primary downside to Tanovea?

A

Pulmonary fibrosis
West Highland terriers, its bad!!
Must radiograph lungs first

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4
Q

What is primary downside to cisplatin?

A

No cats

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5
Q

What happens with extravasation of vincristine

A

Warm compress
DMSO (antioxidant)
Hyaluronic acid

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6
Q

What are 4 drugs in CHOP?

A

Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

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7
Q

What is median remition time for CHOP in lymphoma?

A

12 m

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8
Q

What are 4 drugs in LOPP?

A

Lomustine
Vincristine
Procarbazine
Prednisone

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9
Q

What is percent chance to remission with rescue protocol?

A

50%

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10
Q

What is an indolent lymphoma?

A

Histologically low grade

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11
Q

What do you stage?

A

A patient

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12
Q

What do you grade?

A

a tumor

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13
Q

What is substage A?

A

No clinical signs of disease

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14
Q

What is substage B?

A

Clinical signs of disease

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15
Q

What is CD3?

A

T-cell indicator

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16
Q

What is median survival time or CD3 (-)

A

12m

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17
Q

What is median survival time of CD3(+)

A

6m

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18
Q

What is prognosis of monotherapy with lymphoma?

A

6-8m

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19
Q

What is median survival time of A substage?

A

12m

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20
Q

What is median survival time of B substage?

A

1-2m

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21
Q

How is leukemia initially broken down into?

A

Lymphoid or myeloid

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22
Q

How is leukemia further broken down?

A

Acute or chronic

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23
Q

What type of cell is acute and chronic respectively

A

Large cell, small cell

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24
Q

What does AML stand for?

A

Acute myeloid leukemia

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25
Q

is acute leukemia common?

A

No

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26
Q

What is usually seen in CBC of ALL?

A

Very high WBCs

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27
Q

How is chronic leukemia diagnosed?

A

Market lymphocytosis persistently

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28
Q

What are clinical signs of CLL?

A

Vague and nonspecific lethargy, reduced appetite

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29
Q

What type of cell is CLL usually?

A

T cell

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30
Q

Do cats with lyphoma present with peripheral lymphadenopathy?

A

No

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31
Q

What is the most common site of feline lymphoma?

A

GI tract

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32
Q

What is the most common recommendation for treatment of feline lymphoma?

A

Chemo

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33
Q

What is the exception to this recommendation?

A

Localized nasal lymphoma

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34
Q

What is the multimodal treatment for feline lymphoma and what does it stand for?

A

COP
Cyclophosphamide
Vincristine
Pred
Doxorubicin isnt as effective in cats

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35
Q

What is the 1/3, 1/3, 1/3 rule in feline lymphoma?

A

1/3 complete response
1/3 partial response
1/3 don’t respond

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36
Q

What is the single treatment option for feline lymphoma?

A

Lomustine + pred

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37
Q

What is the most common side effect of COP in cats?

A

GI
Generally better tolerated than dogs

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38
Q

Do FeLV + cats or FeLV- cats respond better to treatment

A

FeLV-

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39
Q

Do fatter cats do respond better to therapy?

A

Yes

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40
Q

Where would Stage 1 nasal lymphoma be?

A

Still in nasal cavity

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41
Q

Nasal lymphoma is prognostically the best high grade lymphoma

A
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42
Q

What is a huge prognostic factor for mediastinal lymphoma?

A

FeLV status 3m vs 1 year

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43
Q

What are 2 chemo drugs that can be used with CNS lymphoma that cross BBB?

A

Lomusine and cytarabine

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44
Q

What is the best anatomical place to have lymphoma if youre a cat?

A

Nasal cavity

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45
Q

Should you still use doxorubicin if you can?

A

Yeah, not really a down side

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46
Q

Is surgery often indicated in lymphoma in cats?

A

No except biopsies or intestinal obstruction

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47
Q

What cancer has the pseudo capsule that look like tendrils?

A

Soft tissue sarcoma

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48
Q

Where do soft tissue sarcomas most commonly spread?

A

Lungs through hematogenous spread

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49
Q

What is the most important factor in staging soft tissue sarcomas?

A

3 view chest rads

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50
Q

What are the margins for STS?

A

3cm laterally and 1 fascial plane deep

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51
Q

What is a radical excision?

A

Removal of whole organ or compartment (limb)

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52
Q

What is a wide surgical excision?

A

3cm + 1 fascial plane

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53
Q

What is a marginal excision

A

Essentially just the tumor is excised (aim to remove macroscopic disease not microscopic)

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54
Q

Tumors below the _____ and _______ can have a lower rate of recurrence <25%

A

Knee and elbow

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55
Q

If just doing marginal excision of STS, what is the ideal follow up?

A

RT

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56
Q

What are 4 options with STS if you have incompletely excised margins after surgery?

A

Surveillance: see what happens
Scar revision: Take out more
RT: Treats microscopic dx
Electrochemo: less expensive than RT

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57
Q

Is STS a good prognosis?

A

Yes if excised and adjunctive RT
One of few cancers that cure can be reached

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58
Q

What should the monitoring of STS look like?

A

Every month for 3 months
Every 3 months for 1 year
Every 6 months for 2 years

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59
Q

What are the 2 vaccines that are most common with feline injection site sarcomas?

A

Rabies and FeLV

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60
Q

What are the 3 indications to get a biopsy after a injection site mass

A

Increase in size 1 month after injection
Larger than 2cm
Persistence after 3 months

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61
Q

What is metastatic rate of feline injection site sarcomas?

A

25%!

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62
Q

Should FISS be referred?

A

Yes
Unless can get really large margins

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63
Q

Should you do an excisional biopsy for FISS?

A

NO!!

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64
Q

What are the margins for FISS?

A

3-5cm plus 2 fascial planes

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65
Q

Is the risk of metastasis with FISS low or high?

A

Low 25%

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66
Q

Because risk of metastasis is relatively low, systemic treatment is not normally recommended

A
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67
Q

“If its not a tail FISS, refer”

A

Monitoring timeline for FISS is same as Canine STS

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68
Q

What is neoadjunctive therapy?

A

Before surgery to decrease tumor size

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69
Q

What is induction therapy?

A

Treatment with intent to cure

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70
Q

What is rescue therapy?

A

Used after tumor fails to respond

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71
Q

What is the maximum tolerated dose?

A

Highest dose that can be administered in the abscence of unaccepatble or irreversible side effects

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72
Q

What is the nadir?

A

When the side effects of a certain drug have the maximal effect on the patient (lowest neutrophils, lowest platlets)

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73
Q

At what point does the cell cycle become self directed?

A

When it passes (r) restriction point

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74
Q

What do cell cycle non specific drugs kill?

A

Actively dividing cells and resting cells

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75
Q

What do cell cycle specific drugs kill?

A

Just actively dividing cells

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76
Q

How are chemo drugs calculated?

A

With body surface area

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77
Q

What do you have to be cautious with using doxorubicin and vincristine with collies and shepherds?

A

Lower threshold due to MDR1 mutation

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78
Q

Which drug is released unchanged in urine?

A

The Platinum agents (carboplatin)

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79
Q

What is nadir for vincristine?

A

7 day

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80
Q

What is nadir for carboplatin?

A

7 and 21 day

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81
Q

What is nadir for lomustine in dog?

A

21 day

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82
Q

What is nadir for lomustine in cat?

A

42 days

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83
Q

What is a side effect of doxorubicin?

A

Nephrotoxicity

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84
Q

Which drug is nephrotoxic to dogs?

A

Cisplatin

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85
Q

What is the chelator for doxorubicin called?

A

Zinecard

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86
Q

What drug is contraindicated in cats?

A

Cisplatin - pulmonary edema
5FU - Neurotoxicity

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87
Q

What drug is contraindicated in West Highland White Terriers?

A

Tanovia - pulmonary fibrosis

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88
Q

What is a way to assess response of lymph node (in lymphoma) to chemo?

A

Measure the lymph node size
CR: normal size
PR: >30%
SD=stable disease = <30%
PD = Progressive disease = >20%

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89
Q

What anatomical location is uncommonly affected by high grade lymphoma in cats?

A

Peripheral lymph nodes

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90
Q

Cat who are FeLV positive are likely to be younger whne they develop lymphoma than cats who are FeLV negative

A
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91
Q

What type of radiation does RT utilize?

A

Ionizing radiation

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92
Q

What are teh 2 ways that ionizing radiation damages DNA?

A

Indirect - 70%
Direct - 30%

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93
Q

What is 1 gray equal to?

A

1 joule/kg of tissue

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94
Q

What is fractionation?

A

Dividing total dose of radiation into small fractions given over several weeks

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95
Q

Is palliative fraction size large or small

A

Large but not given nearly as often

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96
Q

When are RT side effects usually at their peak for definitive treatment?

A

1 week after RT

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97
Q

What is a common side effect of acute RT?

A

Desquamation (pealing and drying of skin
Halitosis
Alopecia
Nasal discharge
Uveitis
Basically anything “itis”

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98
Q

How often do chronic RT side effects occur?

A

<5%

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99
Q

What is a common late side effect?

A

Leukotrichia (white hair)

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100
Q

What is the difference between intensity modulated RT and 3D conformal RT?

A

3D = uniform dose distribution
IMRT = Non-uniform dose
IMRT can really avoid critical organs to minimize side effects

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101
Q

What is GTV

A

gross tumor volume

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102
Q

what is ctv

A

clinical target volume

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103
Q

what is ptv

A

planning target volume

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104
Q

What are teh 5 steps of RT in order?

A

Diagnosis/staging
Planning CT
RT plan creating
Verification of plan
Patient treatment

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105
Q

What technique is used for deep, superficial RT?

A

Photons are deep
Electrons are superficial

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106
Q

What is the long term control of tumor size called in RT?

A

Definitive RT

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107
Q

What is good local control for early stage gross tumor with minimal treatment and time in hosptital?

A

Steotactic RT

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108
Q

What is the most common oral tumor of dogs?

A

Oral malignant melanoma

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109
Q

What is the metastatic rate?

A

60-80%

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110
Q

What are the margins for oral malignant melanomas?

A

2-3cm bone and 1cm soft tissue

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111
Q

What is the reoccurence rate for oral malignant melanomas?

A

50% local reoccurence

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112
Q

What is stage 1 for oral malignant melanomas?

A

<2 cm, no LN, no mets

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113
Q

what is stage 2 for oral malignant melanomas?

A

2-4 cm, no LN, no mets

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114
Q

what is stage 3 for oral malignant melanomas?

A

> 4, LN involvement, no mets

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115
Q

what is stage 4 for oral malignant melanomas?

A

Any size, LN involvement, mets

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116
Q

What is the intrralesional chemo for oral malignant melanomas?

A

cisplatin

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117
Q

What is the systemic chemo for oral malignant melanomas?

A

carboplatin

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118
Q

What is an additional promising area of research for treatment of oral malignant melanomas?

A

immunotherpay (Oncept vaccine)

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119
Q

What is electrochemotherapy?

A

Electrical pulses to allow greater influx of chemo agent into cells

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120
Q

What is prognosis of tonsillar SCC?

A

45 d
Sx is palliative
Chemo is inneffective since it is already mets

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121
Q

What are 2 Tx options in cat SCC?

A

RT + Chemo

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122
Q

Is mouth OSA better prognostically than appendicular OSAs?

A

Yes

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123
Q

Does adjunctive therapy help mouth OSAs?

A

No

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124
Q

What is stage 1 lymphoma?

A

Stage I: 1 LN

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125
Q

What is stage II lymphoma?

A

Stage II: Multiple nodes in a region

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126
Q

What is stage III lymphoma?

A

Stage III: Generalized (everywhere)

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127
Q

What is stage IV lymphoma?

A

Stage IV: Spleen and liver involvement

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128
Q

What is stage V lymphoma?

A

Stage V: Bone marrow (anemic present maybe)

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129
Q

What is a common benign lesion of the mouth?

A

Canine acanthomatous ameloblastoma

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130
Q

What are the treatments (3) for CAA?

A

Mandibulectomy/Maxillectomy
Can also RT but will often recur in RT field
Intralesional bleomycin is an optional injection

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131
Q

What is an odotoma full of?

A

Teeth

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132
Q

What are the margins on an intestinal tumor?

A

3-5 cm of grossly normal tissue orad and aborad

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133
Q

What are of the small intestine is easiest to resect from?

A

Jejunum

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134
Q

What is something that needs to be done on resection and anastomosis of intestinal tumors?

A

Leak test

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135
Q

What is typhlectomy?

A

Resection of the cecumW

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136
Q

What is colectomy?

A

Resection of a segment of colon

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137
Q

What is colorectal resection?

A

Resection of variable portions of both descending colon and rectum. Rectal pull-through procedure

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138
Q

How large is the exision of normal tissue in each direction for rectal tumors?

A

1-2cm

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139
Q

How large is teh excision of normal tissue in each direction for colonic masses?

A

2-5cm

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140
Q

What is a surgical technique for small, single, and superficial tumors in caudal-midrectum?

A

Rectal eversion

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141
Q

What are the 5 principles of treating IMHA in order?

A
  1. Prevent hemolysis with immosuppressive therapy
  2. Treat tissue hypoxia
  3. Deter formation of thromboembolic disease
  4. Provide supportive care
  5. Treat associated cause
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142
Q

How do you treat the immunosuppressive therapy?

A

Pred (2-3mg/kg/day) or dex

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143
Q

What is the mechanism of action of immunospressors?

A

Decreases macrophage phagocytosis of Ab-coated RBCs
Reduces macrophage cytokine production
Reduces effective antigen presentation to T cells
Long term: minimizes autoantibody production by B cells

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144
Q

How fast does pred work?

A

See results in 3-7 days

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145
Q

What is the most common cause of death in dogs with IMHA?

A

Thromboembolic disease

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146
Q

What is something owners need to be aware of with steroids in IMHA?

A

Steroid withdraw takes 2-4 months minimum

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147
Q

What are 4 principles of treatment for ITP?

A
  1. Prevent platelet destruction with steroids
  2. treat hypoxia
  3. Supportive care
  4. Treat associated cause
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148
Q

What is the mechanism of anemia in IMHA?

A

hemolysis

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149
Q

What is the mechanism of anemia in ITP?

A

Hemorrhage

150
Q

What is long term therapy for IMHA and ITP?

A

Decrease steroids by 25% every 2-4 weeks

151
Q

What is IMHA + ITP at same time?

A

Rare: Evan’s Syndrome

152
Q

Why do a lot of people think they have a patient with Evan’s syndrome?

A

They have an ITP patient with anemia but really anemia is from hemorrhage

153
Q

What are survival times for local therapies for thyroid tumors?

A

2-3 years

154
Q

What do bigger thyroid tumors mean?

A

Worse (palpate thyroid glands during physical)

155
Q

What si teh gold standard for feline thyroid tumor treatment?

A

Radioiodine

156
Q

Are Pituitary tumors or pituitary tumors more common?

A

Pituitary tumors

157
Q

What is the treatment for pituitary macroadenomas?

A

RT

158
Q

Do insulinomas metastasize?

A

Yes 90-95%!

159
Q

Where do insulinomas mostly metastasize?

A

Liver

160
Q

What is Stage I for insulinoma?

A

Just pancreas 2 year MST

161
Q

What is Stage II for insulinoma?

A

LN mets 1.5 year MST

162
Q

What is Stage III for insulinoma?

A

Distant mets 0.75 MST

163
Q

How do you medically manage insulinomas?

A

Smaller more frequent feedings
Diets with complex carbs, no simple carbs, lots of fiber
Avoid strenous exercise
Pred
Diazoxide: Inhibits insulin release

164
Q

What are 6 sources of pain in cancer patients?

A

Visceral stretching
Invasion of cancer cells into surrounding cells
Organ distension/obstrcution
Neuropathic Pain
Release of chemical mediators
Poor circulation

165
Q

What are the 3 levels of WHO recommendations for controlling pain?

A

Mild pain - NSAIDs
Moderate pain - weak opioids
Severe pain - strong opioids

166
Q

What tumors do NSAIDs have anti-tumor effects in?

A

Carcinomas

167
Q

How can you decrease the calcium (hypercalcemia)?

A

Bisphosphonates

168
Q

What is paraneoplastic syndroms?

A

Produces chemicals or hormones like calcium

169
Q

How often should you consider rechecks for QOL?

A

1-2 months

170
Q

what is the most common cutaneous tumor in dogs?

A

Mast cell

171
Q

What are the most common sites of metastasis for mast cell tumors?

A

LNs, liver, spleen

172
Q

What is a rare place for mast cells to metastasize?

A

Lungs

173
Q

What are the margins for Mast cell?

A

2-3cm lateral and 1 fascial plane deep

174
Q

What is an adjunctive therapy that can be injected into MSTs?

A

Stelfonta is injected causing tissue necrosis

175
Q

Where can you inject stelfonta SQ?

A

Distal to elbow and hock

176
Q

What is the response rate with stelfonta?

A

75% with one injection

177
Q

What do you still need to do with stelfonta?

A

Sedate the animal so you dont stick yourself

178
Q

What is another interesting treatment for MST?

A

Oral pred can help reduce tumor size prior to surgery

179
Q

How many levels of grade are there for MCT?

A

1-3 AND high vs low

180
Q

What is HN0

A

Non-metastatic

181
Q

What is HN1

A

Pre-metastatic

182
Q

What is HN2

A

Early metastatic

183
Q

What is HN3

A

overt metastatic

184
Q

What does monitoring look like?

A

Exam every month for 3 months then every 3 months for a year then every 6 months

185
Q

Up to 70% of incompletely excised low grade MCTs will not recur

A
186
Q

What are some palliative options for MCTs?

A

H1 antagonistis (diphenhydramine)
H2 Antagonists (famotidine and omprazone)
Steroids

187
Q

What is the average age of AGASACA patients?

A

9-11

188
Q

What is the most common clinical sign of AGASACA?

A

PU/PD - hypercalcemia

189
Q

What is the most common malignant neoplasia to cause hypercalcemia?

A

T cell lymphoma

190
Q

What are the most common sites of metastasis for AGASACA?

A

Medial and internal iliac LNs

191
Q

Lungs are uncommon sites of metastasis

A
192
Q

What is the staging of the clinical AGASACA?

A

o 1: <2.5cm mass, no LN, no distant mets
o 2: >2.5cm mass, no LN, no distant mets
o 3: any tumor, <4.5cm node metastasis, no distant mets
o 4: Any tumor, >4.5cm node metastasis, no distant mets
o 5: Any tumor, any node met, distant mets

193
Q

What is prognosis of AGASACA dogs?

A

Multiple years

194
Q

What is treatment for AGASACA?

A

Surgery
Adjunctive is usually RT

195
Q

What are the margins for surgical excision of sarcoids?

A

at least 1cm+

196
Q

What is the gold standard for sarcoids in horses?

A

Radiation therapy

197
Q

What horses get melanoma the most?

A

Grey horses!

198
Q

Where are horse melanomas usually located?

A

Under the tail

199
Q

What percentage of grey horses over 17 were melanoma free?

A

6%

200
Q

What is staging of equine melanomas?

A

o 1. <0.5cm nodule
o 2. Several <0.5cm nodules or single >2cm
o 3. One or several of >5cm or SQ at typical locations
o 4. Extensive SQ nodules with necrosis or metastasis
o 5. Exophytic tumor growth with wet surface and ulceration, metastasis to organs with clinical signs

201
Q

What are the treatment options for equine SCC?

A

Surgery: excisional, cryosurgery, adjunctive treatments
Chemo: Intralesional (cisplatin, carboplatin) Topical (5-FU, mitomycin-C ophthalmic)
RT

202
Q

What are margins of SCC surgery?

A

5mm

203
Q

What are the common sites for SCC surgery?

A

3rd eyelid removal
Penis and prepuce

204
Q

What are the best options for topical SCC chemo

A

5-FU
Mitomycin-C
Intralesional - injection of beads

205
Q

What is the most common bone tumor?

A

Osteosarcoma

206
Q

What is teh most common metastatic site for osteosarcomas?

A

Lungs!!

207
Q

With amputation, how do dogs die?

A

Systemic, not local disease

208
Q

BOTTOM LINE IS THAT CHEMO AFTER SURGERY DOUBLES SURVIVAL TIME!! WITH OSA

A
209
Q

What chemo drug choice is best for OSA?

A

Carboplatin

210
Q

What is teh Popcorn ball of the skull?

A

Multilobular osteochondroma (MLO)

211
Q

Good or bad: OSA in foot

A

good

212
Q

Good or bad: OSA in radius or femur

A

bad

213
Q

Good or bad: OSA in scapula humerus

A

Ugly

214
Q

Good or bad: OSA in extra-skeletal

A

Ugly

215
Q

Good or bad: OSA in rib

A

Ugly

216
Q

Good or bad: OSA in vertebrae

A

Ugly

217
Q

What dogs have really bad prognosis?

A

Younger dogs or obvious metastasis at diagnosis

218
Q

What percent of dogs undergoing splenectomy develop arrhythmias?

A

25%

219
Q

What is teh MST of hemangiosarcoma with sx alone?

A

1-3m

220
Q

What is the drug used for metronomic chemo?

A

Cyclophosphamide

221
Q

What is a side effect of metronomic chemo with cyclophosphamide?

A

Sterile hemorrhagic cystitis

222
Q

Is there a benefit in hemangiosarcoma patients to supplements?

A

No

223
Q

What may cause dermal HSAs?

A

UV light exposure

224
Q

How do you protect patients from further staging dermal HSA?

A

Prevent exposure to UV light

225
Q

What is teh most common cardiac site for HSA to show up?

A

Right auricle

226
Q

What percent of hemoperotineum is neoplasia in cats?

A

46%

227
Q

What percent of those neoplasias are HSA?

A

60%

228
Q

Surgery now baby half way there I think…

A
229
Q

What is the extrinsic pathway for coagulation cascade?

A

VII

230
Q

What is the epinephrine concentration for vasoconstriciton?

A

1:10

231
Q

How many mLs does a fully soaked sponge hold?

A

15mL

232
Q

What are the forceps from smallest to largest

A

Mosquito>Kelly>Crile>pean>Carmault

233
Q

What suture size should be used for SQ bleeder?

A

3-0 or 4-0

234
Q

Which direction do you point you forceps using the tip clamping technique?

A

Tip of clamp is pointing down

235
Q

What are the 2 techniques for hemostasis?

A

Tip clamp
Jaw clamp

236
Q

Which direction do you clamp using the jaw clamp technique?

A

Curvature facing up

237
Q

What vessels usually need transecting hemostatsis?

A

Prepuscial artery and vein

238
Q

How do you clamp and transect larger vessels?

A

Use 2 hemostats and point them toward each other
Then cut between them with Metzenbaum scissors

239
Q

How are hemostats handed to surgeon via the assisstant?

A

With curve positioned AWAY from the palm of the surgeons hand

240
Q

During hernia repair, what is an option if the local region is inadequate for closure?

A

Bring in muscle flaps or use synthetic mesh

241
Q

What do you close a hernia with?

A

PDS

242
Q

What is the most common hernia?

A

Umbilical hernias

243
Q

Do umbilical hernias resolve spontaneously sometimes?

A

Yes
Will repair early in shelter dogs to get them adopted

244
Q

What is the most common cause of acute incisional hernias?

A

Surgeon’s error

245
Q

What can be mistaken as an inguinal hernia in obese cats?

A

Caudal fat pad

246
Q

How many hiatuses are in teh diaphram

A

3

247
Q

What is an important position doe diaphragm surgery?

A

Reverse Trengelenburg’s

248
Q

What is the most dangerous part of anesthesia in diaphragm surgery?

A

Induction

249
Q

What is overall prognosis of diaphragmatic hernias?

A

82-89% survival

250
Q

What needs to be done before surgical intervention of perineal hernias?

A

Appropriate medical management of constipation adn obstipation

251
Q

What can be done to medically manage constipation or obstipation?

A

Enemas
Lactulose
Miralax

252
Q

What is a surgical emergency for perineal prolapse?

A

Bladder prolapse with obstruction

253
Q

What is the most commonly utilized method for surgical treatment?

A

Transposition of the internal obturator

254
Q

What is the most common complication of surgical repair?

A

Temporary surgical incontinence

255
Q

What is first step in removing a LN?

A

Determinign the sentinel lymph node with contrast CT

256
Q

What is the gold standard in determining if metastasis is present?

A

LN biopsy

257
Q

What are 2 commonly removed LNs?

A

Mandibular and popliteal

258
Q

How should you position for a popliteal LN removal?

A

Hanging limb

259
Q

What is a concern with LN removal?

A

Seeding of cancer cells

260
Q

What is something to look out for in mandibular LNs?

A

2-5 nodes in the area, remove them all

261
Q

Which direction are LNs excised?

A

In longitudinal direction

262
Q

What is a tool that is very useful for LN excision?

A

electrocaudery

263
Q

Where does the liver get teh majority of the blood? oxygen?

A

80% from portal vein
20% from hepatic artery
Both provide 50% of oxygen

264
Q

What dogs typically get extra-hepatic PSS?

A

Toy breed dogs

265
Q

What is gold standard diagnosis of PSS?

A

CT

266
Q

What are 2 medical managements for PSS?

A

Lactulose
Restrict protein
(Maybe antibiotics and omeprazole)

267
Q

What is MST with medical management?

A

3 years

268
Q

What is MST with surgery?

A

11 years

269
Q

Where do you amputate for a total caudectomy?

A

Sacrococcygeal joint

270
Q

What is sterile definition?

A

Removal of ALL microbial life

271
Q

What is asepsis?

A

Inhibition of microbial growth
Bacteriostatic NOT bactericidal

272
Q

What is a disinfectant?

A

Bactericidal agents intended for inanimate objects
Bactericidal!

273
Q

Is an ultrasonic cleaner antibacterial?

A

No!

274
Q

What temp do autoclaves reach?

A

13 minutes at 120C (250)

275
Q

What temp do flash sterilizations occur?

A

3 minutes at 131C (270F)

276
Q

What chemical is used for chemical sterilization?

A

Ethylene oxide

277
Q

What much occur after ethylene oxide sterilization?

A

Aeration (take 24 hours)

278
Q

How are items sensitive to heat sterilized?

A

Radiation

279
Q

How many microbes does 1 person bring into a room?

A

10^3-10^4

280
Q

What are antiseptics?

A

Chemicals which are applied to living tissues to suppress or eliminate bacterial growth and development on living tissues

281
Q

How long must skin be in contact with antiseptic?

A

5 minutes

282
Q

Is Chlorohex a better Gram + or Gram -

A

Game +

283
Q

Explain the dirty scrub

A

Antiseptic scrub applied for 5 minutes
Scrub until sponges are visually clean

284
Q

How much of the skin is exposed with draping?

A

2cm
Fold is placed DOWN

285
Q

When do you put on the light handles?

A

Only after the top drape is in place

286
Q

What is capillarity?

A

Process by which fluid and bacteria are carried into the interstices of a multifilament suture

287
Q

What is relative knot security?

A

Force required to untie or break a knot as compared to the force required to break an untied strand of suture (knots weaken suture up to 50%!)

288
Q

What is the accepted rule of knot tensile strength?

A

Should not need to exceed tensile strength of tissue

289
Q

What are the 3 primary properties of suture material?

A

Absorbable v non absorbable
Natural v synthetic
Monofilament v multifilament

290
Q

How does natural suture break down?

A

Phagocytosis

291
Q

How does synthetic suture break down?

A

Hydrolysis

292
Q

What is monocryl?

A

Poliglecaprone

293
Q

What is PDS?

A

Polydioxinone

294
Q

Where is braided suture never place?

A

Below the skin

295
Q

What is chatter?

A

Tissue drag from multifilament suture

296
Q

What is the slowest healing tissue?

A

Fascia

297
Q

What is the only tissue that returns to 100% strength?

A

Bladder

298
Q

Whats the general rule for highly collagenous tissue?

A

50% strength in 50 days

299
Q

What is the general rull for parenchymal tissue?

A

> 80% strength in 14-21 days

300
Q

Should you resterilize?

A

No

301
Q

Where should you grasp a needle?

A

2/3rds

302
Q

When do you use a cutting needle vs tapered?

A

In tougher collagenous tissue (Skin and intradermal)

303
Q

When do you use a taper needle?

A

Soft tissues (parenchymal tissue)

304
Q

What is the most common mass in the perianal region?

A

Adenoma

305
Q

Are adenomas or adenocarcinomas more superficial/pedunculated in perianal masses? Which have a poorer prognosis?

A

adenomas
Adenocarcinomas

306
Q

What is treatment for perianal fistulas?

A

Cyclosporine and tacrolimus

307
Q

What are the 4 classification of surgery sterility?

A

Clean
Clean/contaminated
Contaminated
Dirty

308
Q

What is a clean surgery?

A

Elective, no breaks in aseptic technique: TPLO, spay/neuter

309
Q

What is clean/contaminated

A

Entry into a hollow viscus without gross contamination
Minor breaks in aseptic technique (head hits light)

310
Q

What is contaminated

A

Traumatic wounds (penetrating wound, laceration)
Major breaks in aseptic technique (glove tears while holding something)

311
Q

What is dirty?

A

Purulent material encountered
Perforated viscus

312
Q

What is the time frame for giving antibiotic for surgery?

A

90 minutes
OR if there is an implant
OR contaminated Sx
OR dirty Sx

313
Q

What is cefazolin given for?

A

Skin 47min half life

314
Q

What is unasyn given for?

A

GI 60 min half life

315
Q

How do you redose antibiotics in surgery?

A

Based on half life

316
Q

What are the 3 goals for onco surgical intent?

A

Curative intent
Palliative intent
Cytoreductive intent

317
Q

What is intralesional surgical dosing?

A

Just removing part of the tumor to potentially allow movement of a limb
Most of macro and micro dx will be left behind

318
Q

What is marginal surgical dosing?

A

Tumor excised just outside capsule
Micro dx likely left behind

319
Q

** YOU ARE ONLY AS WIDE AS YOUR NARROWEST MARGIN

A
320
Q

What are 2 primary tumor sampling methods?

A

FNA
Biopsy

321
Q

What is the difference between incisional and excisional biopsy?

A

Incisional just removes a piece for diagnosis, excisional removes the whole thing

322
Q

What do you put a mass into for pathology review? What the ratio of sample to formalin?

A

Formalin
1:10

323
Q

What do you ink on a sample?

A

Lateral margins, areas of special interest, and deep margin

324
Q

What is the residual tumor classification?

A

R0 = no tumor at inked edge
R1 = micro dx at inked edge
R2 = macro dx at inked edge

325
Q

**What is the major blood supplies of the spleen

A

All arise from celiac artery
Splenic artery
Left gastroepiploic artery
Short gastric

326
Q

What is a tool that cuts and seals vessels up to 7mm?

A

Ligasure

327
Q

Where do you ligate the splenic artery?

A

Distal to pancreatic arteries as to not disrupt blood flow to pancreas

328
Q

What has an increased risk in splenectomies?

A

GDV (5.3x)

329
Q

How many layers of closure is there for pinnectomy?

A

Just one
DONT INCLUDE CARTILAGE IN CLOSURE

330
Q

How do you close the dead space of the ear with sutures?

A

4-0 Nonabsorbable mattress pattern through both layers of cartilage!

331
Q

How long do you need to bandage the incision and drain?

A

2weeks with concave surface facing up!

332
Q

Is bandage required for punch biopsy repair?

A

No

333
Q

What does TECA stand for?

A

Total ear canal ablation

334
Q

What must be performed with every TECA?

A

Removal of tympanic bulla (TECA +LBO)

335
Q

What important nerves are in this area?

A

Fascial nerve
VIII (vestibulococclear)

336
Q

With TECALBO, who is much more likely to get Horner’s?

A

Cats

337
Q

What is goal of ventral bulla osteotomy?

A

Removal of aural poly via ear canal

338
Q

What is the most common indication for ventral bulla osteotomy?

A

Nasopharyngeal polyp cats>dogs

339
Q

How do you prep a limb for toe amputation?

A

Towel clamp through nail hanging

340
Q

How do you do a bier block?

A

Toes up to remove blood
Place tourniquet
Middle of dorsal paw to block superficial branches of radial nerve

341
Q

Where is the toe amputated?

A

Proximal phalangeal joint

342
Q

What are the 4 mechanisms of wounding?

A

Friction
Shear
Tension
Compression

343
Q

What are the 4 phases of wound healing

A

Hemostasis
Inflammation
Proliferative
Remodeling

344
Q

What are the primary cell types of phase 2 healing?

A

Neutrophils and macrophages

345
Q

What is primary cell type in phase 3 of healing?

A

Fibroblasts

346
Q

What is something that increases the risk of wound healing complications?

A

Endocrinopathies (diabetes mellitus, cushings)
Steroids
Hypoproteineinemia

347
Q

What is the difference between contaminations, colonizations, and infection

A

Class 1:Contamination: Microbes are present
Class 2: Colonization: Microbes are replicating but not invading
Class 3: Infection: Microbes are invading and replciating

348
Q

How mich infection is required to cause an actual infection?

A

10^5

349
Q

What should be performed at the debridement step of wound healing?

A

Deep tissue culture

350
Q

Should you forefully close a wound?

A

NO! when in doubt, wait it out

351
Q

What bandage is good for the limbs?

A

Modified Robert Jones

352
Q

What bandage is good for thoracic or abdominal wounds?

A

Cross your heart

353
Q

What bandage is good for basically all others?

A

Tie over

354
Q

What 3 things about a primary layer should you consider?

A

Debridement, moist wound healing, topical antimicrobial

355
Q

How do you apply adherent primary layer?

A

Under sedation

356
Q

What can be used for all wound types?

A

Non-adherent moist wound healing types

357
Q

How often do you need to change adherent primary layers?

A

Every 24 hours

358
Q

What is primary wound closure?

A

Direct apposition of wound edges

359
Q

What is delayed primary wound closure?

A

within 3-5 days post-wounding

360
Q

What is second intention healing?

A

Healing via contraction and reepithelialization

361
Q

What is secondary wound closure?

A

Appositional closure of a wound >3-5 days post wounding

362
Q

What suture should you use on fascia closure?

A

0, 2-0. or 3-0

363
Q

How can you fix dog ears on suture?

A

Elliptical incision

364
Q

How to fix a step defect?

A

Suture no perfectly opposed

365
Q

With an advancement flap. how long can the length be?

A

No more than 2x the width

366
Q

Where should you exit a passive drain?

A

Never through the incision, always a separate stab incision

367
Q

If incision is dorsal, what type of drain do you use?

A

Suction drain

368
Q

What should you never do to a drain?

A

NEVER flush any drain
ON EXAM: NEVER EXIT A DRAIN THROUGH THE WOUND OR SURGICAL INCISION

369
Q

How long should a patient have a drain?

A

1-14 days
3-5 is most common

370
Q

youre done

A

Diseases and Diagnosis (24 decks)

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