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ACVS Phase I > Mary Dulish Board Questions > Flashcards

Mary Dulish Board Questions Flashcards

1
Q

What are the 4 cardinal signs of intussusception?

A

Vomiting, Abdominal Pain, hematochezia, Palpable Mass

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2
Q

What are the components of an Intussusception?

A

Intussusceptum (inside)
Intussuscipiens (outside)

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3
Q

How do you reduce an intussusception?

A

Apply gentle pressure upon the intussuscipiens and traction upon the intussusceptum.

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4
Q

What is the most common site for intussusception in dog, cat, and children?

A

Dog: Iliocolic
Cat: Jejunal-jejunal
Children: Ileocecal

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5
Q

What dog breed is particularly predisposed to intussusception?

A

German Shepherd

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6
Q

How common are recurrences following surgical therapy of intussusception? Where do the normally occur?

A

According to Larose et all. VetSurg 2024 (Retrospective, n:153)
Median age: 10 months
Post-op complications: 34% (14% severe → Diarrhea, constipation, septic peritonitis)
Recurrence rate: 3%
14-day mortality: 6%

  1. Larose PC, Singh A, Giuffrida MA, et al. Clinical findings and outcomes of 153 dogs surgically treated for intestinal intussusceptions. Veterinary Surgery. 2020;49(5):870-878. doi:10.1111/vsu.13442
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7
Q

What are methods to decrease the recurrence of intestinal intussusception?

A

Enteroplication
Enteropexy

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8
Q

What is the most common cause of intussusception in cats?

A

Lymphoma

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9
Q

How many pairs of salivary glands in dogs?

A

4

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10
Q

Considering a sialocele involving the sublingual and mandibular glands, what are 3 ways the condition may clinically manifest?

A

Ranula (Sublingual)
Cervical
Pharyngeal

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11
Q

Three possible clinical presentations of a sialocele affect the mandibular and sublingual glands. How is each one treated?

A

Ranula (Sublingual) - Sialoadenectomy of mandibilar and sublingual +/- marsupialization
Cervical - Sialoadenectomy of mandibilar and sublingual
Pharyngeal - Sialoadenectomy of mandibular and sublingual

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12
Q

According to Poirier et all (JVIM 2018), what is the recurrence rate following surgical therapy of sialoceles in dogs?

A

5-14%
All treated dogs responded to radiation.
27% recurred within 12 months but were successfully re-treated.

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13
Q

In a cat with pleural effusion and no history of trauma, what are the 4 main rule-outs?

A

Pyothorax (purulent exudate)
Cardiac (transudate)
Chylothorax (Chile)
Neoplasia (Modified transudate)

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14
Q

You have a dog with hypercalcemia and high PTH, strongly suggesting primary hyperparathyroidism. During surgery you do not observe a parathyroid mass. What do you do? What is the main potential detrimental consequence of this decision?

A

IV New Methylene Blue
May cause Heinz Body Anemia

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15
Q

What factors determine knot security?

A

Two suture factors:
Suture material (affects Coefficient of friction)
Suture size (also affects Coefficient of friction)

Two knot factors:
Knot configuration
Knot tension

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16
Q

You intubate a patient who has arrested, but you cannot inflate the lungs. Give 8 reasons why this may be occurring.

A

1) ET tube obstruction
2) Upper airway obstruction
3) Esophageal intubation
4) Severe lung hemorrhage
5) Severe atelectasis
6) Severe pulmonary edema
7) Pleural space disease (air, fluid, or mass)
8) Diaphragmatic hernia

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17
Q

Describe and draw an in-circle vaporizer system

A

In the in-circle system, the anesthetic gas vaporizer is located in the inspiratory conduit and is part of the system. Gas exhaled though the expiratory limb passes through the expiratory valve and works upon a breathing bag and pressure-relief valve connected to the circuit. Expired air then passes through a CO2 absorber and receives gas before passing through the vaporizer and entering the inspiratory limb again.

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18
Q

Name 4 advantages of a closed-circle anesthetic system

A

1) Economy of anesthetic consumption.
2) Warming and humidification of the inspired gases.
3) Reduced atmospheric pollution.
4) More efficient use of soda lime than in Waters’ canister.

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19
Q

Name 5 disadvantages of a closed-circle anesthetic system

A

1) Expensive and rather bulky.
2) Unstable if used closed.
3) Slow changes in the inspired anesthetic concentration with low flows and out-of-circuit vaporizers.
4) The soda-lime and valves in the system increase resistance to breathing.
5) Inhalation of soda-lime dust.

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20
Q

From a ventilatory perspective, what is the main disadvantage of a non-rebreathing anesthetic system like the Bain or Ayres models? What needs to be done to circumvent this deficiency partially and what is the consequence of not knowing about this fact?

A

Non-rebreathing systems do not have check valves so that the patient may re-breath exhaled gas from the outer corrugated tube. This is avoided by keeping a sufficiently high gas flow through the system. Low flow may lead to excessive CO2 rebreathing and respiratory acidosis.

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21
Q

Draw and describe an in-circle vaporizer

A

Total fresh gas flow (FGF) enters and splits into carrier gas (much less than 20%, which becomes enriched- saturated, actually- with vapor) and bypass gas (more than 80%). These two flows rejoin at the vaporizer outlet. The splitting ratio of these two flows depends on the ratio of resistances to their flow, which is controlled by the concentration control dial, and the automatic temperature compensation valve.

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22
Q

List 4 methods to decompress a GVD patient

A

Orogastric tube
Right (typical) abdominal trocharization
Temporary right paracostal gastrostomy
Definitive surgery

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23
Q

Name 3 ways to convert a patient in ventricular tachycardia and stabilize the heart

A

1) Electrical defibrillation (only for pulseless V-tach)
2) For V-tach with pulses: Lidocaine 2-4 mg/kg bolus followed by 40-60 ug/kg/min OR Procainamide
3) For V-tach with pulses if lidocaine fails: Mexiletine or Quinidine

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24
Q

Simple rule to estimate prognosis with Salter-Haris system

A

The higher the number, the worse the prognosis.

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25
What is the difference between epiphysis and apophysis?
Epiphysis: The extremities of long bones, separated from the diaphyses by the physis. Apophysis: Bone process or outgrowth with its own ossification center. Typically an origin or insertion for tendons and ligaments.
26
Name 5 apophysis
Acromion for the scapula Olecranon Tuber Ischii Great trochanter Calcanous
27
What is the vascular supply to cortical bone in the normal state?
Periosteal arteries that penetrate the bone; Principal nutrient arteries; Metaphyseal arteries proximally and distally. Blood flows centrifugally from the medullary canal to the endosteum.
28
What is the blood supply to the fractured cortical bone?
Transient interosseous blood supply develops from soft tissues and surrounding fractures to supply the early periosteal callus. When stability is restored, the medullary blood supply is reestablished.
29
What would be your anesthetic protocol for a C-section? Justify your answers
Pre-medication: Neuroleptoanalgesia with benzodiazepine (midazolam) and Opioid (Fentanyl or methadone). Both drugs are minimally fetal depressing in low doses. Local anesthesia: Epidural block with morphine and ropivacaine (MAC-sparing, minimal systemic absorption, safe for fetuses) Induction: Propofol or Alfaxalone (fast-acting and smooth Induction) Maintenance: Iso or Sevoflurane After fetal removal, administer NSAID and/or further opioids.
30
What are the recommended landmarks for an OVH incision in a dog Vs. cat?
Dog: Umbilicus to pubis Cat: Caudal to umbilicus to pubis
31
List the following sutures in the order of increasing reactivity: Nylon, stainless steel, sink, catgut, chromic gut, Dexon, Polydek
1) Stainless steel 2) Nylon 3) Dexon (Glycolic acid) 4)Polydek (Polyesther) 5) Silk 6) Chromic Gut 7) Gut
32
By what process are the following sutures absorbed? Catgut Dexon Vicryl
Catgut: Enzymatic action of cellular proteases and collagenases (inflammation) Dexon (Glycolic acid): hydrolysis Vicryl (Polyglactin 910): hydrolysis
33
What suture would you use to perform a sutured intestinal anastomosis in a patient with peritonitis? Justify.
Peritonitis involves the presence of a bacterial burden and inflammatory cells producing proteinases and collagenases. These enzymes weaken tissues through a prolonged debridement phase, and bacteria can seed multifilament material. Choose monofilament, non-reactive, slow-absorbing, or non-absorbing sutures such as polydioxanone (PDS) or polypropylene (Prolene).
34
List four reasons not to consider venous autotransfusion
1) Risk of septic embolism from contaminated blood 2) Low platelet and clotting protein levels in transfused blood may predispose the patient to DIC 3) The presence of RBC-leukocyte antibodies may predispose to DIC 4) Possible spreading of neoplastic cells
35
What is the weight cut-off for the use of a Bain's non-rebreathing system?
8kg
36
What is the advantage of a Bain's circuit vs. T piece?
1) Less dead space 2) Less heat loss 3) Less moisture loss
37
What is the minimum PCV at which surgery should be considered without pre or intra-operative transfusion?
20%
38
What is the importance of sighing a patient during surgery? What happens at the level of the lungs during this maneuver?
Sighing (giving a deep breath) prevents atelectasis and leads to the release of surfactant by Type II pneumocytes.
39
Name two reasons why a patient may not be able to sigh following thoracic surgery
Pain Encircling thoracic bandage Diaphragmatic paralysis due to phrenic nerve damage.
40
How can you determine of a lateral thoracoabdominal radiograph is adequately labeled (laterality label)?
- Pillars of the diaphragm: "Y" shaped on LEFT lateral or parallel lines on RIGHT lateral
41
How can you determine if a ventrodorsal abdominal radiograph is adequately marked for laterality?
- Right kidney more cranial than left - colon on left - Cardiac apex on left
42
How much blood volume can be replaced by splenic contraction in hemorrhagic shock?
20%
43
List 8 associated signs of acute reaction to a blood transfusion
1) Fever 2) Tachycardia 3) Tachypnea 4) GI signs (diarrhea/vomiting) 5) Hives 6) Collapse (hypotension) 7) Cardiac arrhythmias 8) Hemoglobinuria
44
What size cerclage wire would you use to assist in the stabilization of a long-oblique femoral fracture in a cat vs. 5kg dog vs. 30kg dog?
Cat: 20 gauge Small dog: 20 gauge Large dog: 18 gauge
45
Name three ways to control splanchnic pain in dogs.
Opioids (Butorphanol, for example) Epidural block Na-channel blocker in peritoneal cavity
46
Describe the steps for placement of a lag screw in a lateral humeral condylar fracture. Mention drillbit and tap size for a 2-0 cortical screw.
1) Reduce and temporarily support the fracture with pointed reduction or Vulsellum forceps 2) Drill a tunnel 0.3x condylar diameter (HCD) (at isthmus - measured on radiographs) cranial and distal to the lateral epicondyle using a 2.0mm drillbit to the level of the fracture. 3) Insert a 1.5/2.0 universal drill guide and drill the medial condyle using a 1.5mm drill bit. The medial exit should be 0.3x HCD cranial and 0.2x HCD distal 4) Apply a washer to the screws and insert until tight and promoting interfragmentary compression.
47
What is the order of clinical signs of a cat experiencing an adverse reaction to lidocaine?
"Top to bottom" 1) CNS signs: Excitation, tremors, seizures 2) Cardiovascular: Cardiac arrhythmias (typically bradycardia, hypotension, and tachycardia/ventricular fibrillation in severe cases). 3) GI signs: Vomiting, diarrhea
48
How would you treat a cat displaying clinical signs compatible with an adverse reaction to IV lidocaine?
IV benzodiazepine first IV sedation (propofol PRN)
49
How quickly does Prednisolone Sodium Succinate (Solu-Delta-Cortef) get to cell level? What is the half-life?
Enters cells in 1 min Half-life 90 minutes
50
How quickly does Methylprednisolone Sodium Succinate (Solu_Medrol) get to the cell level, and what is the half-life?
Cell level at 1 min Half-life 240 minutes
51
How quickly does Dexamethasone (Azium) get to the cell level, and what is the half-life?
Cell level in 3 hours Half-life 10 hours
52
What are the three most common malignant oral tumors in dogs? What is their biological behavior?
1) Squamous cell Carcinoma - Rostral mandible; low metastatic potential, good prognosis with surgery and /or radiation 2) Fibrosarcoma: Pallate; Fair prognosis with surgery, poor with radiation; Overall guarded prognosis; Usually "low grade" histologically but biologically aggressive. 3) Melanoma: Buccal mucosa; Prognosis fair with surgery and poor with radiation; Often metastatic to regional LN's. The presence or absence of pigment is NOT prognostic.
53
How does the panniculus reflex work and what structures are involved?
Stimulation of cutaneous sensory receptors on dorsal lumbar region → sensory branches of spinal nerves → Dorsal routes → afferent spinal tracts (white matter) → ventral routes at C8-T2 → lateral thoracic nerves to cutaneous trunci muscle.
54
What spinal cord segments need to be injured to cause Horner's Syndrome? Why?
T1-3 Site where sympathetic fibers leave the cord to synapse with the cranial cervical node.
55
What forces need to be counteracted when stabilizing a fracture?
1) Tension 2) Compression 3) Shear 4) Bending 5) Torsion
56
What is the Terrible triad of O'Donahue?
ACL, MCL, and Medial Meniscal Injury
57
What are the components of Whipple's Triad?
Hypoglycemia with clinical signs Response to therapy with glucose
58
What is the foramen on Winslow?
Epiploic foramen
59
Where are the papilla of Vater and the sphincter of Oddi?
- Papilla of Vater = Major Duodenal Papilla - Sphincter of Oddi → on end of Common Bile Duct (controls biliary flow)
60
What are the three stages of the body's reaction to stress?
1) Flight or Fight response (Sympathetic) 2) Stress resistance (corticosteroid release) 3) Exhaustion (end of energetic reserves)
61
List the order of tissue layers and muscles you would transect during an approach for a persistent right aortic arch
1) Skin 2) SQ 3) Cutaneous Trunci 4) Latissimus Dorsi 5) Scalene 6) Serratus Ventralis 7) Pectoral muscles 8) External intercostal 9) Internal Intercostal 10) Pleura
62
List William Halstead's 7 principles
1) Gentle handling of tissues 2) Meticulous hemostasis 3) Preservation of blood supply 4) Sharp anatomic dissection between tissue planes 5) Asseptic technique 6) Obliteration of dead space 7) Tension-free closure
63
What is bougienage? Name 2 different methods. What is it used for?
A procedure involves using a bougie - a thin cylinder of rubber, plastic, or metal inserted into a passageway to dislodge a foreign body or dilate a stricture using a balloon filled with air or fluid.
64
What is the recommended temperature and time to flash sterilize a surgical instrument?
132F 3min 28Lbs
65
What 4 variables affect EO sterilization?
Exposure time Gas concentration Temperature Humidity
66
What does the term "Stressing a graft" mean?
Partially harvesting and re-suturing a graft, returning 24 to 48 hours later to harvest and transfer the graft finally. Stimulates blood supply.
67

ACVS Phase I (10 decks)

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