Mid-Sem 1 Exam Flashcards
Which of the following is NOT a potential cause for laryngeal paralysis?
a) Hypothyroidism
b) A very large thyroid neoplasm
c) High negative inspiratory pressures
d) Cranial mediastinum neoplasia
c) High negative inspiratory pressures
Regarding permanent tracheostomies which of the following is/are correct?
a) Decreases the risk of tracheal collapse
b) Allow easy access for anaesthesia in the upper airway patient
c) Is a salvage procedure
d) Is appropriate treatment for stage 1 laryngeal collapse
c) Is a salvage procedure
A 5 year old Maltese terrier is presented to a vet for the first time for a chronic cough. After a thorough diagnostic evaluation you diagnose it with moderate intrathoracic tracheal collapse. How would you initially best manage the dog?
a) Application of an intraluminal stent into the thoracic trachea
b) Medical management including anti-inflammatories and anti-tussives
c) Application of an intraluminal stent in the cervical trachea
d) Application of external polypropylene rings
b) Medical management including anti-inflammatories and anti-tussives
Which of the following are secondary upper airway diseases due to high negative inspiratory airway pressures?
a) Elongated soft palate
b) Stenotic nares
c) Hypoplastic trachea
d) All stages of laryngeal collapse
d) All stages of laryngeal collapse
When performing a staphylectomy in a dog with brachycephalic airway syndrome, it is important to resect the correct amount of tissue. What landmark is used to judge this length correctly?
a) Rostral margin of the tonsil crypt
b) The base of the epiglottis
c) Caudal margin of the tonsil crypt
d) Level with the rostral most portion of the cuneiform process
c) Caudal margin of the tonsil crypt
The anatomic sites for chest drain placement are:
a) Penetrating the chest wall at the 7th or 8th intercostal space
b) Penetrating the chest immediately below the costochondral junction
c) Penetrating the skin at the 7th or 8th intercostal space
d) Penetrating the thorax at the very dorsal aspect of the chest wall to ensure maximum tube length incision
a) Penetrating the chest wall at the 7th or 8th intercostal space
The perforated section of a chest drain ideally sits:
a) Along the dorsal aspect of the chest
b) Partially in the subcutaneous tissues and partially in the thoracic cavity
c) In the middle of the chest (1/2 way between spine and sternum)
d) Along the ventral floor of the chest
d) Along the ventral floor of the chest
With regards to tracheostomy tube placement in dogs which of the following is correct?
a) Should pass greater than 6 tracheal rings when in situ
b) None of the above
c) Provide permanent airway access for laryngeal collapse
d) Should be about 70% the diameter of the trachea
b) None of the above
- Should not pass more than 6 tracheal rings
- Should not be greater than 50% of the diameter of trachea
If threatened a cat’s preferred first line of defence is:
a) Escape
b) Curl up into a ball
c) Attack
d) Meow or hiss loudly
a) Escape
Feliway is:
a) A drug used to treat aggression in cats
b) A synthetic pheromone that mimics the natural familiarity pheromone
c) A strong-smelling spray to deter cats from soiling outside the tray
d) A disinfectant used to disguise the smell of urine
b) A synthetic pheromone that mimics the natural familiarity pheromone
The critical socialisation period for the developing kitten is:
a) Weaning to 12 weeks
b) 2-9 weeks
c) Birth to weaning
d) 4-16 weeks
b) 2-9 weeks
Scratching the furniture in the home is best managed by:
a) Providing an alternative structure to scratch
b) Shouting “no” at the cat
c) Declawing the cat
d) Using a water pistol on the cat
a) Providing an alternative structure to scratch
Which of the following statements is NOT correct. Caesarean section is urgently indicated in the bitch when:
a) The foetal heart rate is greater than 200bpm indicating foetal distress
b) There is meconium in the vagina
c) The bitch is systemically unwell
d) The bitch has been straining unproductively for 40 minutes
a) The foetal heart rate is greater than 200bpm indicating foetal distress
Which of the following statements regarding canine mammary neoplasia is correct?
a) The most common tumour type is sarcoma
b) After two oestrus cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing
c) More than 90% of mammary tumours are malignant
d) The most appropriate surgical treatment is unilateral mastectomy if the tumour is confined to one side
b) After two oestrus cycles in a bitch the lifetime risk of mammary tumour development is not significantly altered by desexing
Regarding cervical sialocoele in dogs which of the following answer is correct:
a) Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated
b) Removal of the parotid and sublingual salivary glands on the ipsilateral side is indicated
c) Repeated needle drainage is effective in 50% of cases and should be performed prior to surgery
d) The sialocoele is surrounded by a secretory lining that must be excised
a) Removal of the mandibular and sublingual salivary glands on the ipsilateral side is indicated
Which of the following statement regarding oral tumours in cats is correct?
a) Oral melanoma is relatively benign and rarely spreads
b) Squamous cell carcinoma is the most commonly identified oral tumour in cats
c) Biopsy of oral masses or ulcers is rarely indicated as it does not affect the surgical treatment
d) Surgery is rarely an option for oral neoplasia in cats as the bone is frequently involved
b) Squamous cell carcinoma is the most commonly identified oral tumour in cats
Elmo a 7 year-old 7kg male castrated daschund with hind limb paralysis and no deep pain sensation. Elmo’s presumptive diagnosis is intervertebral disc disease (IVDD).
Physical exam: HR = 190bpm, RR = 54bpm, temp = 38.3
Blood work: PCV = 60% (35-58%), TP = 85g/L (52-82)
Based on Elmo’s PCV and TP what is the most likely cause?
Dehydration
Elmo a 7 year-old 7kg male castrated daschund with hind limb paralysis and no deep pain sensation. Elmo’s presumptive diagnosis is intervertebral disc disease (IVDD).
Physical exam: HR = 190bpm, RR = 54bpm, temp = 38.3
Blood work: PCV = 60% (35-58%), TP = 85g/L (52-82)
What condition listed is NOT associated with an elevation in the HR?
Hypothermia
Elmo a 7 year-old 7kg male castrated daschund with hind limb paralysis and no deep pain sensation. Elmo’s presumptive diagnosis is intervertebral disc disease (IVDD).
Physical exam: HR = 190bpm, RR = 54bpm, temp = 38.3
Blood work: PCV = 60% (35-58%), TP = 85g/L (52-82)
The ASA recommends categorising patients undergoing an anaesthetic procedure into one of five possible statuses. What is the most likely ASA status for Elmo?
IIE
Elmo a 7 year-old 7kg male castrated daschund with hind limb paralysis and no deep pain sensation. Elmo’s presumptive diagnosis is intervertebral disc disease (IVDD).
Physical exam: HR = 190bpm, RR = 54bpm, temp = 38.3
Blood work: PCV = 60% (35-58%), TP = 85g/L (52-82)
A 22G intravenous catheter has been placed in Elmo’s cephalic vein. What is the best sole opioid analgesic protocol for this patient, whilst awaiting surgery? Include drug route and frequency of administration.
As a catheter is already in place the best route of administration is intravenous.
The best opioid for Elmo would be???
During anaesthesia for spinal investigation Elmo is placed on a non-rebreathing system and connected to the capnograph. What is wrong with this capnograph trace below and what would you do to troubleshoot this?
The capnograph bottom line never reaches 0. Not returning to baseline means the animal is rebreathing CO2. To troubleshoot this one-way valves and soda lime needs to be checked.
Hypothermia is common under prolonged general anesthesia. How do you attempt to avoid this and if it occurs how do you treat hypothermia?
Main methods of heat loss during general anaesthesia include radiation, convection & convention. Alfoil blankets and towels on the trunk and bubblewrap on distal limbs should be used as a standard on all patients to prevent heat loss.
Anaesthesia should be kept as light as possible as deep anaesthesia results in less heat production. Anaesthesia should be kept as short as possible in duration to reduce heat loss.
Hypothermia should be treated with external heat sources such as Baer (air) warmers, warm water circulating blankets & normal blankets. Fluid warming can also be used to heat IV fluids entering the patient.
During anaesthesia Elmo becomes hypotensive (MAP <60mmHg). What would be the first thing you would do to correct the hypotension?
a) Turn down the inhalant agent, if possible
b) Pinch animal’s toe to cause stimulation
c) Increase the fluid rate
d) Administer vasopressin
a) Turn down the inhalant agent, if possible
*If check the patient (to assess anaesthetic depth) were an option pick this first!
Elmo’s heart rate and EtCO2 start to decrease during anaesthesia. Suddenly you notice an abnormal rhythm after the 7th QRS complex (flat line). What is this called? How would you manage this condition?
Ventricular asystole.
CPCR should be initiated…
Elmo should be given adrenaline (epinephrine) and/or vasopressin and his airway sohuld be checked for obstruction before manual ventilation is begun.
A cat is presented with idiopathic feline asthma. For home management the owner prefers to give inhalation therapy, rather than oral therapy. From the following list, select the combination of drugs commonly delivered as inhalation therapy for acute attack episodes as well as for chronic ongoing feline asthma.
a) Antibiotic (acute), bronchodilators (chronic)
b) Antibiotic (acute), corticosteroid (chronic)
c) Bronchodilators (acute), corticosteroid (chronic)
d) Bronchodilators (acute), non-steroidal anti-inflammatory (chronic)
c) Bronchodilators (acute), corticosteroid (chronic)
A geriatric Golden Retriever is presented because of noisy inspiration that is evident only when the dog is exercising strenuously. Select from the list below the most likely cause.
a) Brachycephalic syndrome
b) Collapsing trachea
c) Laryngeal paralysis
d) Aspergillosis
c) Laryngeal paralysis
An elderly dog is presented with 1 week of persistent sneezing and a unilateral mucopurulent nasal discharge. Which of the following options is the approach most likely to lead to diagnosis?
a) Thorough physical examination, followed by skull radiographs or CT and then rhinoscopy
b) Complete blood count and chemistry panel followed by rhinoscopy, then CT scan
c) Complete blood count and coagulation panel followed by rhinoscopy and cytology or biopsy
d) Rhinoscopy, nasal wash, cytology and/or biopsy followed by skull radiographs or CT
a) Thorough physical examination, followed by skull radiographs or CT and then rhinoscopy
Which of the following statement about stertor and stridor is most correct?
a) Stridor or goose honk noises are typical of brachycephalic syndrome
b) Stertor and stridor indicate obstruction to airflow in the bronchi
c) Stertorous respiration indicates obstruction to airflow in the larynx
d) Stridor is a high pitched inspiratory noise, stertor is snoring or snorting
d) Stridor is a high pitched inspiratory noise, stertor is snoring or snorting
Which of the following would be a pre-anaesthetic concern in a brachy dog?
a) All of the above
b) Chronic hypoventilation
c) Chronic hypoxaemia - PaO2 <85mmHg
d) Chronic hypercapnia - PaCO2 >45mmHg
a) All of the above
Which pre-anaesthetic drug is most likely to cause pharyngeal and soft palate relaxation resulting in upper airway obstruction?
a) Benzodiazepines
b) Butorphanol
c) Low dose ACP
d) Alpha 2 agonists
a) Benzodiazepines
In geriatric patients cardiac output is often increased.
a) True
b) False
b) False
In geriatric patients: the use of sedatives, analgesics, and anaesthetic agents may cause a significant decrease in functional respiratory reserve due to respiratory depression.
a) True
b) False
a) True
In a pregnant bitch, progesterone and beta endorphins are increased, this makes them less sensitive to the effects of all anaesthetic drugs.
a) True
b) False
b) False
Surgery repro tract - what do you do if you drop a pedicle?
?
CPR long answer:
What do you do / check for in CPR, like airway breathing etc?
What is the equipment / thing to monitor?
ABC’s of CPR = airway (is it clear), breathing (manually ventilate 10 breaths/min), circulation (perform compressions 100-120bpm at 1/3-1/2 depth of chest)
Monitor end tidal CO2 (>15mmHg indicates adequate compressions)
Look for return to spontaneous circulation (sudden peak) on ECG
Repro surgery: what are some indications for caesarean?
There are 2 types of caesarean, when to do each one?
Single incision into uterine body:
- Only one incision (less to suture, less time for mother to be under anaesthetic)
- Good if only a few puppies - can usually easily milk the puppies to the single incision for removal
- Access to foetuses is more difficult > increased risk of puppy death
Multiple uterine horn incisions:
- Quicker & hence may be safer for getting larger litters of puppies out
- More sites to suture closed & more sites at risk of dehiscence or infection
Head and neck surgery - key points?
What is the most common malignant oral tumour in dogs?
What is the most common oral tumour in cats?
Most common malignant oral tumour in dogs = malignant melanoma
Most common oral tumour in cats = squamous cell carcinoma
Anaesthetic case discussions - differences between brachycephalic, old & pregnant?
??
Anaesthetic complications long question:
List things that can occur during anaesthesia (hypotension, hypercapnia, hypothermia)
How do you monitor for them?
How do you treat them?
2 most common anaesthetic complications = hypothermia & hypotension
Hypothermia:
- body temp <37.6 (clinically significant = <36)
- monitor temp using rectal thermometer and/or oesophageal temp. probe
- prevention better than treatment - can keep warm with warm water circulating blanket, baer (air) warming blankets, bubble wrap around paws for insulation, warming of IV fluids.
Hypotension:
- when MAP <60mmHg, or SAP <80mmHg
- monitor using blood pressure monitoring (cuff) - palpation of strong pulse doesn’t necessarily mean BP is adequate
- treatment: check anaesthetic depth & then reduce inhalant if possible, can give an inhalant-sparing drug like fentanyl as a CRI, could give fluid bolus, treat any underlying cause (e.g. hypothermia), if none of the above fixes it can give anticholinergics (glycopyrrolate / atropine) if hypotension is caused by bradycardia or give ionotropes (dopamine / dobutamine) as CRI
Bradycardia:
- Diagnosed by: auscultation, pulse palpation, ECG, pulse oximetry, doppler
- Over-anaesthetised patient - reduce inhalant concentration +/- inhalant-sparing drug
- Increased parasympathetic nervous system tone - give an anticholinergic (glycopyrrolate / atropine)
- Hypothermia - minimise heat loss
- Severe hypoxaemia - check ETT connection & equipment, IPPV if necessary
- Provide noxious stimulus (e.g. toe pinch) & observe response
Tachycardia:
- Diagnosed by: auscultation, pulse palpation, ECG, pulse oximetry, doppler
- Increased sympathetic NS tone from pain (provide pain relief e.g. ketamine CRI)
- Insufficiently anaesthetised (increase inhalant concentration)
Hypoventilation:
- Diagnosed by: ETCO2 >45mmHg on capnograph, PaCO2 >45mmHg, reservoir bag movements
- Causes: CNS depression from drugs used during anaesthetic (particularly opioids, propofol or alfax used at induction) =, airway obstruction, lung disease, closed pop-off valve, severe hypotension or hypothermia
- Treatment: treat underlying problem, decrease concentration of inhalant where possible, open the pop-off valve (if shut), initiate IPPV, antagonise drugs if life threatening
Cat behaviour - know how to treat a behavioural problem e.g. how to treat / prevent cat spraying
??
Sally, a 3 year old female spayed Golden Retriever, presents to your clinic after having her first generalised seizure. Outline your intitial diagnostic approach.
- History of access to toxins
- Physical examination
- Neurological examination
- CBC
- Serum biochemistry
- Urinalysis
- Fasting blood glucose
What medication can you give to counteract the severe depression sometimes caused by apomorphine?
a) Prednisolone
b) Adrenaline
c) Maropitant
d) Carprofen
e) Naloxone
e) Naloxone
In cases with suspected tracheal collapse, the definitive diagnosis is made using:
a) Endoscopic examination of the trachea under general anaesthesia
b) Palpation of the trachea eliciting a honking cough
c) Endoscopic examination of the trachea under light sedation
d) Plain radiographs of the trachea with the animal anaesthetised
c) Endoscopic examination of the trachea under light sedation
Clomipramine is a:
a) TCA, which is a triceptide antidepressant, a serotonin and noradrenaline reuptake inhibitor
b) TCA, which is a tetracyclic antidepressant, a serotonin and noradrenaline reuptake inhibitor
c) TCA, which is a tricyclic antidepressant, a serotonin and noradrenaline reuptake inhibitor
d) TCA, which is a tricyclic antidepressant, a specific serotonin reuptake inhibitor
c) TCA, which is a tricyclic antidepressant, a serotonin and noradrenaline reuptake inhibitor
Cats can live as solitary hunters or in colonies. When cats form a larger group it is often comprise of:
a) Linear dominance heirarchy with females being more dominant than males
b) Mixed male and female groups with frequent changes in social structure
c) Related females and their offspring
d) Patrilineal groups of related females
c) Related females and their offspring
A 7 year old neutered female dog presented for intermittent sneezing for 7 days and having a slight mucopurulent discharge from its left nostril. There were no other abnormalities on physical exam. List the 2 most likely differential diagnoses and briefly give your reasons for selecting each diagnosis.
Foreign body (e.g. grass seed) - unilateral discharge, common cause of acute onset signs
Neoplasia - unilateral discharge, relatively common for middle-aged to older dog
Dental disease - unilateral discharge, relatively common or well-described. E.g. oronasal fistula.
Although biphasic defibrillators are preferred because of their greater efficiency to treat VF and pulseless VT than monophasic defibrillators. The same dose chart can be used for both types of defibrillators.
a) True
b) False
b) False
The best chest compressions during CPR produce about… % of cardiac output.
30%
After administration of the first low dose of adrenaline during CPR in a cat with a non-shockable rhythm, how long should you wait before giving another dose of a vasopressor?
a) 6 min
b) 4 min
c) Vasopressor therapy should not be repeated
d) 2 min
b) 4 min
