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SA Surgical Diseases and Techniques > Midterm Two > Flashcards

Midterm Two Flashcards

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1
Q

What are some techniques that can be used for gentle handling of skin flaps?

A

(Skin hooks and stay sutures)

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2
Q

What are wound characteristics that should be considered when planning reconstruction?

A

(Size, shape and location)

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3
Q

What are patient factors that should be considered when planning reconstruction?

A

(Species and breed, age, temperament, comorbidities)

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4
Q

What structures provide blood supply to the skin?

A

(Direct cutaneous artery and vein and the subdermal plexus)

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5
Q

What is mechanical creep, a characteristic of skin?

A

(The tendency of skin to elongate when a constant load is applied, can happen fairly quickly and allow you to close a large defect in surgery)

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6
Q

If you cannot distinguish between different muscle layers when undermining to relieve tension in a reconstructive surgery, what layer should you undermine to?

A

(The closest muscle fascia)

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7
Q

What are some tension-relieving suture pattern options?

A

(Cruciate, far-near-near-far, far-far-near-near, and both mattresses)

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8
Q

Should the bites taken for walking sutures, used for tension relief, be parallel or perpendicular to the direction of pull/tension?

A

(Parallel)

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9
Q

What are the usual culprits for reconstruction complications?

A

(Necrosis, dehiscence, seromas, and infection)

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10
Q

One of the factors that contributes to reconstruction complications is compromised blood supply, how can this occur?

A

(Vasculature became obstructed in the surgery and/or inappropriate bandage pressures)

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11
Q

Should you use cooling or warming therapies on reconstructive surgical sites?

A

(Cooling no, heating yes because it will encourage blood flow)

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12
Q

Which muscles open the larynx?

A

(Cricoarytenoid muscles)

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13
Q

Which nerve innervates the muscles that opens the larynx?

A

(The recurrent laryngeal nerve innervates the cricoarytenoid muscles)

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14
Q

What are the four laryngeal cartilages?

A

(Epiglottic, arytenoid, thyroid, and cricoid)

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15
Q

Why is the larynx important?

A

(Prevents aspiration, controls airway resistance, and produces voice)

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16
Q

What nerve is the origin of the nerve that innervates the muscles that opens the larynx?

A

(The vagus nerve gives rise to the recurrent laryngeal nerve which innervates the cricoarytenoid muscles)

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17
Q

Contraction/relaxation (choose) of the cricoarytenoideus dorsalis muscle opens the arytenoid cartilages.

A

(Contraction)

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18
Q

What is the primary way to distinguish between congenital and acquired laryngeal paralysis?

A

(Age of onset, congenital < 1 year of age, acquired median is 9)

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19
Q

Laryngeal paralysis is associated with an inspiratory/expiratory (choose) stertor/stridor (choose).

A

(Inspiratory stridor)

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20
Q

What are the early signs of laryngeal paralysis?

A

(Voice change and gagging/coughing when eating or drinking)

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21
Q

Why would you test T4/TSH in a dog with suspect laryngeal paralysis?

A

(Hypothyroidism has been associated with laryngeal paralysis> endocrine polyneuropathy)

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22
Q

(T/F) If a dog with laryngeal paralysis has aspiration pneumonia, it is particularly important to get them to surgery as soon as possible so they will no longer keep aspirating when eating/drinking.

A

(F, should address the aspiration pneumonia prior to going to sx)

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23
Q

Why would you avoid giving a laryngeal paralysis patient hydromorphone in their anesthesia protocol?

A

(Causes panting and if you want to get a good look at the larynx before intubation, panting ain’t gonna help)

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24
Q

What does medical management of laryngeal paralysis entail and what type of patients can it be pursued for, though surgery is inevitable?

A

(Patient should be asymptomatic at rest/only mildly affected, medical management includes weight loss, stress reduction, exercise restriction, and avoidance of high temps; surgery is inevitable bc dz is progressive)

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25
What is the goal of surgical correction of laryngeal paralysis?
(Decrease airway resistance)
26
Why is the risk for aspiration pneumonia much higher post surgical correction of laryngeal paralysis?
(Bc the standard technique is an arytenoid lateralization which permanently opens the larynx)
27
The standard approach for an arytenoid lateralization is a left/right (choose) lateral cervical approach.
(Left)
28
The incision you make for an arytenoid lateralization is made parallel/perpendicular (choose) and ventral/dorsal (choose) to the jugular vein.
(Parallel and ventral)
29
Which of the following is a sound suture, suture size, and needle choice for an arytenoid lateralization in a dog? Trust me, there is actually a correct answer in the choices. A - 2-0, polypropylene, reverse cutting needle B - 3-0, polypropylene, taper needle C - 2-0, polyglactin 910, taper needle D - 3-0, polyglactin 910, reverse cutting needle E - 2-0, polypropylene, taper needle F - None of the above :) G - All of the above :)
(E)
30
What do you need to be careful of when making your first suture pass through the dorsal crest of the cricoid cartilage?
(Check the ET tube, don’t wanna suture that bitch in there)
31
What are potential complications of arytenoid lateralization?
(Aspiration pneumonia, persistent signs (coughing, gagging, stridor), suture failure, and cartilage fracture)
32
What characteristics are associated with congenital brachycephalic airway syndrome?
(Stenotic nares, aberrant turbinates, soft palate elongation and hyperplasia, and tracheal hypoplasia)
33
What conditions typically occur secondarily to brachycephalic airway syndrome?
(Everted laryngeal saccules, laryngeal collapse, mucosal edema, and gastroesophageal reflux)
34
Why types of medications and give an example of each can be used if a BAS patient has GI signs (vomiting, regurg)?
(Gastric acid reducers → H2 blockers, PPIs and prokinetics → metoclopramide and cisapride)
35
For an obstructive nares alaplasty, you want to close with an absorbable monofilament suture, what type of suture is the best choice?
(Monocryl, PDS sticks around for too long)
36
What procedure can be performed to correct aberrant turbinates?
(Turbinectomy → resection of malformed obstructive conchae in ventral and medial nasal turbinates, decreases intranasal airway resistance, unknown if it really helps)
37
Pair the stage of laryngeal collapse to the appropriate abnormality: Stage I A - Medial displacement of cuneiform process B - Laryngeal saccule eversion C - Collapse of corniculate process
(B)
38
Pair the stage of laryngeal collapse to the appropriate abnormality: Stage II A - Medial displacement of cuneiform process B - Laryngeal saccule eversion C - Collapse of corniculate process
(A)
39
Pair the stage of laryngeal collapse to the appropriate abnormality: Stage III A - Medial displacement of cuneiform process B - Laryngeal saccule eversion C - Collapse of corniculate process
(C)
40
How does indirect diaphragmatic injury occur?
(An acute increase in intra-abdominal pressure causes rupture of the diaphragm)
41
Where do diaphragmatic ruptures most commonly occur?
(At its attachments to the ribs)
42
What organ most commonly herniates through diaphragmatic tears?
(Liver)
43
What are some clinical signs associated with diaphragmatic trauma/hernias?
(Dyspnea, signs of hypovolemic shock, GI signs, lethargy, difficulty lying down, or no clinical signs at all)
44
What are some changes you might see on a physical exam of a patient with diaphragmatic trauma/herniation?
(Muffled heart and lungs sounds, thoracic borborygmi, a tucked up abdomen, or the physical exam can be entirely normal)
45
What are some things that you look for on a thoracic radiograph to try and identify diaphragmatic trauma/herniation?
(Loss of diaphragmatic outline, abdominal viscera in thorax, obscured/displaced cardiac shadow, and excessively cranial pylorus/duodenum)
46
What are some reasons to not wait to stabilize a patient prior to surgery if you suspect a diaphragmatic injury?
(If the patient experiences persistent deterioration despite appropriate management, the stomach is involved in the herniation and there is tympany, and if there is persistent abdominal pain (indicates strangulation))
47
Inspiratory pressures should not exceed what value while a patient with diaphragmatic trauma is undergoing surgery?
(20 cmH20, can cause inflation injury if greater than that)
48
Why should you use a simple continuous pattern when fixing a defect in the diaphragm?
(It will minimize time under anesthesia)
49
What are possible sequela of chronic adhesion dissection in diaphragmatic trauma/hernia cases?
(Hemorrhage and/or pulmonary air leak (if lung was involved))
50
Acute re-expansion of chronically atelectatic lungs can lead to what complications?
(Reperfusion injury and pulmonary edema)
51
How can you prevent re-expansion injury?
(Keep airway pressures under 20 cmH20 during sx, do not force inflate atelectatic lung lobes, do not completely re-establish negative intrathoracic pressure during closure, and reduce pneumothoraxes slowly over 8-10 hours)
52
What is loss of domain?
(Chronic absence of viscera from the abdomen → no space for herniated organs, will need to remove an organ, advance the diaphragm or reconstruct the abdominal wall to prevent having to force close the abdomen and risk excessive intra-abdominal pressure)
53
What is the force that pulls fractured pieces away from each other?
(Distraction)
54
What were the issues with the first widely adopted fracture fixing principles that came from the AO that was leading to high rates of nonunion and post surgical infections?
(Too much emphasis on mechanics and neglecting both the soft tissues (main blood supply to early healing fracture) and the bone)
55
What are the main disadvantages to using non-locking plates for fracture repairs?
(Relies on bone to plate friction (damages periosteum where plate touches) and the screws need to penetrate two cortexes (destroys periosteum and endosteum on both sides))
56
What are the main fracture healing concepts that are currently used that resulted from the incorrect principles put in place by the AO?
(Preservation of blood supply is very important so instead of focusing on anatomic reduction and killing the blood supply, just need to make sure there is appropriate alignment between the joint above and below; soft tissue damage should also be minimal)
57
(T/F) The use of plates in fixing fractures can neutralize all of the forces working on that fracture.
(T)
58
What is the difference between segmental and comminuted fractures?
(Both mean the bone is broken in more than one site (there are more than two pieces of bone), fracture lines do not intersect in segmental fractures whereas the fracture lines do intersect with comminuted fractures)
59
Plates placed to fix fractures should be placed on the side of the bone under tension/compression (choose) force.
(Tension)
60
What are the disadvantages to monocortical locking? Two answers.
(Compromises torsional stability and risk of screw pullout (particularly in thin cortices such as the metaphysis))
61
What are the advantages of monocortical locking?
(Reduced vascular damage and versatility (can use multiple plates and rods with monocortical, cannot do this with a screw that goes through both cortices))
62
The stress on a fracture is the inverse of the unit area that force is applied so as you increase the unit area that force is applied, the stress on the fracture will decrease (stress = force/unit area). How can that information be used in a fracture fix?
(Including a rod with a plate will increase the unit area that force is spread over and prevent failure at the weakest portion of the plate)
63
Why is your goal of a fracture fix (in which you use a plate and screws) to place a screw as close to the fracture line(s) as possible?
(Because minimizing change in length decreases the strain on the fracture (remember the equation strain = change in length/original length))
64
Do you want to increase or decrease the bending moment of a fracture?
(Decrease)
65
How is the bending moment of a fracture repair decreased most commonly?
(Placing a rod, this decreases the distance from the force applied to the limb to the implant which will decrease bending moment (remember the equation bending moment = force x distance, force is weight of animal, distance is force to implant, cannot change force so must change distance))
66
Where does the cranial cruciate ligament originate?
(Intercondylar fossa on the caudomedial aspect of the lateral femoral condyle)
67
Where does the cranial cruciate ligament insert?
(Runs distal and cranial to insert on the intercondylar area of the tibia)
68
Where does the caudal cruciate ligament originate?
(Intercondylar fossa of the medial femoral condyle (cranial in the stifle joint))
69
Where does the caudal cruciate ligament insert?
(Runs distal and caudal to insert on the lateral edge of the popliteal notch of the tibia)
70
(T/F) Unlike human ACL tears which are related primarily to injuries, cranial cruciate ligament rupture is a degenerative process in dogs.
(T)
71
What are the purposes of the cruciate ligaments?
(Limit cranial translation of the tibia with respect to the femur, prevent hyperextension of the stifle joint, limits internal rotation of the tibia, varus-valgus support when the stifle is flexed, and provide proprioceptive feedback to prevent excessive flexion/extension)
72
What muscles’ tendons form the medial crural fascia?
(Caudal belly of the sartorius m, gracilis m, and semitendinosus m)
73
What are the two functions of the medial crural fascia?
(Stifle flexion and internal rotation)
74
What muscle externally rotates the stifle?
(Biceps femoris)
75
Are the CCLs, menisci, and collateral ligaments of the stifle passive or active restraints?
(Passive, muscles are active restraints)
76
What hindlimb conformation is particularly over represented in CCL tears?
(Hyperextended stifles combined with internally rotated tibia)
77
Pair the following history with the more likely diagnosis: Sudden onset non-weight bearing lameness followed by improvement (may not improve if there is a concurrent meniscal injury) A - Acute injury B - Chronic injury C - Partial tear
(A)
78
Pair the following history with the more likely diagnosis: Prolonged weight-bearing lameness, difficulty rising and sitting, sit with the affected limb out to the side of the body A - Acute injury B - Chronic injury C - Partial tear
(B)
79
Pair the following history with the more likely diagnosis: Mild weight bearing lameness associated with exercise, may resolve with rest, may last for months A - Acute injury B - Chronic injury C - Partial tear
(C)
80
If a dog fails a sit test (one leg hiked out with the tuber ischii and tuber calcaneus not lined up), what is a differential besides CCL rupture?
(Tarsal injury)
81
(T/F) Cranial drawer tests can only diagnose complete CCL tears, whereas tibial thrust can diagnose both complete and partial tears.
(F, cranial drawer test can diagnose both partial and complete tears whereas tibial thrust can only diagnose complete tears)
82
What is the normal amount of movement in an adult dog's stifle when performing a cranial drawer test?
(0-2 mm)
83
You’re performing a cranial drawer motion test on a 6 month old rottweiler after acute onset lameness was noted by the owner, you get about 4 mm of cranial motion of the tibia with an obvious stopping point, does this animal have a CCL tear?
(No, normal for immature dogs to have 4-5 mm of motion, should come to an abrupt stop)
84
How can you distinguish between a partial and complete tear using the cranial drawer test?
(Partial tear → no cranial drawer in extension, positive drawer in flexion; complete tear → positive drawer in both extension and flexion)
85
What should you feel in a CCL rupture stifle when performing a tibial thrust test?
(Cranial advancement of the tibial crest as the hock is flexed)
86
Joint effusion in CCL cases usually translates to what radiographic presentation?
(Cranial compression of the fat pad)
87
Where do periarticular osteophytes develop in CCL tear stifles?
(Trochlear ridge, caudal tibial plateau, and distal pole of the patella)
88
When is arthrocentesis indicated in suspect CCL rupture cases?
(When joint palpation and radiographs are inconclusive)
89
What medication inhibits collagenase activity and other metalloproteinases and therefore reduces the severity of osteoarthritis?
(Doxycycline → dog who might have been treated with doxycycline might not have as bad OA)
90
What might you see on arthrocentesis of a stifle with a suspect CCL tear?
(Anticollagen antibodies and immune complexes, non-inflammatory arthropathy (WBC < 5000), lymphoplasmacytic synovitis, and elevated collagenase (which are produced by cartilage cells)
91
Why is the medial meniscus more commonly injured in CCL tear cases?
(Bc it is attached to the tibial plateau and does not move with the femur so the caudal pole of the medial meniscus gets wedged between the medial femoral condyle and the tibial plateau; lateral is more mobile and has a femoral attachment so it moves out of the way (can still happen though))
92
What type of tear in the menisci most commonly occurs in association with CCL tears?
(Bucket handle/longitudinal tear in the caudal body)
93
(T/F) Progressive osteoarthritis occurs after CCL rupture regardless of treatment method pursued.
(T)
94
The basis behind a TPLO is converting what type of force associated with CCL tears into compressive force?
(Shearing force → by making the angle of the tibial plateau close to 0, it converts the previously shearing force between the femur and the tibia into compressive force)
95
(T/F) TPLOs move the tibial plateau to meet the forces whereas TTAs move the forces to meet the plateau.
(T)
96
Is a narrow or wide proximal tibia appropriate for a TTA?
(Narrow, TPLO is better suited for wide proximal tibias)
97
Can a TPLO or TTA fix varus/valgus deformities?
(TPLO)

SA Surgical Diseases and Techniques (3 decks)

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