questions Flashcards
All the following except one are important surgical principles used to avoid impaired wound repair (select the INCORRECT technique/action which you would want to avoid). When debriding a wound:
Perform a thorough debridement and remove all foreign material
Be meticulous with hemostasis to avoid hematoma and seroma formation without compromising vascular supply
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
Minimize tension (mechanical stress) on wound edges
Minimize dead space
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
With regard to wound debridement, which is FALSE?
Autolytic wound debridement is accomplished by providing a moist wound environment, which allows wound fluid containing endogenous enzymes and growth factors to remain in contact with the wound
An advantage of biosurgical debridement (medicinal maggot application) is that when used appropriately it is capable of both removing necrotic tissue and stimulating granulation tissue formation
The use of scissors is preferred to scalpel during surgical debridement
Debridement may need to be staged, particularly in areas dense with vital structures and limited amount of overlying skin
The use of scissors is preferred to scalpel during surgical debridement (scalpel preferred!)
Which is TRUE regarding the development of wound healing complications?
Any degree of contamination with microorganisms will lead to development of chronic wound
Gentle tissue handling and meticulous surgical technique positively influence outcome in wound management
Wound contraction never leads to contracture
Geriatric patients and young puppies are equally susceptible to wound healing complications
Bandages and splints should always be avoided due to concern that they may compromise vascular supply
Gentle tissue handling and meticulous surgical technique positively influence outcome in wound management
Regarding epithelialization, which is FALSE?
In partial thickness wounds, the process begins almost immediately from wound margins and existing epidermal appendages
Is inhibited by a moist, sterile environment
Occurs along suture tracts and can cause/incite inflammatory reaction if sutures are not removed in an appropriate time frame
Is independent of wound contraction
Central scar epithelium is thinner and more fragile than normal epithelium
Is inhibited by a moist, sterile environment (epithelial migration facilitated by moist, sterile environment)
Which of the following is FALSE regarding epithelialization of wounds?
In partial thickness wounds, re-epithelialization may occur both from the wound edges as well as from existing epidermal appendages
Re-epithelialization is dependent on contraction
Epithelialization may occur along suture tracks with subsequent keratinization
Keratinocyte migration ceases due to contact inhibition
Re-epithelialization may be incomplete in large wounds
Re-epithelialization is dependent on contraction (epithelialization independent of contraction!)
Which is INCORRECT regarding angiogenesis during wound repair?
The earliest phase involves endothelial cell migration rather than cell division
It is initially stimulated by low oxygen tension
Capillary loops are initially open but are replaced by closed arcades
It is stimulated by a variety of cytokines including basic FGF and VEGF
Occurs in the epithelial layer
Occurs in the epithelial layer
With regard to wound strength and extracellular matrix deposition in the wound, which is FALSE?
The greatest change in wound strength occurs in the repair/proliferative phase
If given long enough (years), a wound will eventually attain preinjury strength
The ratio of Types III:I collagen decreases over time
Orientation of wound fibers is originally vertical but the orientation changes to horizontal in response to tension
The provisional wound matrix is comprised of fibrin, fibronectin, and hyaluronic acid
If given long enough (years), a wound will eventually attain preinjury strength
Which cell type is NOT found in granulation tissue?
Vascular endothelial cells
Myofibroblasts
Macrophages
Keratinocytes
Fibroblasts
Keratinocytes
Which of the following statements regarding granulation tissue is FALSE?
It protects the wound bed (provides coverage)
It provides a barrier for infection
It typically begins to appear approx 3-5 days post wounding
It appears as a thin, pale tan tissue in the wound
It provides a scaffold for epithelial cell (keratinocyte) migration
It appears as a thin, pale tan tissue in the wound (red, shiny, fleshy)
Which is INCORRECT regarding the inflammatory/debridement phase of wound repair>
Occurs after granulation tissue has filled the wound bed
Corresponds to the lag phase of wound repair
Macrophages, platelets, mast cells, and eosinophils are all cells that migrate into the wound bed during this phase and secrete substances which promote later angiogenesis during the repair process
Vasodilation follows initial vasoconstriction during the vascular phase
Macrophages play a central role in mediating cellular and biochemical responses in wound repair
Occurs after granulation tissue has filled the wound bed (inflammatory phase first)
Identify the TRUE statement regarding the inflammatory/debridement phase of wound repair:
Occurs after granulation tissue has filled the wound bed (happens first)
Macrophages play a central role in mediating cellular and biochemical responses in wound repair
Corresponds to the log phase of wound repair because of significant increase in wound strength attained during this phase (repair/proliferative phase = log phase)
Vasoconstriction follows initial vasodilation during the vascular phase (initial vasocontriction followed by vasodilation)
None of the above
Macrophages play a central role in mediating cellular and biochemical responses in wound repair
With respect to the hypodermis and cutaneous circulation, which of the following statements is true?
The cutaneous circulation in the dog is identical to that found in people
In areas of the body where the panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus
The middle and superficial plexi lie within the epidermis
Capillary loops of the subpapillary/superficial plexi are better developed in dogs and cats compared to primates and pigs
The hypodermis is considered the deepest layer of skin but does not contribute significantly to skin function
In areas of the body where the panniculus is present, the small animal surgeon must undermine the fascial plane beneath the cutaneous musculature to preserve the vital subdermal plexus (must go between the subdermal plexus/panniculus muscle and the underlying skeletal muscle)
All the following except one are important surgical principles used to avoid impaired wound repair (select the INCORRECT technique/action which you would want to avoid). When debriding a wound:
Perform a thorough debridement and remove all foreign material
Be meticulous with hemostasis to avoid hematoma and seroma formation without compromising vascular supply
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
Minimize tension (mechanical stress) on wound edges
Minimize dead space
Flushing with antiseptics may be used as a substitute for thorough debridement of wound
With regard to wound debridement, which is FALSE?
Autolytic wound debridement is accomplished by providing a moist wound environment, which allows wound fluid containing endogenous enzymes and growth factors to remain in contact with the wound
An advantage of biosurgical debridement (medicinal maggot application) is that when used appropriately it is capable of both removing necrotic tissue and stimulating granulation tissue formation
The use of scissors is preferred to scalpel during surgical debridement
Debridement may need to be staged, particularly in areas dense with vital structures and limited amount of overlying skin
A significant disadvantage of mechanical (bandage) debridement is that it traumatizes healthy tissue (is non-selective)
The use of scissors is preferred to scalpel during surgical debridement (scalpel preferred!)
A dog with a common bile duct obstruction that needs surgery:
a.
Should be anesthetized with drugs metabolized by the liver
b.
Requires only a complete blood count before the procedure
C.
Is not a candidate for general anesthesia
d. Should have coagulation screen before surgery
e. Should not be given vitamin K before surgery.
d. Should have coagulation screen before surgery
Preoperative Fasting:
a.
Should be initiated 2 hours before anesthesia
b.
Has not effect on respiration under anesthesia
C.
Increases the amount of acid in the stomach
d. Increases cranial esophageal sphincter tone- anesthesia decreases
tone sphincter btw esophagus and stomach relaxes under anesthesia
therefore if have food in stomach can reflux up into esophagus
e. Decreases the risk of reflux esophagitis
e. Decreases the risk of reflux esophagitis
Animal is admitted to your clinic with a mass of the left forelimb. The MOST
appropriate investigation of this animal before planning a definitive surgery
would include:
a.
Radiographs of the limb and lateral radiograph of thorax
b. Palpation of the mass and the local lymph nodes, opposite lateral
thoracic radiographs and biopsy of mass
C.
Radiograph of limbs and biopsy of mass
d.
CBC, biochem analysis and thoracic radiographs
e.
Need aspiration of mass and local lymph nodes
b. Palpation of the mass and the local lymph nodes, opposite lateral
thoracic radiographs and biopsy of mass
5) A ten year old dog is admitted to your clinic for mammary mass removal.
Which of the following is not an appropriate preoperative test or procedure:
a.Opposite lateral thoracic radiographs
b. Clipping the operative site 24 hours before surgery
c. A thorough physical exam including cardiac auscultation
d.Preoperative blood count and biochemical panel
e. Careful palpation of the regional lymph nodes
b. Clipping the operative site 24 hours before surgery
an animal is admitted with a mass on the rostral mandible. The most
appropriate investigation for this animal when planning for surgery would
include:
a. radiographs of the mandible and lateral and dorsoventral radiograph
of thorax
b. palpation of the mass and local lymph nodes, opposite lateral
thoracic radiographs and biopsy of mass
C.radiographs of mandible and biopsy of mass
d. a cbc, biochem analysis and thoracic radiographs
e.needle aspiration of the mass and local lymph node
b. palpation of the mass and local lymph nodes, opposite lateral
thoracic radiographs and biopsy of mass
12) in which animal are perioperative antibiotics NOT indicated?
a. A dog with a pyometra
b. A dog having surgery that will likely involve opening the intestine
C. A dog have exploratory surgery for peritonitis
d. A dog being castrated
e. A dog having a total hip replacement
d. A dog being castrated
which of the following is not a reasonable, frequently used objective
indication of tissue perfusion:
a. mucous membrane color, capillary refill time
b.
urine output
C.
arterial blood pressure
d. partial pressure of oxygen in the blood (Pa02)
e.
serum lactate levels
d. partial pressure of oxygen in the blood (Pa02)
Tracheostomy care should include all of the following except
a. Hydration using IV fluids
b. Routine suction
c. Nebulization
d. Cleaning the inner canula of the tracheostomy tube
e.
None of the above
b. Routine suction
Indicate which is false: Dogs with Tracheostomy tube in place should:
a.
Be put on intravenous fluids to maintain hydration
b.
Have tracheostomy tube with an inner cannula
C.
Have the tube suctioned frequently
d.
Be nebulized at the tracheostomy site
e.
Be observed frequently for signs of respiratory obstruction of
difficulty
C.
Have the tube suctioned frequently
which of the following statements about post op management of the surgical
patient is correct?
a. In case of potential postoperative hemorrhage the peripheral packed
cell volume (PCV) fall early
b.
Aspiration pneumonia should be anticipated as a potential
complication is dogs with GDV or laryngeal paralysis
C.
Larger dogs are more likely to loose body heat than smaller animals
because of their larger surface area (false->smaller dogs more likely
to loos body heat)
d.
Gas exchange in thoracotomy patients is generally better in the post
op period because of the beneficial effects and intraoperative
ventilations
b.
Aspiration pneumonia should be anticipated as a potential
complication is dogs with GDV or laryngeal paralysis
all the following statements about the post-operative thoracotomy patient
are true except:
a. pulse ox monitors the concentration of o2 dissolved in plasma and
provides useful info on gas exchange
b.
oxygen supplementation may be provided by nasal catheters
C.
posteroperative hypothermia is more of a concern in smaller dogs
d
atelectasis may impar gas exvhage postoperatively
e. and epidural anesthetic may help to miminze pain at recovery
a. pulse ox monitors the concentration of o2 dissolved in plasma and
provides useful info on gas exchange
11) All of the following statements about the post-op thoracotomy patient are
true except:
a. a pulse ox monitors the concentration of oxygen dissolved in the
plasma and provides useful infor on has exchange
b.
oxygen supplementation may be provided by nasal catheters
C.
postoperative hypothermia is more of a concern in smaller dogs
d.
atelectiasis my impair gas exchange postoperatives
e.
an epidural anesthetic may help minimize pain at recovery
a. a pulse ox monitors the concentration of oxygen dissolved in the
plasma and provides useful infor on has exchange
All of the following may be indicated in a dog with post-op pneumonia
except:
a.
nebulization
b. coupage
C.
a trans-tracheal wash to obtain material for culture and sensitivity
d.
coticosteriods to reduce inflammation
e
supplemental oxygen
d.
coticosteriods to reduce inflammation
Which of the following statements about postoperative thoracotomy patient
is FALSE
a. Ventilation may be depressed by pneumothorax
b. Intercostal never blocks with bupivicain can provide substantial pain
relief
C.
Decrease chest wall movement most op can cause atelectasis
d. Hypoventiliation is indicated when aerial CO2 is decreased
e.
In ventilation perfusion mismatch, the co2 level is normal and the 02
level is low.
d. Hypoventiliation is indicated when aerial CO2 is decreased
___ blood with a ___ PCV on post op may indicate an
ongoing hemorrhage
non-clotting
high
___ drugs have effect on auto
regulation of renal blood flow
NSAID
which of the following statements about post operative management of the
surgical patient is FALSE:
a. it is unlikely that a dog will require intravenous fluids after recovering
from a routine spay
b.
a dog with a proximal duodenal obstruction is likely to lose
hydrochloric acid when vomiting postoperatively; this should be
replaced with normal saline supplemented with postassium
C.
electrical blankets for warming dogs and cats may cause thermal
injury
d. serum lactate measurement is not a reasonable, obiective
measurement of tissue perfusion
e.
none of the above
d. serum lactate measurement is not a reasonable, obiective
measurement of tissue perfusion
which of the following statements about hemostasis is TRUE:
a.
a lack of von Willebrand’s affects secondary hemostasis (affects primary)
b.
a buccal mucosal bleeding time is a useful test in dogs of having
suspected von Willebrand’s disease
C. a lack of von Willebrand’s factor prevents fibrin from stabilizing the
platelet plug (WF important for platelet adherence)
d.
thromboxane stimulate the release of thrombin from platelets
(thromboxane stimulates further platelet aggregation)
e
aspirin interferes with secondary hemostasis (primary hemostasis,
platelets do not produce thromboxane)
b.
a buccal mucosal bleeding time is a useful test in dogs of having
suspected von Willebrand’s disease
which of the following statements about hemostasis is FALSE:
d.
A large artery (i.e a renal artery) should be ligated with a transfixation
suture
Small arteries can be clamped and then ligated using hand ties
C.
Clips are less secure method of hemostasis then vessel ligation
d.
A “one clamp” technique is appropriate method for ligating the
ovarian pedicle in a large dog
e.
Large vessels (i.e vena cava) can be temporarily occluded with
Rummel tourniquets
d.
A “one clamp” technique is appropriate method for ligating the
ovarian pedicle in a large dog (“(“3 clamp method”)
14) The initial platelet plug:
a. requires factor XII for the platelets to adhere to the underlying
exposed collagen
b.
releases prostacyclin that dilates the damaged blood vessel
preventing vascular occlusion
C.
is stabilized by the deposition of fibrin
d. release thromboxane even if the animal has been pretreated with
aspirin
e.
releases thromboplastin to initiate the extrinsic clotting cascade.
C.
is stabilized by the deposition of fibrin
A hamster suffers a splenic laceration and the bleeding is uncontrollable. You proceed to perform a procedure in which you opened the abdominal cavity, removed the spleen, and repaired an umbilical hernia that had been present since birth. On your surgery report, you write you performed (in order) 3 correctly termed surgical procedures.
Laparotomy
Splenectomy
Umbilical herniorrhaphy
You have surgically treated an Irish setter with a gastric dilation volvulus. In order to prevent recurrence of the volvulus, you want to fix the stomach to the body wall. The surgery would be termed a:
Gastropexy
Which of the following sutures has the most memory?
Polyester
Polypropylene
Polyglactin 910
Caprolactam
Polypropylene
What is the chemical used in “gas sterilizing”?
Ethylene oxide
