SASx Exam II Material - Reproductive

Question 1

T/F: Surgical excision is curative for ovarian cysts

Answer 1

True

Question 2

Pyometra can occur due to persistent __________ secretion from granulosa cell tumors of stromal origin

Answer 2

progesterone

Pyometra can occur due to persistent _progesterone_ secretion from granulosa cell tumors of stromal origin

Question 3

How is Ovarian Remnant Syndrome (ORS) diagnosed in the dog?

Answer 3

Vaginal cytology

• Mimics normal heat cycle
• Must be done in standing heat
• Vaginal cytology in cats is inconsistent

Question 4

With regard to Ovarian Remnant Syndrome (ORS), where should you look for the remnant?

Answer 4

caudal pole of kidney

• Remnant at caudal pole of kidney
  
  • Identification easier during estrus/diestrus
  • Follicles or corpora lutea present
• Proximity to ureter

Question 5

What are the indications for medical treatment for metritis?

Answer 5

Medical treatment is only indicated if all of the following are true:

• Valuable breeding animal
• Good response to initial therapy
• No devitalized tissue/retained placenta or fetus

Otherwise, surgical exploration is indicated

Question 6

Ovarian neoplasia is most commonly of ________ or ________ origin

Answer 6

Ovarian neoplasia is most commonly of epithelial or stromal origin

• Epithelial: adenoma or adenocarcinoma
• Stromal: granulosa cell tumor
  
  • Usually functional – estrogen, progesterone, both
  • Pyometra with persistent progesterone

Question 7

T/F: With regard to ovarian neoplasia, metastatic disease is fairly uncommon in dogs

Answer 7

True

Metastatic disease is much more common in cats

Question 8

What is the most common bacteria that you will see associated with pyometra?

Answer 8

E. coli

Question 9

Which of the following sets of clinical signs would be most typical of a case of pyometra?

• Palpable uterus, fever, anemia, neutropenia, lymphocytosis
• Palpable uterus, fever, eosinophilia, neutrophilia, azotemia
• Palpable uterus, anemia, polyuria, neutrophilia with left shift
• Palpable uterus, vomiting, pulmonary congestion, anuria

Answer 9

Palpable uterus, anemia, polyuria, neutrophilia with left shift

Question 10

What is the treatment protocol for closed pyometra in a dog?

• Immediate ovariohysterectomy - this is a surgical emergency, like GDV
• Ovariohysterectomy within a few hours, after rehydration, IV antibiotic therapy and sometimes blood transfusion.
• Drainage of the uterine contents by catheterization per vagina, antibiotics, ovariohysterectomy when the patient is healthy
• Evacuation of uterine contents with prostaglandin therapy, antibiotics, ovariohysterectomy when the patient is healthy
• Replacement of fluid deficits, IV antibiotics for 2 days followed by oral antibiotics for 2 weeks - the dog should be bred at the next estrus to prevent recurrence

Answer 10

Ovariohysterectomy within a few hours, after rehydration, IV antibiotic therapy and sometimes blood transfusion.​

Question 11

T/F: OHE does not affect milk production

Answer 11

True

Milk production is based on prolactin, which is produced by pituitary, so spaying a dog has no effect on milk production

Question 12

T/F: What are the anatomical indications for an episiotomy approach?

Answer 12

vestibular and vaginal lesions

• Incision limited dorsally due to rectum​
• Position for perineal surgery
• Incise on midline from vulvar opening
• Moderate hemorrhage
  
  • Electrocautery
  • Noncrushing clamps
• Close in 3 layers

Question 13

This is a surgical procedure used to open the vulvar orifice to allow access to the vestibule and caudal vagina:

Answer 13

episiotomy

Question 14

T/F: Vaginal tumors are most common in young, large-breed dogs in estrus

Answer 14

False

• Most common in older, intact female dogs
  
  • > 10 years old
  • Intact suggests hormonal influence

Question 15

What is the most common vaginal neoplasia in dogs?

Answer 15

leiomyoma (LMO)

• Most masses (80%) are benign
  
  • Leiomyoma (LMO) most common
  • Fibroma, polyp, cyst
• Masses usually pedunculated, intraluminal
• Excisional biopsy via episiotomy
• Full-thickness resection at base
• Electrocautery highly recommended

Question 16

What is the most common malignant vaginal tumor in dogs?

Answer 16

leiomyosarcoma

• Leiomyosarcoma most common malignancy
  
  • Relatively low risk of metastasis
  • Locally invasive
• Aggressive resection necessary
• Vulvovaginectomy
• Also requires perineal urethrostomy

Question 17

What is the most common neoplasm in intact female dogs?

Answer 17

canine mammary tumors

• Most common neoplasm in intact female dogs
  
  • 70% of all tumors (benign and malignant)
  • Median age at presentation is 7-11 years
• Mammary tumors reported in males
  
  • Extremely rare
  • When seen, tend to be benign
  • This is different from the situation in cats

Question 18

What breed of dog is presdisposed to developing malignant mammary tumors?

Answer 18

German Shepherds

Question 19

A dog is brought to you with mammary tumors of the 3^rd, 4^th and 5^th glands in the left chain. There is no evidence of metastasis. What surgery is indicated?

• Lumpectomy of each mass
• Local mastectomy – removal of each gland as well as each mass
• Regional caudal mastectomy
• Full left chain mastectomy

Answer 19

Regional caudal mastectomy

Question 20

Bilateral full-chain mastectomy in the dog is not usually recommended. Why?

• Blood loss is excessive.
• Length of procedure results in high risk of infection.
• Closure of the resulting wound may be difficult or impossible.
• Mammary tumors are usually benign, so an extensive surgery is not indicated.
• The prognosis for dogs with bilateral tumors is very poor.

Answer 20

Closure of the resulting wound may be difficult or impossible​

Question 21

What are the most common sites of metastasis for canine mammary tumors (CMT)?

Answer 21

Lung, Bone, Kidney, Spleen, Liver, Distant lymph node

Question 22

Ovariohysterectomy is most effective in reducing the incidence of mammary tumors in the dog if done:

• Before the first estrus cycle
• Between the first and second estrus cycles
• After the dog has whelped 1 litter
• As soon as possible after diagnosis of a mammary tumor

Answer 22

Before the first estrus cycle​

• OHE before 2 years of age reduces risk
  
  • 0.5% risk if spayed before 1st estrus
  • 8% risk if spayed between 1st and 2nd cycle
  • 26% risk if spayed after 2nd but before 2 y/o

Question 23

T/F: Surgical treatment is recommended for inflammatory carcinoma

Answer 23

False

• Suspicion based on clinical signs, rapid progression
• Usually metastatic – depends on duration
• Median survival < 1 month
• Treatment
  
  • NSAID may improve survival
  • Surgical treatment not recommended

Question 24

T/F: Mammary tumors are more common in the cat than the dog

Answer 24

False

Question 25

Which of the following is true? **Mammary tumors** in the cat: * Are usually (\>80%) adenocarcinoma * Are most common in the 5^th pair of mammae * Are often diagnosed in cats between 2-4 years of age * Are effectively treated by simple excision (lumpectomy) in most cases

Answer 25

**Are usually (\>80%) adenocarcinoma​**

Question 26

You have a cat with a **mammary tumor** on the left 3rd mammae. T/F: Simple mastectomy is indicated in this cat

Answer 26

**False** *For any mammary tumor in cats, chain mastectomy should be done on the affected side (regardless of tumor size, number)*

Question 27

What's going on with these weird cat boobs?

Answer 27

**fibroadenomatous hyperplasia** * *Benign lesion* * *Usually occurs in young (\< 2 year old) cats* * *Progesterone-dependent* * *During first estrus cycle* * *Pregnancy/pseudopregnancy* * *Reported in older and male cats* * *Complicated by trauma, infection, necrosis* * *Treatment* * *OVH/OVE* * *Flank approach recommended* * *Condition resolves over weeks to months* * *Resect of tissues that do not regress after spay*

Question 28

At what age do the testicles usually descend in dogs?

Answer 28

**30-40 days** *Diagnosis of cryptorchidism can be made after 6 months*

Question 29

You are treating an 8 month old Shar pei with a firm, non-reducible, painful, cordlike swelling extending from the inguinal region to the scrotum. The tissues have bluish-black appearance. The most likely diagnosis is? * Testicular torsion * Brucellosis * Scrotal hernia * Prepubic tendon rupture * Seminoma

Answer 29

**Testicular torsion​** * *More common with abdominal testicles* * *Clinical signs variable* * *Mild signs (anorexia, lethargy)* * *Acute abdomen (marked pain, shock)* * *Diagnosis by ultrasound, palpation* * *Condition fatal without surgical treatment* * *Prognosis good with surgery*

Question 30

Hyperestrogenism is a common paraneoplastic syndrome seen with **sertoli cell tumors**. What is the clinical significance of this to the patient?

Answer 30

**Bone marrow suppression may be irreversible and determines prognosis**

Question 31

T/F: **Vasectomy** has no effect on testosterone

Answer 31

**True** * *No change in testosterone-dependent disease* * *Perineal hernia* * *Perianal adenoma* * *Prostatic disease* * *No change in secondary characteristics* * *Urine odor* * *Roaming* * *Agression* * *May be helpful in controlling feral populations*

Question 32

Incomplete formation of the penile urethra is termed:

Answer 32

**hypospadias** * *Most common developmental anomaly of the external male genitalia* * *Most common in Boston Terriers* * *Signs depend upon location* * *Minimal signs* * *Urine scalding*

Question 33

How do you treat **hypospadias**?

Answer 33

**Urethrostomy proximal to the abnormality** *Excision of exposed mucosa, penile remnants*

Question 34

Inability to retract the penis into the prepuce is termed:

Answer 34

**paraphimosis** * *Congenital causes* * *Narrowed orifice* * *Shortened prepuce* * *Acquired causes* * *Trauma* * *Infection* * *Priapism*

Question 35

How do you treat this condition in the dog?

Answer 35

**amputate the penis**

Question 36

What procedure is shown below?

Answer 36

**penile amputation**

Question 37

What is the most common neoplasia in the prepuce?

Answer 37

**mast cell tumor (MCT)** *more malignant than other sites*

Question 38

Which of these prostatic diseases is seen in castrated as well as intact dogs? * Benign prostatic hypertrophy * Prostatic abscess * Prostatic neoplasia * None – all are diseases of intact dogs

Answer 38

**Prostatic neoplasia​**

Question 39

What is the most common organism associated with **prostatic abscess**?

Answer 39

***E. coli*** * *Prostatic abscess/prostatitis* * *Ascending infection from the urethra* * *E.coli most common organism* * *Middle-aged to older intact dogs* * *Pre-existing BPH required* * *Clinical signs due to prostatomegaly, infection*

Question 40

What is the surgical treatment of choice for **prostatitis**?

Answer 40

**exploratory laparotomy and _omentalization_** * *Omentalization consistently successful* * *Fewer complications vs. other techniques* * *Shorter hospitalization vs. other techniques* * *Recurrence if loculations not properly broken down* * *Same for treatment of benign prostatic hypertrophy*

Question 41

T/F: With regard to **prostatic neoplasia**, castration is neither palliative nor protective

Answer 41

**True** * *Prostatic neoplasia* * *Usually malignant* * *Adenocarcinoma, various subtypes* * *80% have metastasis on necropsy* * *Similar to aggressive form of human disease* * *Effect of castration* * *Increased incidence* * *Increased risk of metastasis* * *Castration neither palliative nor protective*

Question 42

T/F: **Episiotomy** is commonly performed to facilitate removal of a fetus from the vagina in the dog or cat with dystocia.

Answer 42

**False**

Question 43

To which lymph node do these **mammary glands** drain?

Answer 43

**inguinal lymph node**