SASx Final Exam - Thoracic/Respiratory Flashcards
1
Q
Lung lobe torsion is a rare condition resulting in rotation of the lung lobe on its hilus. In what types of dogs do we typically see this?
A
large, deep chested dogs and pugs
- Large dogs: right middle or left cranial lung lobe
- Pugs: left cranial lung lobe
2
Q
T/F: When surgically repairing a perineal hernia in an intact male dog, it is recommended to castrate at the time of repair
A
True
Testosterone may be a predisposing cause for perineal hernias. (Recurrence is 2.7x greater in intact dogs)
3
Q
This surgical approach to the thoracic cavity allows access to thoracic cavity during celiotomy. It may be used in thoracic duct ligation, surgery of the caudal esophagus, intra-operative CPR/cardiac massage, etc.
A
transdiaphragmatic
4
Q
T/F: Radiography is the gold standard for diagnosis of tracheal collapse
A
False
Tracheoscopy is the gold standard for diagnosis of tracheal collapse
Radiographs can help rule in or rule out tracheal collapse by showing signs for other causes of cough
5
Q
When is surgical intervention indicated in the case of tracheal trauma?
A
- When dyspnea persists or worsens with medical management
- If pneumothorax persists > 2-3 days
- Severe tracheal damage is visible
6
Q
When performing surgery to repair a hernia, what type of suture is typically used?
A
Monofilament, prolonged absorbable or non- absorbable suture
PDS or Prolene
7
Q
T/F: Lung lobectomy (for treatment of lung lobe torsion) is associated with a good prognosis
A
kind of true?
good prognosis in pugs; fair to guarded for other breeds
8
Q
What breed of dog is overrepresented in the case of hypoplastic trachea with brachycephalic airway syndrome (BAS)?
A
English bulldog
9
Q
How do you diagnose chylothorax?
A
cytologic evaluation of pleural effusion
- Modified transudate, lymphocytic effusion
- Triglycerides in fluid will be higher than in the serum
- Cholesterol in fluid will be lower than in the serum
10
Q
________ is the most commonly herniated organ
A
liver
11
Q
Which component of brachycephalic airway syndrome (BAS) is typically associated with a poorer prognosis?
A
n/a
There is no single component of BAS associated with poorer outcome
12
Q
Which of these images shows an actual animal?
A
Nice job!
13
Q
For diagnosis of lung lobe torsion, what would you expect to see on thoracocentesis?
A
serosanguineous or chylous effusion
rarely see evidence of sepsis (bacteria) unless there’s some other secondary problem
14
Q
What surgical approach is indicated for bilateral thoracic exploration, cranial mediastinal masses, or surgery of the cranial thoracic trachea?
A
median sternotomy
Important to stay midline with this approach to avoid the internal thoracic arteries on either side of the sternebrae
15
Q
The major risk associated with nasal surgery is hemorrhage. What arteries should you be aware of in this region?
A
dorsal, lateral, and major palatine arteries
Other risks and complications include (but are not limited to) flap necrosis, oronasal fistula, dehiscence, stenosis of airways, incomplete resection/local recurrence (for neoplasia)
16
Q
T/F: Surgery is considered an emergency if the stomach is herniated
A
True
17
Q
T/F: The prognosis associated with permanent tracheostomy is generally good for dogs and cats if the underlying disease is a benign process
A
False
- Prognosis is generally good for dogs if the underlying disease is a benign process.
-
Prognosis is guarded to poor for cats!!
- Mucus plugs very common leading to acute death
- Median survival time ranges from 20-42 days
-
Soft tracheal cartilage may predispose trachea to collapse
- Consider placement of external rings adjacent to tracheostomy site
18
Q
When anesthetizing patients for diagnosis of brachycephalic airway syndrome (BAS), it is important to avoid drugs that affect laryngeal function. Name a few to avoid:
A
- Ketamine
- Diazepam (and maybe Midazolam)
- Large doses of pure µ agonists
19
Q
There are many known causes of chylothorax, but ________ is most common
A
idiopathic
20
Q
What is the maximum lung mass (%) that can be acutely removed without being fatal?
A
65%
21
Q
The treatment of choice for lung lobe torsion is:
A
lung lobectomy
This is pretty much the only treatment for lung lobe torsion
-
DO NOT untorse the lung!!
- Avoid release of cytokines and endotoxins (reperfusion injury)
22
Q
A ________ is the protrusion of an organ through a defect in the wall of the anatomical cavity in which it normally lies
A
hernia
23
Q
What three surgical procedures are indicated for treatment of chylothorax?
A
- Thoracic duct ligation
- Cysterna chyli ablation
- Subtotal pericardectomy
All three procedures can be performed concurrently
24
Q
What is the #1 condition we see affecting the larynx?
A
laryngeal paralysis
-
Dysfunction/damage to the vagus nerve and its braches (recurrent laryngeal and caudal laryngeal nerves) affecting function of cricoarytenoideus dorsalis muscle
- Failure of the arytenoid(s) to abduct on inspiration
25
What types of clinical signs are most commonly seen in patients with **chronic diaphragmatic hernias**?
**respiratory and GI signs**
* *Dyspnea, exercise intolerance, lethargy*
* *Vomiting, regurgitation, inappetance*
26
What is the most common component of **brachycephalic airway syndrome (BAS)**?
**elongated soft palate**
* *Results in both inspiratory and expiratory dyspnea (stertor)*
* *Extension into rima glottidis*
* *Severe obstruction*
* *Loss of protective laryngeal function*
* *Anything more than 1-2 mm past tip of the epiglottis is TOO LONG*
27
**Tracheal collapse** is associated with a progressive cough that sounds like:
**"goose honk"**
*Other clinical signs of tracheal collapse include waxing and waning dyspnea, exercise intolerance, cyanosis, and syncope*
28
You have a patient with **lung lobe torsion** and you'd like to perform a *lung lobectomy*. You know what lobe is affected, so what surgical approach is indicated?
**intercostal thoracotomy**
29
What anesthetic drug is typically used in diagnosis of **brachycephalic airway syndrome (BAS)**?
**Propofol**
* Can also use Butorphanol or Buprenorphine to lower the amount of Propofol that you have to give.*
* If you've gone ahead and given these drugs and they're still not taking good, deep breaths, you can give a dose of Doxopram to stimulate deep respiration.*
* Be prepared to intubate immediately post-exam!*
30
Animals with flail chest are at risk for all of the following _except_:
* Pneumothorax
* Pleural effusion
* Pericardial Pendulum
* Pulmonary contusion
**Pericardial Pendulum**
*I don't actually even know if that's a thing*
31
This abnormality is due to weakness and separation of the muscles of the pelvic diaphragm:
**perineal hernia**
32
\_\_\_\_\_\_\_\_ hernias have mesothelials linings. ________ hernias do not have mesothelial linings.
**_True hernias_** have mesothelials linings. **_False hernias_** do not have mesothelial linings.
33
This is the most common abdominal hernia:
**umbilical hernia**
* *Most are congenital and inherited (you should not breed these animals)*
* *High risk breeds*
* *Airedale terrier*
* *Basenji*
* *Pekignese*
* *No sex predilection*
34
What is the most common indication for **nasal planum resection**?
**neoplasia**
* *Squamous cell carcinoma (SCC) is the most common cause for nasal planum resection.*
* *Others: lymphoma, malignant histiocytosis, malignant melanoma, basal cell carcinoma, mast cell tumor, HSA*
* *Complete vs. unlateral*
* *Must obtain wide margins (2-3 cm)*
* *Completely stage prior to surgery*
* *LN aspirates, abdominal and thoracic rads, etc.*
35
In a patient with pulmonary cysts, bullae, and blebs, when is surgical intervention recommended?
**if medical treatment fails**
* *Conservative treatment with thoracostomy tubes for 48-72 hours*
* *If after that time you're still getting a ton of air out, it's probably best to go exploring (surgically)*
* *Pre-op CT may be helpful in identifying lesions*
36
T/F: Pulmonary **cysts, bullae, and blebs** are common causes of spontaneous pneumothorax
**True!**
* *Can be secondary to blunt trauma (cysts) or traumatic rupture of alveoli secondary to underlying lung disease*
* *Other two main causes of spontaneous pneumothorax: heartworm disease and neoplasia*
37
What is the typical signalment associated with **tracheal collapse**?
**middle aged small and toy breed dogs**
* *Yorkshire terriers, Pomeranians, miniature poodles, and pugs*
* *No evidence of sex predilection*
38
What imaging modality is the gold standard for diagnosing **tracheal collapse**?
**tracheoscopy**
* *Allows direct visualization of collapse*
* *Grading of severity of collapse*
* *Allows visualization of tracheal mucosa, dorsal tracheal membrane*
* *Can obtain samples for cytology and bacterial culture/sensitivity*
* *Requires anesthesia*
* *May incite dyspneic episode!!*
39
Collapse of 75% of the tracheal lumen would be categorized as a Grade ___ tracheal collapse
**Grade III**
40
\_\_\_\_\_\_\_\_\_\_ is a congenital communication between pericardium and peritoneal cavity
**Peritoneopericardial Diaphragmatic Hernia (PPDH)**
* *Commonly associated with other congenital defects*
* *Polycystic kidneys (cats)*
* *Ventricular septal defects*
* *Sternal deformities*
* *Weimaraners, Cocker spaniels, DLHs and Himalayans may be at increased risk*
41
In the case of **tracheal collapse**, there is progressive, irreversible degeneration of the lower airway, which results also in laxity of the __________ muscle, leading to weakness of the tracheal rings and ultimately collapse
**trachealis muscle**
42
Removal of all lobes of one of the lungs (left/right) is termed:
**pneumonectomy**
* *Indicated for cases where disease is diffuse through the lung (neoplasia, abscess, trauma)*
* *Performed through lateral intercostal approach*
43
What are the two surgical treatment options for **tracheal collapse**?
**external prosthetic tracheal rings** and **intraluminal stent**
44
If you suspect a diaphragmatic hernia in your patient, you've taken standard radiographs, and you don't have access to ultrasound, what modality is most helpful for confirming your diagnosis?
**positive contrast celiography**
* *Inject dilute sterile contrast into abdomen*
* *Look for leakage of contrast in thorax on radiographs*
* *If you have access to ultrasound, you don't really need to do this*
45
T/F: Diagnosis of **tracheal collapse** is based on signalment, history, clinical signs, and PE
**False**
*Diagnosis of tracheal collapse is based on signalment, history, clinical signs, PE, and _IMAGING_. You cannot make this diagnosis without the use of some sort of imaging*
46
Name a complication associated with rapid expansion of a previously atelectic lung, seen after treatment of a **diaphragmatic hernia**
**Re-expansion pulmonary edema**
*There is _no treatment_ for this and is almost invariably fatal*
47
How is a **perineal hernia** most commonly diagnosed?
**rectal palpation**
* finger will pass through into rectal dilation; can palpate thumb*
* Radiographs, ultrasound, and minimum database can also be helpful*
48
T/F: Clinical signs and thoracic auscultation may provide enough information for diagnosis of pneumothorax
**True**
* *Thoracic auscultation: dull/absent bronchovesicular sounds dorsally*
* *Diagnosis can be confirmed with thoracic radiographs*
49
This is the most common type of perineal hernia:
**caudal perineal hernia**
## Footnote
*contents that herniate between the levator ani mm, external anal sphincter mm., and internal obturator mm.*
50
What is the surgical treatment for **epiglottic retroversion**?
**surgical pexy** of **ventral epiglottis** and **dorsal tongue**
## Footnote
*surgical pexy of the _ventral aspect of the epiglottis_ and the _dorsal base of the tongue_*
51
In which breed of dog do we most commonly see **congenital laryngeal paralysis** that presents as a progressive generalized degenerative disease and carries a grave prognosis?
**Rottweilers**
* *Onset of signs between 11 and 13 weeks of age*
* *Ataxia, paresis, head tremors, neurogenic muscle atrophy*
* *Grave prognosis :(*
52
T/F: If an **umbilical hernia** is the size of intestines (~finger size) in a small to medium-sized dog, it should be repaired immediately due to increased risk of strangulation
**True**
53
What muscle is responsible for laryngeal abduction (opening of the larynx) upon inhalation?
**cricoarytenoideus dorsalis**
* Innervated by the caudal laryngeal nerve, which is a branch of the recurrent laryngeal nerve, which is a branch of the vagus nerve.*
* So anything that damages any of these nerves or the muscle itself can result in inappropriate function of the larynx*
54
What are the most common types of primary pulmonary neoplasia?
**bronchiolar or alveolar carcinoma**
* *These can usually be picked up on 3 view thoracic radiographs*
* *CT provides additional information regarding LN involvement and invasiveness of mass*
* *Lung lobectomy indicated for peripheral tumors not involving the hilus*
* *Good prognosis if no LN involvement*
55
What landmark should we use for level of excision with regard to **soft palate resection**?
**\*\*midpoint of the tonsils\*\***
56
Based on the grading system for **tracheal collapse**, what grade would you assign this patient?
**Grade 3**
57
What are the main complications associated with **external prosthetic tracheal rings** for treatment of tracheal collapse?
**laryngeal paralysis, tracheal necrosis, pneumothorax**
\*\*
58
Brachycephalic breeds have local chondrodysplasia that results in early ankylosis of _________ and __________ bones. This results in a shortened and broadened skull
Brachycephalic breeds have local chondrodysplasia that results in early ankylosis of **_basioccipital_** and **_basisphenoid_** bones. This results in a shortened and broadened skull
59
If you note collapse of the cuneiform cartilage, this is a **Stage ___ laryngeal collapse**
**Stage 2**
60
Air passage through nasal cavities accounts for \_\_\_\_% of airway resistance
**~75%**
*Abnormal anatomy causes external and internal resistance (inability to dilate nostrils)*
61
What surgical treatment for **tracheal collapse** can be used in the cervical _and_ thoracic trachea?
**intraluminal stent**
* *External prosthetic tracheal rings can only be used on the cervical trachea*
62
This is a salvage procedure for untreatable upper airway obstruction that creates a permanent opening at the level of the proximal cervical trachea:
**permanent tracheostomy**
63
T/F: Medical management is going to be the first line of defense in a case of **tracheal collapse**
**True**
*Surgery for this has a lot of complications and a relatively high failure rate. Only when a patient fails to respond to medical management should surgical intervention be considered*
64
What is considered the "gold standard" for diagnosis of **brachycephalic airway syndrome (BAS)**?
**endoscopy/tracheoscopy**
65
What is the most important imaging modality for investigation of nasal disease?
**Computed topography (CT)**
* CT will give you a cross-sectional anatomy of the nares and the skull and you'll be able to get a much better idea of what's going on*
* (Note: if you're performing a rhinoscopy too, do the CT first. Rhinoscopy can cause some bleeding, so you don't want to have that shit all over your nice CT image.*
66
What is the gold standard surgery for moderate to severe cases of **laryngeal paralysis**?
**unilateral arytenoid lateralization**
* *Performing the procedure:*
* *A. The larynx is exposed through a lateral cervical approach during arytenoid lateralization. Incise the skin and subcutaneous tissue ventral to the jugular vein. Then incise the thyropharyngeus muscle at the dorsal edge of the thyroid cartilage.*
* *B. Separate the cricothyroid and cricoarytenoid articulations.*
* *C. Place a suture from the muscular process of the arytenoid to the dorsocaudal aspect of the cricoid or thyroid cartilage.*
67
T/F: **Unilateral arytenoid lateralization** eliminates the risk of post-operative aspiration pneumonia
**No.**
* It does not do that.*
* Risk of aspiration pneumonia is always present post-operatively.*
68
How do we diagnose hypoplastic trachea on radiographs?
**measure the tracheal lumen:thoracic inlet ratio**
69
What are the three main functions of the larynx?
**swallowing, **_ab_**duction, voice production**
70
T/F: Surgical intervention should be recommended if a dog presents with any of the components of **bracycephalic airway syndrome (BAS)**
**True**
71
What procedure is shown below?
**excision of everted laryngeal saccules**
72
Describe the pathophysiology associated with Brachycephalic airway syndrome (BAS):
* **Higher negative pressure is required to overcome obstruction**
* **--\> This results in the animal being more prone to secondary soft tissue changes (edema, hyperplasia, collapse)**
* **--\> This leads to even further decreased airflow with increased obstruction**
* **--\> This all circles back and it happens all over again.**
* **--\> Wow.**
73
After surgical intervention in dogs with brachycephalic airway syndrome (BAS), what *severe* post-operative complications are important to monitor for?
**pharyngeal swelling, vomiting, regurgitation, ASPIRATION PNEUMONIA**
74
What imaging modality is best for diagnosis of **lung lobe torsion**?
**Computed topography (CT)**
*You can probably see it on radiographs too, but CT is going to be better*
75
What modalities are most helpful for diagnosis of **Peritoneopericardial Diaphragmatic Hernia (PPDH)**?
**radiographs or ultrasound**
* *These are really the only diagnostic tools you'll need for this. Contrast studies considered only if diagnosis cannot be made with plain films or ultrasound*
* *Radiographic findings*
* *Enlarged cardiac silhouette*
* *Dorsal elevation of trachea*
* *Overlap of heart and diaphragmatic borders*
* *Discontinuity of diaphragm*
* *_Gas-filled structures in pericardial sac_*
76
T/F: For treatment of lung lobe torsion, it is important to untorse the lung to allow blood flow back to the affected lobe
**NO.**
## Footnote
**DO NOT UNTORSE THE LUNG!**
*Avoid release of cytokines and endotoxins (reperfusion injury)*
77
T/F: **Congenital laryngeal paralysis** is the most common type of laryngeal paralysis that we see in our small animal patients
**False**
* *_Idiopathic laryngeal paralysis_ is the most common type of laryngeal paralysis that we see in our small animal patients*
* *Older, large breed dogs*
* *Part of generalized neuropathy (complete PE and neuro exam is essential!)*
* *_Other causes include hypothyroidism, trauma, immune-mediated (myasthenia gravis), infectious, and toxic (lead, organophosphates)_* *- KNOW THESE\*\**
78
What is the most common surgical treatment for **perineal hernia**?
**internal obturator muscle transposition**
79
T/F: If your patient has a penetrating chest wound, it is generally best to remove the object penetrating the chest wall immediately to avoid excessive bleeding
**NO.**
## Footnote
* *Unless you are Clark Kent and have x-ray vision, do not remove objects penetrating the chest wall!!*
* *Radiographs or CT should be performed to determine the location of the object*
* *Thoracotomy for removal of the object*
80
How do you reach a *definitive diagnosis* of **laryngeal paralysis**?
**laryngeal (airway) exam**
*This can be done with a laryngoscope or rigid scope*
* *Arytenoids should abduct on inhalation*
* *Watch for paroxysmal motion (larynx closing on inhalation)*
* *Assistance required for monitoring of respiratory cycle*
* *Be prepared to proceed immediately with further diagnostics or surgery based on findings*
81
If you're performing surgery on a specific structure in the thoracic cavity, what is the surgical approach of choice?
**lateral/intercostal thoracotomy**
82
All of the following are complications associated with treatment of **chylothorax** except:
* Persistent chylous or non-chylous effusion
* Diaphragmatic hernia
* Lung lobe torsion
* Pneumothorax
**diaphragmatic hernia**
83
What is the correct order of diagnostics for a **nasal tumor**?
minimum database → thoracic rads → skull rads → cytology → biopsy → culture
\*\*
