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RUSVM Small Animal Surgery I > SASx Final Exam - Thoracic/Respiratory > Flashcards

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
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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)

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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

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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

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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
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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

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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

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8
Q

What breed of dog is overrepresented in the case of hypoplastic trachea with brachycephalic airway syndrome (BAS)?

A

English bulldog

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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
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10
Q

________ is the most commonly herniated organ

A

liver

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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

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12
Q

Which of these images shows an actual animal?

A

Nice job!

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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

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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

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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)

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16
Q

T/F: Surgery is considered an emergency if the stomach is herniated

A

True

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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
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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
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19
Q

There are many known causes of chylothorax, but ________ is most common

A

idiopathic

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20
Q

What is the maximum lung mass (%) that can be acutely removed without being fatal?

A

65%

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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)
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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

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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

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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
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25
Q

What types of clinical signs are most commonly seen in patients with chronic diaphragmatic hernias?

A

respiratory and GI signs

  • Dyspnea, exercise intolerance, lethargy
  • Vomiting, regurgitation, inappetance
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26
Q

What is the most common component of brachycephalic airway syndrome (BAS)?

A

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
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27
Q

Tracheal collapse is associated with a progressive cough that sounds like:

A

“goose honk”

Other clinical signs of tracheal collapse include waxing and waning dyspnea, exercise intolerance, cyanosis, and syncope

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28
Q

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?

A

intercostal thoracotomy

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29
Q

What anesthetic drug is typically used in diagnosis of brachycephalic airway syndrome (BAS)?

A

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!*
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30
Q

Animals with flail chest are at risk for all of the following except:

  • Pneumothorax
  • Pleural effusion
  • Pericardial Pendulum
  • Pulmonary contusion
A

Pericardial Pendulum​

I don’t actually even know if that’s a thing

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31
Q

This abnormality is due to weakness and separation of the muscles of the pelvic diaphragm:

A

perineal hernia

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32
Q

________ hernias have mesothelials linings. ________ hernias do not have mesothelial linings.

A

True hernias have mesothelials linings. False hernias do not have mesothelial linings.

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33
Q

This is the most common abdominal hernia:

A

umbilical hernia

  • Most are congenital and inherited (you should not breed these animals)
  • High risk breeds
    • ​Airedale terrier
    • Basenji
    • Pekignese
  • No sex predilection
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34
Q

What is the most common indication for nasal planum resection?

A

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
Q

In a patient with pulmonary cysts, bullae, and blebs, when is surgical intervention recommended?

A

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
Q

T/F: Pulmonary cysts, bullae, and blebs are common causes of spontaneous pneumothorax

A

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
Q

What is the typical signalment associated with tracheal collapse?

A

middle aged small and toy breed dogs

  • Yorkshire terriers, Pomeranians, miniature poodles, and pugs
  • No evidence of sex predilection
38
Q

What imaging modality is the gold standard for diagnosing tracheal collapse?

A

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
Q

Collapse of 75% of the tracheal lumen would be categorized as a Grade ___ tracheal collapse

A

Grade III

40
Q

__________ is a congenital communication between pericardium and peritoneal cavity

A

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
Q

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

A

trachealis muscle

42
Q

Removal of all lobes of one of the lungs (left/right) is termed:

A

pneumonectomy

  • Indicated for cases where disease is diffuse through the lung (neoplasia, abscess, trauma)
  • Performed through lateral intercostal approach
43
Q

What are the two surgical treatment options for tracheal collapse?

A

external prosthetic tracheal rings and intraluminal stent

44
Q

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?

A

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
Q

T/F: Diagnosis of tracheal collapse is based on signalment, history, clinical signs, and PE

A

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
Q

Name a complication associated with rapid expansion of a previously atelectic lung, seen after treatment of a diaphragmatic hernia

A

Re-expansion pulmonary edema

There is no treatment for this and is almost invariably fatal

47
Q

How is a perineal hernia most commonly diagnosed?

A

rectal palpation

  • finger will pass through into rectal dilation; can palpate thumb*
  • Radiographs, ultrasound, and minimum database can also be helpful*
48
Q

T/F: Clinical signs and thoracic auscultation may provide enough information for diagnosis of pneumothorax

A

True

  • Thoracic auscultation: dull/absent bronchovesicular sounds dorsally
  • Diagnosis can be confirmed with thoracic radiographs
49
Q

This is the most common type of perineal hernia:

A

caudal perineal hernia

contents that herniate between the levator ani mm, external anal sphincter mm., and internal obturator mm.

50
Q

What is the surgical treatment for epiglottic retroversion?

A

surgical pexy of ventral epiglottis and dorsal tongue

surgical pexy of the ventral aspect of the epiglottis and the dorsal base of the tongue

51
Q

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?

A

Rottweilers

  • Onset of signs between 11 and 13 weeks of age
  • Ataxia, paresis, head tremors, neurogenic muscle atrophy
  • Grave prognosis :(
52
Q

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

A

True

53
Q

What muscle is responsible for laryngeal abduction (opening of the larynx) upon inhalation?

A

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
Q

What are the most common types of primary pulmonary neoplasia?

A

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
Q

What landmark should we use for level of excision with regard to soft palate resection?

A

**midpoint of the tonsils**

56
Q

Based on the grading system for tracheal collapse, what grade would you assign this patient?

A

Grade 3

57
Q

What are the main complications associated with external prosthetic tracheal rings for treatment of tracheal collapse?

A

laryngeal paralysis, tracheal necrosis, pneumothorax

**

58
Q

Brachycephalic breeds have local chondrodysplasia that results in early ankylosis of _________ and __________ bones. This results in a shortened and broadened skull

A

Brachycephalic breeds have local chondrodysplasia that results in early ankylosis of basioccipital and basisphenoid bones. This results in a shortened and broadened skull

59
Q

If you note collapse of the cuneiform cartilage, this is a Stage ___ laryngeal collapse

A

Stage 2

60
Q

Air passage through nasal cavities accounts for ____% of airway resistance

A

~75%

Abnormal anatomy causes external and internal resistance (inability to dilate nostrils)

61
Q

What surgical treatment for tracheal collapse can be used in the cervical and thoracic trachea?

A

intraluminal stent

  • External prosthetic tracheal rings can only be used on the cervical trachea
62
Q

This is a salvage procedure for untreatable upper airway obstruction that creates a permanent opening at the level of the proximal cervical trachea:

A

permanent tracheostomy

63
Q

T/F: Medical management is going to be the first line of defense in a case of tracheal collapse

A

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
Q

What is considered the “gold standard” for diagnosis of brachycephalic airway syndrome (BAS)?

A

endoscopy/tracheoscopy

65
Q

What is the most important imaging modality for investigation of nasal disease?

A

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
Q

What is the gold standard surgery for moderate to severe cases of laryngeal paralysis?

A

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
Q

T/F: Unilateral arytenoid lateralization eliminates the risk of post-operative aspiration pneumonia

A

No.

  • It does not do that.*
  • Risk of aspiration pneumonia is always present post-operatively.*
68
Q

How do we diagnose hypoplastic trachea on radiographs?

A

measure the tracheal lumen:thoracic inlet ratio

69
Q

What are the three main functions of the larynx?

A

swallowing, abduction, voice production

70
Q

T/F: Surgical intervention should be recommended if a dog presents with any of the components of bracycephalic airway syndrome (BAS)

A

True

71
Q

What procedure is shown below?

A

excision of everted laryngeal saccules

72
Q

Describe the pathophysiology associated with Brachycephalic airway syndrome (BAS):

A
  • 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
Q

After surgical intervention in dogs with brachycephalic airway syndrome (BAS), what severe post-operative complications are important to monitor for?

A

pharyngeal swelling, vomiting, regurgitation, ASPIRATION PNEUMONIA

74
Q

What imaging modality is best for diagnosis of lung lobe torsion?

A

Computed topography (CT)

You can probably see it on radiographs too, but CT is going to be better

75
Q

What modalities are most helpful for diagnosis of Peritoneopericardial Diaphragmatic Hernia (PPDH)?

A

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
Q

T/F: For treatment of lung lobe torsion, it is important to untorse the lung to allow blood flow back to the affected lobe

A

NO.

DO NOT UNTORSE THE LUNG!

Avoid release of cytokines and endotoxins (reperfusion injury)

77
Q

T/F: Congenital laryngeal paralysis is the most common type of laryngeal paralysis that we see in our small animal patients

A

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
Q

What is the most common surgical treatment for perineal hernia?

A

internal obturator muscle transposition

79
Q

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

A

NO.

  • 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
Q

How do you reach a definitive diagnosis of laryngeal paralysis?

A

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
Q

If you’re performing surgery on a specific structure in the thoracic cavity, what is the surgical approach of choice?

A

lateral/intercostal thoracotomy

82
Q

All of the following are complications associated with treatment of chylothorax except:

  • Persistent chylous or non-chylous effusion
  • Diaphragmatic hernia
  • Lung lobe torsion
  • Pneumothorax
A

diaphragmatic hernia

83
Q

What is the correct order of diagnostics for a nasal tumor?

A

minimum database → thoracic rads → skull rads → cytology → biopsy → culture

**

RUSVM Small Animal Surgery I (15 decks)

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