THORAX, PERICARDIUM: 104, 105, 107

Question 1

What lung protdrude more cranially?

Answer 1

the left cranial lobe compared to the right cranial

Question 2

arterial supply of the dorsolateral skin of the thorax

Answer 2

thoracodorsal artery

Question 3

surgical access to ICS cranial to 5 (not comprised)

Answer 3

skin, latissimus dorsally + deep pectoralis ventrally, scalenus, (rectus toracis very ventral), serratus dorsalis+ serratus ventralis, ICS muscle

Question 4

origin of the intercostal artery

Answer 4

the first 3-4 are branches of the thoracic vertebral artery

remainder direct brances from aorta

Question 5

what vessel always accompany dorsal the transverse thoracic muscle?

Answer 5

internal thoracic artery (arise fromo left and right subclavian arteries)

Question 6

in sternotomy closure is preferred to use a figure of eight or a double loop cerclage?

Answer 6

figure of 8

Question 7

what breeds are predisposed to pectus excavatum?

Answer 7

bengala and burmese. cause of a shortened or hypoplastic diaphragm

Question 8

name some of the muscles that could serve as flaps in the thoracic region

Answer 8

latissimus dorsi, external abdominal oblique, transversus abdominis, diaphragm

Question 9

surgical access caudal to ICS 5 (included)

Answer 9

latissimus dorsi, only a small portion ventrally of pectoralis deep. serratus dorsalis and ventralis (not until last ribs), NO scalenus, YES external abdominal oblique ventrally

Question 10

physiologic content of pleural fluid in dogs and cats

Answer 10

dogs: 0,1 ml/kg
cats: 0,3 ml/kg

Question 11

lymphatic drainage of the thorax

Answer 11

VISCERAL NODES:
mediastinal: cranial mediastinum, hearth surface
bronchial: pulmonary + tracheobronchial

PARIETAL NODES:
ventral center: right and left sternal (or single)
dorsal center: aortic thoracic nodes, inconsistent in dimensions and presence (25% of dogs)

Question 12

cisterna chili anatomic landmarks

Answer 12

ventral to 1-4 lumbar vertebrae

Question 13

anatomic differences in thoracic duct beetween dogs and cats

Answer 13

dorsolateral to aorta RIGHT in dogs, LEFT in cats. crosses to the left in dogs at 6-7 thoracic vertebra.

boths terminates in ext jugular vein or jugosubclavian angle

Question 14

pleural fluid classification

Answer 14

trasudate: <3 PRO, <1015 PS, < 1500 NCC/microlitro

modif trasudate: 2,5-5 PRO, 1015-1025 PS: 1500-7000 NCC/microlitro

exudate: > 3 PRO, >1025 PS, >7000 NCC/microlitro

Question 15

how to diagnose a chylous effusion

Answer 15

triglyceride effusion > triglyceride serum

cholesterol effusion < cholesterol serum

detection of chylomicrons

Question 16

what is pseudochylous?

Answer 16

not descrubed in pets, in human medicine when cholesterol effusion> cholesterol serum and viceversa trygliceride.

Question 17

frequently present bacteria in septic pleural exudate

Answer 17

nocardia and actinomyces. usually are more frequent anaerobes

Question 18

common RX finding in a dog with lung lobe torsion

Answer 18

increased opacity, up to 87% have the emphisematous appearance on the malpositioned LL

Question 19

thoracostomy tube placement anatomic landmarks

Answer 19

skin incision: 10-11 ICS, insertion 7-8 ICS

Question 20

what structures can be approached with only a monolateral toracotomy?

Answer 20

PDA, PRAA: 4-5 LEFT
PULMONIC VALVE: 4 LEFT
MIDDLE LUNG LOBE: 5 RIGHT
CRANIAL VENA CAVA: 4 right commonly, but also 4 left
THORACIC DUCT: 8-9-10-11 right dog, left feline.

Question 21

surgical access to perform a LN injection and simoultaneously thoracic duct ligation

Answer 21

right lateral paracostal (LN) + right ICS

Question 22

reported percentage of success with pericardiectomy+thoracic duct ligation

Answer 22

80-100%

Question 23

septic effusion lactate, glucose and pH

Answer 23

usually lactate >200 IU/L. glucose <1,68 mmol/L, pH <6.9

Question 24

time to pleural drain removal

Answer 24

4-8 days. usually removed when it produces less than 3-5 o less than 2 ml/Kg/day

Question 25

common neurological disorder associated with tymoma in dogs

Answer 25

up to 47% develop myasthenia gravis

Question 26

where does the pericardium attaches in the thorax?

Answer 26

base of the hearth (Aortic arch, brachiocephalic trunk, left atrium, interatrial groove) caudoventral apex anchors ventrally on to muscolar insertion of the diaphragm

Question 27

describe the pericardium vascular supply

Answer 27

-paired pericardial branches of the internal thoracic artery (course caudoventrally on LV aspect of the pericardium). -perciardiocophrenic arteries (from internal thoracic, supply dorsolateral aspect of the pericardium

Question 28

describe the sequelae of event that occurs after cardiac tamponade

Answer 28

1) cardiac output decrease, systemic venous pressure increase 2) activation of compensatory neurohumoral response 3) RAAS activation 4) sympatethic stimulation 5) catecholamine release

Question 29

what does the NON stretching of the right atrium determine

Answer 29

lack of releasing of atrial natiouretic peptide. id does not counteract the action of RAAS. as a consequence there will be portal hypertensions and venous hypertension

Question 30

descrive the mechanism at the base of pulsus paradoxus

Answer 30

1) during inspiration pericardial and right atrium pressure decrease 2) inspiration -> higher venous flow to RA 3) interventricular septum shift to the left 4) inspiration -> left hearth output and arterial pressure decrease 5) variation in systolic pressure (>10 mmHg) and pulse regarding to the phase of breathing

Question 31

what patologies can cause pulsus paradoxus other than cardiac tamponade?

Answer 31

-restrictive cardiomiopaty -obstructive lung desease -hypovolemic shock

Question 32

ICS space access for vena cava stricture surgery

Answer 32

Right sided 5-6th ICS

Question 33

What is a possible fungal infection to the pericardium?

Answer 33

coccidioides immitis (southern USA)

Question 34

most 2 frequent causes of pericardial effusion

Answer 34

1) idiopathic pericardial effusion 2) neoplasia (hemangio, hearth base, pericardium, chemodectoma, mesotelima)

Question 35

ICS space for thoracocentesis

Answer 35

right (avoid main coronary arteries) 5-6 ICS

Question 36

description of transdiaphragmatic subxiphoid approach

Answer 36

Duprè 2001

Question 37

what is the kussmaul sign

Answer 37

persistent increase in jugular venous pressure during inspiration

Question 38

surgical access to perform a LN injection and simoultaneously thoracic duct ligation

Answer 38

right lateral paracostal (LN) + right ICS

Question 39

what structures can be approached with only a monolateral toracotomy?

Answer 39

PDA, PRAA: 4-5 LEFT PULMONIC VALVE: 4 LEFT MIDDLE LUNG LOBE: 5 RIGHT CRANIAL VENA CAVA: 4 right commonly, but also 4 left THORACIC DUCT: 8-9-10-11 right dog, left feline.

Question 40

what breeds are predisposed to pectus excavatum?

Answer 40

bengala and burmese. cause of a shortened or hypoplastic diaphragm