Tobias Rounds Questions (From Powerpoints) Flashcards
1
Q
Which of the following is false regarding hemilaminectomy?
a. The hemilaminectomy is the most common procedure used to provide exposure to the vertebral canal and spinal cord in dogs and cats.
b. The procedure results in removal of only the lamina on one side of the vertebra; the pedicle is left intact.
c. Hemilaminectomy provides exposure to the ventral, dorsal, and lateral (unilateral) aspects of the spinal cord and vertebral canal.
d. Hemilaminectomy can be performed via a dorsal or dorsolateral approach to the vertebral column.
A
B is FALSE.
Hemilaminectomy is the removal of half of the vertebral arch, including the lamina, pedicle, and articular process.
2
Q
True or False: Variations of the hemilaminectomy include the mini-hemilaminectomy and the pediculectomy.
A
True. These procedures are meant to preserve the zygapophyseal joint, thus resulting in less mechanical instability.
3
Q
Which of the following is true regarding dorsal laminectomy?
a. Various modifications of this technique can be used, including Funkquist A, Funkquist B, Funkquist C, and modified dorsal laminectomy.
b. Funkquist A involves removing the spinous process, laminae, articular processes, and approximately a quarter of the dorsal portion of the pedicles of a vertebra to gain access to the vertebral canal.
c. Funkquist B leaves the articular processes intact, but removes the pedicles, spinous process and laminae.
d. For the modified dorsal laminectomy, the laminae, spinous process, and caudal articular processes are removed.
A
D is TRUE.
- a is false because there is no Funkquist C
- b is false because it is approx 1/2 of the dorsal portion of the pedicles, not 1/4
- c is false because Funkquist B leaves the articular processes and pedicles intact but removes the spinous process and laminae.
4
Q
Sensitivity is defined as the number of ______ animals identified by a test divided by the total number of animals with the disease.
A
Positive.
Sensitivity= TP/(TP+FN)
5
Q
Specificity is defined as the number of ______ animals identified by a test divided by the total number of animals without disease.
A
Negative.
Specificity= TN/(TN+FP)
6
Q
Define prevalence?
A
Prevalence is the proportion of animals in a population affected by a disease.
7
Q
Define accuracy?
A
Accuracy is the proportion of correct diagnoses a test provides.
8
Q
Accuracy of radiographs for identification of intervertebral disc herniation is ___%?
A
50-60%
9
Q
What are the three different basic myelographic patterns to describe location of pathology?
A
Extradural, intradural-extramedullary, intramedullary
10
Q
True or False: Length of the intramedullary pattern:length of L2 vertebra ratio after myelography has been used to predict outcome in dogs that lack nociception.
A
True.
11
Q
Name four factors that positively affect the performance of noncontrast CT for detecting intervertebral disc herniation?
A
- Use of multiplanar reconstruction techniques
- Chronic history of disc herniation
- Chondrodystrophic breed type
- The presence of mineral dense intervertebral disc material.
12
Q
The flow of cerebrospinal fluid within the subarachnoid space of the spinal cord is _____ to ______, and sampling CSF _____ to the location of the pathology might be less likely to reflect abnormalities?
A
The flow of cerebrospinal fluid within the subarachnoid space of the spinal cord is CRANIAL to CAUDAL, and sampling CSF CRANIAL to the location of the pathology might be less likely to reflect abnormalities.
13
Q
Where can cerebrospinal fluid be acquired from in dogs?
A
- Cerebellomedullary cistern
- Lumbar subarachnoid space
14
Q
In one prospective study of 24 dogs, MRI had ____% sensitivity for determining the location and side of the intervertebral disc herniation, whereas CT myelography had sensitivities of ____% for detecting the site and ___% for detecting the side of intervertebral disc material.
A
MRI had 100% sensitivity for determining the location and side of the intervertebral disc herniation, whereas CT myelography had sensitivities of 90% for detecting the site and 55% for detecting the side of intervertebral disc material
15
Q
What percentage of dogs with FCE have a recognizable lesion/particular signal pattern on MRI?
A
78.8%
16
Q
In a prospective MRI study, Only ___% of dogs with T2W hyperintensity greater in cranial-caudal length than 3 times the length of L2 returned to voluntary ambulatory status.
A
20%
17
Q
Name two findings regarding prognosis and T2W hyperintensity in MRI of the spine:
A
- All dogs lacking T2W signal changes within the spinal cord recovered voluntary ambulation
- T2W length ratio was an independent predictor of functional outcome with the odds of recovery reduced by 1.9 fold per unit of hyperintensity
18
Q
Is T2W hyperintensity a good or bad finding on spinal MRI?
A
BAD! Presence is correlated with reduced odds of recovery. Longer areas of hyperintensity = worse prognosis.
19
Q
What are the three strategies that comprise medical management of IVDD?
A
- Enforced rest to allow healing of the annulus
- Use of analgesics, muscle relaxants and anti inflammatories
- Physical rehabilitation
20
Q
True or False: Tobias currently does not recommend any corticosteroids in the management of IVDH, with or without surgical intervention.
A
True.
21
Q
What is the percentage range for successful surgical outcomes for dogs with normal nociception?
A
72-100%
22
Q
What is the percentage range for successful surgical outcomes for dogs with paraplegia with absent nociception?
A
43-62%
23
Q
True or False: The location of disc herniation is associated with outcome?
A
FALSE
24
Q
The duration of therapy in dogs with UTI secondary to neurogenic bladder dysfunction should be _____ than that recommended for a simple UTI.
A
Longer. Some authors recommend a course of 3-6 weeks for persistent UTI and reculturing urine 2-3 days after completion of antibiotics.
25
What is “spinal walking”?
Use of pelvic limb reflexes, trunk muscles, and any remaining upper motor neurons to generate a gait as opposed to conscious voluntary walking.
26
What breeds have the highest prevalence of vertebral malformations?
Screw-tailed breeds (English Bulldog, Frenchies, Boston Terriers, Pugs)
27
What are butterfly vertebrae?
Butterfly vertebrae are characterized by a sagittal cleft within the affected vertebral body. This cleft may be visible on a dorsoventral radiographic view, creating the specific appearance of the affected vertebra.
28
What is the condition in which there is failure of the laminae to fuse dorsally?
Spina bifida.
29
Dermoid/pilonidal sinuses are a congenital condition wherein the skin fails to completely separate from the neural tube during embryonic development. What breed is predisposed to this?
Rhodesian Ridgeback.
30
What are the five groups of clinical signs of spinal cord disease?
(1) reduction or loss of voluntary movement
(2) spinal reflex abnormalities
(3) alterations in muscle tone
(4) muscle atrophy
(5) sensory dysfunction
31
True or False: Lesions affecting the C1-C5 spinal cord segments may result in *increased* thoracic limb stride length, and those affecting the C6-T2 spinal cord segments may result in *reduced* stride length.
True.
32
What is a two-engine gait and where does this neurolocalize?
Short thoracic limb stride with long pelvic limb stride (C6-T2).
33
What is the most common clinical sign of ‘root signature’ lesion?
Holding a thoracic limb up in a partially flexed position.
34
What is the zygapophyseal joint?
The diarthrodial joint of the articular processes.
Diarthrodial = Mobile joints with cartilage at the articular surfaces, a joint capsule and synovial fluid. An articular cavity is present between joint surfaces.
35
Name a nutritional cause of cervical spinal cord disease?
Hypervitaminosis A in cats.
36
What two breeds of dog are associated with degenerative cervical spinal cord disease?
Rottweilers (C1-C5) and Australian Cattle Dogs (C6-T2).
37
When making a ventral approach to the atlantoaxial joint, surgical orientation can be provided by palpation of a pointed ventral prominence on the caudal aspect of C1, the _________.
Ventral tubercle. This is the ventral midline location of the C1-C2 joint space.
38
True or False: During a lateral approach to the cervical vertebral column, abduction and retraction of the scapula can facilitate access to the articulation of the C6-C7 vertebrae.
True.
39
List four indications for a ventral approach to the cervical vertebral column:
A. Ventral slot/intervertebral disc fenestration
B. Fracture fixation
C. Atlantoaxial stabilization
D. Cervical spondylomyelopathy
40
List three indications for a dorsal approach to the cervical vertebral column:
A. Dorsal laminectomy
B. Fracture fixation
C. Atlantoaxial stabilization
41
Where does the first cervical spinal nerve and its associated vasculature pass through?
The lateral vertebral foramen.
42
What is the cranioventral peg-like projection on the axis vertebra called?
The dens or odontoid process.
43
What are the ligaments that stabilize the dens/odontoid process of the axis?
- Held in the ventral aspect of the vertebral foramen by the transverse ligament and by the apical ligament attached to the basiocccipital bone.
- Held to the occipital condyles by bilateral alar ligaments.
44
What breeds of dogs are most often affected/predisposed to atlantoaxial instability and subluxation?
Small/miniature breed dogs - Yorkies, Chihuahuas, mini/toy poodles, Pomeranians, Pekingese.
45
Why are small breed dogs predisposed to atlantoaxial instability?
Their dens is prone to maldevelopment due to aberrations in physeal growth plate closure, dysplasia, hypoplasia, dorsal angulation, separation of the dens, absence of transverse ligament etc.
46
Traumatic atlantoaxial subluxation can occur in dogs of any breed - what happens when this occurs?
Forceful overflexion of the head may tear the ligaments or cause a fracture of the dens or laminae of the axis.
47
What is the angle between the atlas and the axis that is more predictive of instability (vs decreased overlap)?
162 degrees
48
What are possible treatments for atlantoaxial instability?
Conservative - external coaptation with rigid cervical brace until ligaments hopefully heal (at least 6wk).
Surgical- Goal is bony ankylosis of the atlantoaxial joint that permanently stabilizes the articulation.
49
Dorsal and ventral approaches for stabilizing the atlantoaxial joint exist. Which approach is preferred for fractures?
Ventral approach.
50
Dorsal and ventral approaches for stabilizing the atlantoaxial joint exist. What is a contraindication for the dorsal approach?
Compression of the spinal cord due to dorsal deviation of the dens.
51
Osseous fusion generally is not achieved with dorsal techniques for stabilizing the atlantoaxial joint because they cannot resist movement in directions other than flexion, but the dorsal technique may be preferred in what cases?
Dorsal stabilization techniques may be preferable in dogs with small body weight (<2 kg), which may prohibit the use of metallic implants ventrally, and in those dogs in which ventral stabilization techniques initially fail.
52
What are the six classifications of nerve injury?
Class 1 - neuropraxia
Class 2 - axonotmesis
Class 3 - neurotmesis with intact perineurium
Class 4 - neurotmesis with disrupted perineurium
Class 5 - neurotmesis with severed nerve
Class 6 - combines several of the above
53
Define neuropraxia?
Neuropraxia is the mildest form of traumatic peripheral nerve injury with no loss of nerve continuity. The axons maintain their anatomical integrity but become dysfunctional/demyelinated. This condition results in blockage of nerve conduction and transient weakness or paresthesia and is treated conservatively.
54
Define axonotmesis?
Axonotmesis, the second level of PNI, is characterized by a disruptive lesion of the axon and its myelin coating. The integrity of the outer connective tissue covers, namely the perineurium and the epineurium, remains, ensuring that the anatomical shape of the nerve is maintained. The prognosis with conservative tx tends to still be excellent.
55
Define neurotmesis?
Severing of a nerve (the axons) it comes in three levels:
The third and fourth levels of PNI where the axons, myelin sheaths, and endoneurium are disrupted, but the fascicular alignment and integrity of the outer layers of collagen are maintained.
In the third level, the perineurium and epineurium are intact. Recovery with conservative tx is possible but may take months.
In the fourth level, all layers except the epineurium are disrupted.
In the fifth level of PNI, the nerve and all associated structures are severed. Recovery without surgery for 4th and 5th level is almost impossible.
56
True or False: The site of spinal nerve root injury is usually intradural, where the nerve roots arise from the spinal cord.
True.
57
What forms the brachial plexus?
It is formed from the ventral branches of the sixth cervical through the second thoracic spinal cord segments, respective spinal nerve roots, and spinal nerves.
58
In ____% of dogs, the brachial plexus also contains the fifth cervical spinal cord segment and its spinal nerve roots and spinal nerve.
24%
59
Partial injuries to the brachial plexus most commonly involve the spinal nerve roots in the _______ portion of the brachial plexus.
Caudal.
60
Partial injuries to the brachial plexus most commonly involve the spinal nerve roots in the _______ portion of the brachial plexus.
Caudal.
61
True or False: If neurotmesis exists, routine surgical anastomosis of the affected nerves are recommended.
True. These injuries are less likely to respond to conservative therapy.
62
Axonal regrowth can reach at least ____ cm within a 4-month period when avulsed nerves are reimplanted into the spinal cord.
10-15cm
63
What is neurotization?
Neurotization is sacrificing a donor nerve (motor) to restore a recipient nerve (motor).
64
What is Cross-neurotization?
Cross neurotization is sacrificing a donor nerve (sensory) to restore a recipient nerve (motor).
65
The ______ is thicker in the cervical vertebral column, offering greater resistance to dorsal herniation of nucleus pulposus in this region?
Dorsal longitudinal ligament.
66
What percentage of intervertebral disc herniation occurs in the cervical spine?
14-25%
67
Extradural material with a high T2-weighted signal intensity, often with a “seagull” shape on transverse images, is likely associated with what?
Hydrated nucleus pulposus extrusion.
68
A dorsal laminectomy can be extended to _____% the length of the laminae cranial and caudal to the lesion.
75%
69
True or False? Fenestration should not be performed in dogs weighing more than 30 kg due to risk of vertebral collapse or subluxation after removing a large portion of intervertebral disc.
True.
70
A ventral slot is centered over the junction of the annulus fibrosis with the ventral aspect of the adjacent vertebral bodies and should not be greater than ___% the length and ___% the width of the bodies being drilled.
33% length, 50% width.
71
True or False: Cervical IVDD dogs with ventilatory compromise have lesions cranial to origin of phrenic nerve.
True. The neurons of the medullary respiratory center enter the spinal cord via the reticulospinal tracts, which project to cord segments C5 through C7, which give rise to phrenic nerve.
72
Risk for cardiac arrhythmias is _______ with ventral slot compared to thoracolumbar decompression surgery.
Greater.
73
Long-term follow-up for ventral slot decompression of caudal cervical intervertebral disc protrusion in large-breed dogs revealed only a __% success rate, and it was concluded that dynamic compressive lesions may need a stabilization procedure.
66%
74
Cervical spondylomyelopathy is more commonly diagnosed in _____ sized dogs?
Large to giant.
75
What is another term for Wobbler's Syndrome?
Cervical spondylomyelopathy.
76
The pathophysiology of cervical spondylomyelopathy involves both _____ and ______ factors.
Static and dynamic.
77
Static factors in cervical spondylomyelopathy include:
Foraminal stenosis, which can be disc-associated or osseous-associated.
78
Disc-associated stenosis in cervical spondylomyelopathy is typically seen in middle-aged large breed dogs. Most commonly in which breed?
Doberman Pinschers
79
What is the inheritance pattern for cervical spondylomyelopathy in Doberman Pinschers?
Autosomal dominant with incomplete penetrance.
**An autosomal dominant condition is usually represented in each generation, but with reduced penetrance, a generation may appear to be "skipped" because of the lack of phenotypic expression.
80
Is it acceptable to use the term instability when describing cervical spondylomyelopathy with dynamic compression? Why or why not?
No, it is not acceptable. The fact that the spinal cord appears to be compressed upon neck flexion or extension on a myelogram does not mean that there is inherent instability.
81
What are common clinical signs seen in dogs with cervical spondylomyelopathy?
- Gait abnormalities are most common; proprioceptive ataxia, even in the absence of postural reaction deficits
- Neck pain or cervical hyperesthesia (5% of dogs)
Most commonly signs are chronic and progressive, though acute does happen.
82
Name three ways corticosteroids can help in the medical management of cervical spondylomyelopathy:
Decrease vasogenic edema from chronic compression
Protect from glutamate toxicity
Reduce apoptosis of cord
83
What is the success rate of medical management for cervical spondylomyleopathy?
54%
84
True or False: The most common type of cervical spondylomyelopathy is osseous compression?
False, it’s disc-associated.
85
When using a fat graft to prevent postoperative laminectomy membrane formation, graft thickness should be limited to ____mm to prevent neurologic complications.
<5mm
86
For distraction-stabilization of cervical spondylomyelopathy using pins and PMMA, what direction and at what angle should you drive the pins?
Dorsolaterally at 30-35 degrees (45 for C7)
87
What are some complications associated with treatment of cervical spondylomyelopathy?
Neurologic deterioration
Vertebral foramen and trasverse foramina penetration with implant placement
Adjacent segment syndrome - the “domino” effect” (occurs in approximately 20%) of cases especially after distraction-stabilization techniques
Laminectomy membrane (fat graft/ cellulose membrane to minimize occurence)
Implant failure,
Collapse of intervertebral foramina
Insufficient decompression
88
What is the percentage of dogs reported to improve following surgical treatment for disc-associated cervical spondylomyelopathy?
80%
89
The overall recurrence rate for all direct and indirect decompressive procedures to treat disc-associated cervical spondylomyelopathy is ___%?
24%
90
Where do extradural synovial cysts originate from?
The zygapophyseal joints of the vertebral articulations.
Thought to result from degeneration of the joint which causes protrusion of the synovial membrane through defects of the joint capsule - protrusion forms a para-articular cavity filled with synovial fluid.
91
Cervical synovial cysts are mostly seen in ________________?
Young and large breed dogs.
92
Thoracolumbar synovial cysts are mostly seen in __________________?
Older to middle-aged large-breed dogs.
93
Caudal lumbar/lumbosacral synovial cysts are mostly seen in __________________?
Older to middle-aged large-breed dogs.
94
Extradural synovial cysts seen on MRI are ______ in T2-weighted images, with hypointensity, isointensity, or hyperintensity in T1 weighted images, depending on whether the content of the cyst is mostly synovial fluid, mucinous or hemorrhagic material?
Hyperintense.
95
Contusion of the brain or spinal cord causes ______ mechanical damage to the central nervous system and initiates a chain of biochemical events that causes _______ neuronal and glial cell necrosis and apoptosis.
Contusion of the brain or spinal cord causes primary mechanical damage to the central nervous system and initiates a chain of biochemical events that causes secondary neuronal and glial cell necrosis and apoptosis.
96
True or False: Focal brain injuries alone are unusual and result from static loading, which is defined as forces applied to the head during a period longer than 200ms.
True.
97
In ischemic injury, decreased perfusion to the neurons causes lack of energy, resulting in ion pump failure and increased glutamate, which increases intracellular calcium. Name three effects of increased intracellular calcium concentration?
- Activates intracellular proteases such as calpains and caspase, which destroy the cytoskeleton and chromosomes and initiate programmed cell death.
- Activates phospholipase A2, thereby producing eicosanoids and initiating an inflammatory response.
- Binds intracellular phosphates, further depleting the cell of energy sources.
98
Neoplasms in the brainstem or spinal cord are more likely to cause clinical signs at a relatively ______ volume because there is ____ “redundancy” of neural structures.
Smaller volume, less redundancy.
99
Acute compression of the central nervous system is typically associated with?
Vasogenic edema, demyelination.
100
Chronic compression of the central nervous system is typically associated with?
Necrosis and apoptosis of glial cells, demyelination
101
True or False: Gray matter is affected more severely than white matter with pathology that causes vascular occlusion?
True.
102
What are the top 2 differentials for a patient with acute, progressive, and asymmetric neurologic signs?
Inflammatory/infectious
Neoplasia
103
Patients with metabolic neurologic disease display diffuse, nonspecific signs or bilaterally symmetric deficits. The most common localizations are to _______ or _______?
The cerebrum or thalamus.
104
What are the top 5 differentials for a patient with acute, progressive, and symmetric neurologic signs?
Metabolic
Nutritional
Neoplastic
Inflammatory/infectious
Toxicity
105
What are the top 3 differentials for a patient with acute, nonprogressive neurologic signs?
Vascular
Trauma
Idiopathic
106
What are the top 7 differentials for a patient with chronic, progressive, symmetric neurologic signs?
Degenerative
Metabolic
Anomalous
Neoplastic
Nutritional
Inflammatory/infectious
Toxicity
107
What are the top 3 differentials for a patient with chronic, progressive, asymmetric neurologic signs?
Neoplastic
Inflammatory/Infectious
108
List important factors to consider when thinking about differential diagnosis for neurologic disease:
Patient signalment
Disease onset
Disease progression (improved/stabilized/deteriorated)
Lesion distribution (symmetric/asymmetric)
Travel history
109
No more than ____ mL of CSF per 5 kg of body weight should be collected.
no more than 1 mL/5kg in dogs, cats and horses.
110
True or False: Because CSF flows predominantly in a rostrocaudal direction, it is more diagnostic and therefore preferable to collect it caudal to the suspected lesion?
True.
111
Yellow or straw tinged CSF (indicating prior hemorrhagic insult) is referred to as?
Xanthochromic.
112
Xanthochromic (yellow/straw tinged) CSF indicates what?
Prior hemorrhage.
113
Elevations in both serum and CSF IgA levels are strongly suggestive of which neurologic condition?
Steroid-responsive meningitis-arteritis (SRMA).
114
What is SRMA?
Steroid-responsive meningitis-arteritis.
A systemic immune disorder characterized by inflammatory lesions of the leptomeninges and associated arteries that typically is responsive to corticosteroids.
115
Steroid-responsive meningitis-arteritis (SRMA) causes elevations in CSF and serum levels of what?
IgA
116
What are two limitations of myelography for investigating spinal cord lesions?
- Impossible to differentiate between intradural/extramedullary & intramedullary lesions bc there is overlap in imaging characteristics in these locations.
- Does not allow for evaluation of parenchymal changes w/in the spinal cord.
117
Name three advantages of MRI for investigating spinal cord lesions?
Excellent soft tissue detail (improved contrast resolution).
Allows for acquisition of images in multiple planes without a loss of image quality.
MRI is especially sensitive for differentiating intramedullary lesions from intradural/extramedullary lesions (such as FCE from meningioma).
118
What are the most common (non-neoplastic, non-anomalous) medical disorders of the vertebral column & spinal cord?
Degenerative myelopathy
Meningo(encephalo)myelitis (including SRMA, granulomatous meningoencephalomyelitis, & infectious meningomyelitis)
Discospondylitis
Hydrated nucleus pulposus extrusion
FCE
119
Degenerative Myelopathy (DM) is overrepresented in which breeds?
Greman Shepherd Dog, Pembroke Welsh Corgi, Boxers, and Rhodesian Ridgeback.
120
A genetic risk factor for DM exists in dogs, specifically a missense mutation in the _______ gene?
Superoxide dismutase (SOD1). This is the testable one.
121
Regarding SOD1 mutations, most breeds have a G-to-A nucleotide transition, however, the ______ has an A-to-T transition, which becomes important when screening this breed for DM.
Bernese Mountain Dog.
122
Clinical progression of DM usually results in a nonambulatory status within 6-9 months of diagnosis, however, _________ seem to have a slower progression, with a mean duration of signs over 19 months.
Pembroke Welsh Corgis
123
What breeds are overrepresented for SRMA?
Beagles, Boxers, Bernese Mountain Dogs, Weimaraner, and Nova Scotia Duck Tolling Retrievers
124
Age at onset for SRMA is commonly between 6 and 18 months, but may range from 4 months to 7 years, with _______% of cases being in patients less than 1 year of age.
74%
125
True or False - Idiopathic or immune-mediated meningomyelitides (e.g., SRMA, GME) predominate in the dog, whereas infectious meningoencephalomyelitis appears to be more common in the cat?
True.
126
Canine distemper virus is a member of the family Paramyxoviridae and the genus __________, which also contains Measles and Rinderpest viruses?
Morbilivirus. (Canine morbilivirus)
127
Repetitive, rhythmic, involuntary muscle contractions of the limb musculature, neck, and/or masticatory muscles are associated with what infectious meningoencephalitis?
Canine distemper
128
What is the pathologic progression of canine distemper virus meningoencephalomyelitis?
Leptomeningitis/perivascular encephalitis → Gray matter disease → White matter disease → Necrotizing meningoencephalitis.
129
Up to _____% of cats develop neurological signs associated with feline infectious peritonitis and is most commonly the ____ form.
30%, dry
130
Name appropriate empiric antibiotic choices for bacterial meningomyelitis/spinal cord epidural empyema?
Metronidazole, enrofloxacin, chloramphenicol, and TMS
131
The ___ salivary gland is most often associated with sialoliths?
Parotid
132
Name the salivary glands of the dog?
Mandibular
Sublingual
Parotid
Zygomatic
133
The incidence of primary salivary gland neoplasia in dogs can cats is ___.
0.17%
134
True or False: The mandibular and parotid salivary glands are most commonly affected by primary neoplasia?
True.
135
The mandibular gland sits at or just cranial to the bifurcation of the _____________?
External jugular vein.
136
In the ventral approach for sialoadenectomy of the sublingual and mandibular salivary glands, the salivary gland complex is tunneled underneath the ________ to facilitate rostral dissection and ligation.
Digastricus muscle.
137
When performing a parotid sialoadenectomy, which anatomic structure could be damaged that owners should be made aware of?
The facial nerve.
138
When performing a lateral approach for sublingual/mandibular sialoadenectomy, blunt dissection of fascia is performed between the ______ caudomedially and_________ rostrolaterally.
Digastricus muscle caudomedially and masseter muscle rostrolaterally.
139
For ranula marsupialization: describe 2 methods of suturing after a large, full-thickness oval area of tissue overlying the sialocele is excised?
1) external (oral) mucosa is sutured to the lining of the sialocele with small gauge, absorbable, monofilament suture.
2) Mucosal edge is folded inward and sutured (similar to hemming pants); this prevents the exposed edges of mucosa from coming into contact and healing back together.
140
What nerve and spinal cord segments mediate the patellar tendon reflex?
Femoral nerve, spinal cord segments L4-L6
141
What nerve and spinal cord segments mediate the biceps tendon reflex?
Musculocutaneous nerve, spinal cord segments C6-C8
142
What nerve and spinal cord segments mediate the triceps tendon reflex?
Radial nerve, SC segments C7-T2
143
What nerves and spinal cord segments are responsible for the thoracic limb withdrawal reflex?
Musculocutaneous, median, ulnar, and radial nerves; SC segments C6-T2
144
What nerves and spinal cord segments are responsible for the pelvic limb withdrawal reflex?
Sciatic nerve, SC segments L6-S1
145
Which nerve is damaged if a dog is unable to flex the hock or extend digits and walks on the dorsal surface of the paw?
Fibular or peroneal branch of the sciatic nerve
146
Which nerve is damaged if the patient is plantigrade in the pelvic limbs?
Tibial branch of the sciatic nerve
147
Where is the lesion if a cross extensor reflex occurs with a patient in lateral recumbency?
Lesions cranial to the spinal cord segments containing the lower motor neuron unit (ie. T3-L3, C1-C5)
148
What nerves mediate the perineal reflex?
Branches of the sacral and caudal segments of the spinal cord through the pudendal nerve
149
Muscle atrophy secondary to disturbance of the lower motor neuron innervations of the muscle is known as what?
Neurogenic atrophy
150
List the 12 cranial nerves (in order)
olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear, glossopharyngeal, vagus, accessory, hypoglossal
151
Which cranial nerves are involved in the menace response?
CN II & VII
152
The menace is a learned response that might not be present until _______________ age
10 - 12 weeks
153
Which cranial nerves are involved in PLRs?
CN II & III
154
Where is the lesion if a single eye has an absent direct PLR but present indirect PLR?
Ocular, retinal, or optic nerve
155
Where is the lesion if a single eye has absent direct and indirect PLR?
Parasympathetic oculomotor nerve nucleus of CN III or disease of the iris muscle
156
What are the 4 clinical signs of Horner’s?
Enophthalmos, ptosis, elevated 3rd eyelid, miosis
157
Match the CN with type of strabismus:
Ventrolateral →
Medial→
Eyeball extorsion →
Ventrolateral → CN III oculomotor
Medial → CN VI abducens
Eyeball extorsion → CN IV trochlear
158
What are the five major regions of the nervous system?
1. Prosencephalon 2. Mid to caudal brainstem (midbrain, pons, medulla oblongata; 3. Cerebellum 4. Spinal cord 5. LMN/ neuromuscular system
159
What would be the neurological signs associated with behavior and a lesion affecting the prosencephalon?
Seizures; abnormal behavior, propulsive walking; depression to coma
160
What would be the postural/gait associated neurological signs with a lesion affecting the cerebellum?
Intention tremor of head, neck, or eyes; opisthotonus and extensor rigidity of all limbs with hip joints flexed (severe, rostral lesions); truncal sway; head tilt; hypermetric/spastic gait with strength preserved; loss of balance
161
Number of Spinal cord segments:
cervical:
thoracic:
lumbar:
sacral:
caudal:
8 cervical; 13 thoracic, 7 lumbar, 3 sacral, 2 caudal
162
Spinal cord regions for localization?
( C1 - C 5) cranial cervical; (C6- T2) cervicothoracic; (T3- L 3) thoracolumbar; ( L4 - S3//caudal) lumbosacral
163
What are the two pain signal pathways to the brain and what do they carry?
Neospinothalamic tract (fast and acute mechanical and thermal pain type ) and paleospinothalamic tract (slow and chronic type C)
164
What is the neurotransmitter suspected to be secreted in the spinal cord at the type Aδ pain nerve fiber endings?
Glutamate
165
What is another name for the oculocephalic or oculovestibular reflex?
Physiologic nystagmus.
166
When the head is moved in a horizontal plane from side to side, it stimulates this reflex:
oculovestibular reflex / physiologic nystagmus
167
Describe the pathway of the oculovestibular reflex/physiologic nystagmus?
CN VIII sends impulses to the brainstem and vestibular nuclei, which in turn project impulses along the medial longitudinal fasciculus to abducens and oculomotor neurons, which abduct and adduct the eyeball, respectively.
168
Match the sensory branch of the trigeminal nerve to it’s laterality (medial or lateral):
Ophthalmic nerve -->
Maxillary nerve -->
Ophthalmic nerve - medial
Maxillary nerve - lateral
169
What neurologic condition is associated with a “dropped jaw”?
Idiopathic trigeminal neuritis.
170
What branch of the trigeminal nerve is affected by idiopathic trigeminal neuritis?
Mandibular nerve (causes "dropped jaw")
171
What two neural pathways are evaluated by gently stimulating the medial nasal mucosa with a pen or hemostats?
Ipsilateral branch of the ophthalmic and maxillary nerves that innervate the mucosa (local).
Nociceptive pathway to the thalamus and the cerebral cortex (central).
172
When evaluating cranial nerves IX, X and XI, a gag reflex test is commonly performed. Why is it important to take care when examining the larynx/pharynx in animals with dysphagia?
Dysphagia is a common sign of Rabies in small animals.
173
What cranial nerves does the gag reflex test?
Cranial nerves IX, X and XI
174
The response to noxious stimuli is called what?
Nociception
175
True or false, nociception can be used interchangeably with “pain.”
False.
176
Name three responses that indicate the presence of normal nociception:
Vocalization
Turning of the head
Dilation of the pupils (stimulation of thalamus or cerebellum)
177
What two types of skin grafts result in the best hair regrowth and cosmesis?
Full-thickness sheet
Unexpanded mesh
178
If_____ is advancing from the edges of a wound over healthy granulation tissue, the wound should be able to support a skin graft.
Epithelium
179
Name four types of tissue on which a graft will not take?
-Stratified squamous epithelial surfaces
-Heavily irradiated tissues
-Chronic poorly vascularized or hypertrophic granulation tissues
-Bone, cartilage or tendon
180
What happens in phase 1 of graft adherence?
Fibrin polymerization causes the attachment of graft to recipient bed to progressively gain strength. The greatest gains are in the first 8 hours.
181
When does a graft gain the most strength in phase 1 of adherence?
The first 8 hours after placement.
182
What happens in phase 2 of graft adherence?
The fibrinous network is invaded by fibroblasts, leukocytes, and phagocytes. These begin the conversion into a fibrous adhesion.
183
What is the chronological order of grafting?
Plastic imbibition, inosculation, revascularization.
184
What is the indication for a split thickness graft?
In dogs (but NOT cats - skin too thin) for reconstruction of defects with extensive skin loss.
185
What is the instrument in this image?
Brown Dermatome (nitrogen powered)
186
What is the instrument in this image?
Goulian-type graft knife
187
What is the instrument in this image?
Humby (and Watson?) graft knife
188
When the donor site of a split-thickness graft is left to heal via open wound mgmt, it heals by ___________?
Reepithelialization
189
True or False? Randomized clinical trials of human patients, have shown that the use of postop NPWT on split-thickness grafts can improve the percentage of graft survival & the cosmetic appearance.
True
190
True or False? If wound contraction causes a contracture deformity, a split-thickness graft may be advantageous, as the expansion is greater w/ split-thickness than full-thickness grafts in dogs.
True
191
Chronic granulation tissue should be completely excised, and grafting delayed until a healthy acute granulation bed forms in _____ days.
4 to 5 days
192
McKeever & Braden noted an ___% survival for thin partial-thickness grafts on dog forelimbs versus ____% for full-thickness grafts.
89% for partial thickness
58% for full thickness
193
Which grafting method would best be used for a small, non-infected wound on the distal extremity with granulation bed and minimal fluid production?
Full-thickness unmeshed graft
194
Which grafting method would best be used for a granulating wound that is parallel to the long axis of the limb?
Strip graft
195
Which grafting method would best be used for a contaminated wound over an irregular contoured area?
Pinch or punch island graft
196
Stamp grafts (chessboard grafts) are made from split-thickness or full-thickness skin that is cut into square patches. The patches are placed on _________________________________________.
A healthy bed of granulation tissue. These grafts are indicated for granulating wounds.
197
After grafting a paw pad graft, healing in the form of _____________________, ________________________, and ____________________________ forms a durable weight-bearing tissue.
Contraction, epithelialization, and hyperplasia
198
List 5 indications for mucosal grafts:
Replace a nictitans membrane
Surface a preputial reconstruction
Conjunctival replacement for eyelid defect
Line a reconstructed nasal passage
Reconstruct the urethra
199
When harvesting mucosa for a mucosal graft, what solution can be injected submucosally to control hemorrhage?
0.01% epinephrine
200
Name two pros and one con to mucosal grafts:
Rapid revascularization and healing due to thinness
Good lining tissue for where mucosa or mucosa-like tissue is needed
Difficult to handle and tend to contract into a shrivelled mass of tissue
201
An axial pattern flap can be rotated up to ____ degrees at its base to cover wounds adjacent or distant to the donor site.
180 degrees
202
Axial pattern flaps that include muscle, bone, or cartilage with the overlying skin are called___________ flaps?
Composite or compound
203
The overall survival rate of axial pattern flaps is ____%.
87% to 100%.
204
Compared with dogs, integument in cats takes _____to heal and has significantly_____ strength at closure, with _____ rates of granulation, epithelialization, and contraction?
Compared with dogs, integument in cats takes longer to heal and has significantly less strength at closure, with lower rates of granulation, epithelialization, and contraction.
205
Name the vessels the Omocervical axial pattern flap is based on & uses for this flap:
Superficial cervical branch of the omocervical a.v.
Uses: head, neck, facial, ear, cervical, shoulder, and axillary defects; Experimentally used for palatal defects
206
Name the vessels the Thoracodorsal axial pattern flap is based on & uses for this flap:
Cutaneous branch of the thoracodorsal a.v.
Uses: thoracic, shoulder, forelimb, & axillary defects
207
Name the vessels the Dorsal deep circumflex iliac axial pattern flap is based on & uses for this flap:
Dorsal branch of the deep circumflex iliac a.v.
Uses: ipsilateral flank, lateral lumbar, pelvic, & lateromedial thigh defects + areas over the greater trochanter
208
Name the vessels the Ventral deep circumflex iliac axial pattern flap is based on & uses for this flap:
Ventral branch of the deep circumflex iliac a.v.
Uses: lateral abdominal wall and pelvic defects and, as an island arterial flap, can be rotated 180 degrees to cover a sacral defect
209
Name the vessels the Caudal superficial epigastric axial pattern flap is based on & uses for this flap:
External pudendal a.v.
Uses: repair of caudal abdominal, flank, inguinal, preputial, perineal, thigh, stifle defects, & dorsal body reconstruction and full-thickness body wall reconstruction with mesh in cats
210
Name the vessels the Cranial superficial epigastric axial pattern flap is based on & uses for this flap:
Short cutaneous branches of the cranial superficial epigastric a. (which supplies blood to the cranial abdominal mammary glands)
Uses: closure of wounds on the sternal region
211
The most commonly used flaps include the omocervical, thoracodorsal, deep circumflex iliac, and caudal superficial epigastric. Which of these flaps are the most versatile?
Thoracodorsal
Caudal superficial epigastric
212
What is the main concern for the omocervical axial pattern flap since it is not as robust as the thoracodorsal axial pattern flap?
Distal flap necrosis.
213
Name this flap?
True or False: The flap should be elevated above the panniculus muscle.
Cranial superficial epigastric
False
214
Name this flap?
Caudal superficial epigastric
215
Name this flap?
Omocervical
215
Name this flap?
Thoracodorsal
216
Name this flap?
Dorsal deep circumflex iliac
217
Name these flaps?
1. Caudal auricular
2. Omocervical
3. Thoracodorsal
4. Caudal superficial epigastric
5. Lateral genicular
6. deep circumflex iliac
7. Lateral caudal (inset)
8. Superficial brachial (inset)
9. Superficial temporal
218
Name the branches of the facial artery?
Superior labial, Angularis oris, Inferior labial
219
The length of the superficial temporal flap is recommended to extend no further than the middle of __________________?
Dorsal orbital rim of the contralateral eye.
220
True or False? Transection of the rostral auricular nerve plexus
affects eyelid function.
False - it has no effect.
221
Name the landmarks for the caudal auricular pattern flap:
Base: _____
Width: _____
Center: ____
Maximal Flap Length: ______
Base → palpable depression b/w the wing of the atlas and the vertical ear canal at the base of the ear
Width → (dogs) central third of the dog’s lateral profile
Center → over the wing of the atlas with dorsal and ventral incisions parallel to each other; in cats, the dorsal incision is closer to midline because of their conformation
Max flap length → extends to the spine of the scapula
222
The genicular axillary pattern flap is based on genicular branches of the _______artery and _______vein. This flap can be used to repair defects in which part of the limb?
Saphenous a., medial saphenous v.
From the stifle to tibiotarsal joint (medial/lateral aspect)
223
For the latissimus dorsi myocutaneous flap, which artery supplies the dorsal portion of the muscle? Ventral portion?
Dorsal: Thoracodorsal a.
Ventral: Lateral thoracic aa.
