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Phase II 2023 flashcards > Urogenital > Flashcards

Urogenital Flashcards

1
Q
A
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2
Q
  1. What is tunica dartos? Action?
A

a. Smooth muscle that separates cavities and helps draw testes to abdomen / body

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3
Q
  1. What is between outer/inner tunics?
A

a. “Vaginal cavity” – continuous with peritoneal cavity at external inguinal ring

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4
Q
  1. What type of cells do you see on cytology during estrus?
A

a. Keratinized cornified epithelium, superficial cells
b. Some bacterial flora
c. Should NOT see neutrophils (except in diestrus)

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5
Q
  1. Give origin / insertion of each muscle and general location on penis
    a. Retractor penis
    b. Ischiocavernosus
    c. Bulbospongiosus
    d. Ischiourethralis
A

a. Retractor penis – smooth muscle caudal half with external anal sphincter – ventral surface insert on penis at level of preputial fornix
b. Ischiocavernosus
i. O: ischial tuberosity
ii. I: proximal corpus cavernosum
c. Bulbospongiosus
i. O: from tunica albuginea and EAS covers bulb of penis; fuse with retractor peenis at 1/3 of body
d. Ischiourethralis
i. O: dorsal ischial tuberosity
ii. I: fibrous ring at urethral bulb

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6
Q
  1. Where do proper ligament of testis & ligament of tail of epididymis attach?
A

a. Epididymal tail to testis
b. Testis / epididymis to vaginal tunic & spermatic fascia

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7
Q
  1. Describe lymph & nervous systems of prostate
A

a. Lymph: medial iliac + hypogastric chain of nodes
b. Nerves:
i. Fluid excretion / secretion: cholinergic post-ganglionic hypogastric (S)
ii. Smooth mm contraction: adrenergic post-gang hypogastric (S)
iii. +/- parasymp pelvic n to increase rate secretion
iv. Stromal tissue: nonadrenergic to control smooth mm tone, several NTS

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8
Q
  1. What is diameter of feline ureter? Dog ureter?
A

a. Feline: 0.4 mm
b. Dog: “0.07 x length of L2 body” (studies show 2-2.5 mm on CT)

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9
Q
  1. Describe vascular & nerve supply to ureter
A

a. Vascular: Ureteral a from caudal aspect of renal a  ureteric branch of caudal vesicular a
b. Nerve: ANS – PS/S from pelvic plexus; S – celiac plexus

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10
Q
  1. What are macula densa?
A

a. Cells outside of glomerulus that maintain autoregulation of blood flow

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11
Q
  1. What size particles filter in glomerulus?
A

a. <60,000 Daltons

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12
Q
  1. What charged molecules can’t filter in glomerulus?
A

a. Negative (like albumin)

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13
Q
  1. What is normal urine production?
A

a. 20-45 ml/kg/day

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14
Q
  1. What % of cardiac output is through kidney at all times?
A

a. 25%

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15
Q
  1. During embryonic development, what is cranial vagina formed from?
A

a. Paired paramesonephric (Mullerian) ducts

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16
Q
  1. What is the genital tubercle?
A

a. Analogous to penis or vaginal clitoris (lots of nerve endings)

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17
Q
  1. What is the uterine ostium?
A

a. The opening of uterine tube to the uterine body (acts like sphincter)

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18
Q
  1. What is different about the cat with respect to ovarian tube?
A

a. Tube tortuous and can be seen within mesosalpinx

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19
Q
  1. When does mucosal healing occur in bladder?
A

a. 5 days

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20
Q
  1. How long until 100% bladder tissue strength?
A

a. 14-21 days

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21
Q
  1. What are the accessory sex glands of dogs vs cats?
A

a. Dog: prostate
b. Cat: bulbourethral gland (thick mucous) + prostate (alkaline fluid for survival of sperm)

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22
Q
  1. Describe the blood supply, LN, nerves to vagina/vestibule, vulva
A

a. Arteries:
i. Vagina, urethra, vestibule – vaginal a from internal pudendal
ii. Vulva – external pudendal
b. Venous: same as arterial
c. LN:
i. Vagina/vestibule – internal iliac LN
ii. Vulva – superficial iliac LN
d. Nerves:
i. PS – pelvic
ii. S – hypogastric
iii. Sensory – pudendal

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23
Q
  1. Describe innervation and micturition reflex
A

a. Urine fill / retention -> sympathetic via hypogastric
i. + alpha at IUS to contract
ii. + beta 3 on detrusor – relaxes detrusor
b. Urination – full bladder – stretch on m3 receptor – afferent pelvic – pontine contract
i. Parasym via pelvic n – binds m3 to contract detrusor – pees
ii. Inhibits pudendal & hypogastric
1. Pudendal – somatic efferent to m3 on external urethral sphincter
See fig 116.3 bladder

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24
Q
  1. What is contained in spermatic cord?
A

a. Ductus deferens (ductus a/v), testicular a, pampiniform plexus, lymph, nerves, cremaster m

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25
Q
  1. What forms spermatic fascia?
A

a. Transversalis, superficial / deep abdominal fascia

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26
Q
  1. What forms cremaster m? Action?
A

a. IAO, transversus abdominus
b. Raises / lowers testes

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27
Q
  1. Average size of dog / cat ovaries?
A

a. Dog: 15 x 7 x 5 mm
b. Cat: 8-9 mm long

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28
Q
  1. What is the vaginal process?
A

a. Peritoneal fold that encloses round ligament as passes through inguinal canal

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29
Q
  1. Vascular, LN, nerve supply to ovaries?
A

a. Ovarian a from aorta
b. R ovarian V -> Cd VC
c. L ovarian V -> L renal V
d. Lumbar LNs
e. Sympathetic division of ANS

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30
Q
  1. Describe vasculature, nerve, and lymph supply to testes / epididymis
A

a. Testes:
i. Testicular a from aorta
ii. Testicular V -> forms pampiniform flexus
1. R testicular V drains into -> Cd VC
2. L -> L renal V + ductus deferens vein
b. Epididymis:
i. Ductus deferens a - branch of prostatic a – arises from branch of internal iliac
c. Nerves: testicular (internal spermatic plexus)
i. Epi (L4-L6 ganglia of sympathetic trunk)
d. Lymph: lumbar LN

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31
Q
  1. What are main differences between feline & canine reproductive cycles?
A

a. Feline: seasonally polyestrus (+/- 5th “nonestrus” phase)
i. Vulva not responsive to estrogen
ii. CL requires induction of ovulation via copulation (CL functional 37 d in non-preggo cats)
iii. Bone mineralization seen 25-29 days before birth (week earlier than dogs)
iv. Placental secretion of progesterone independent of ovaries – occurs after day 40

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32
Q
  1. Where do preputial muscle originate? Insert?
A

a. O: xiphoid cartilage
b. I: dorsal wall of prepuce
c. Derived from cutaneous trunci

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33
Q
  1. What maintains normal prostate lot (secretion?)?
A

a. Androgens

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34
Q
  1. What breeds already have prostate in abdomen from birth (to adulthood)?
A

a. Chondrodystrophic

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35
Q
  1. What are colliculis seminalis?
A

a. Slits where prostate gland ejaculation ducts enters prostatic urethra

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36
Q
  1. What point in growth is prostate development most marked?
A

a. 20-32 week of age

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37
Q
  1. Where are the nephrons impermeable to urea?
A

a. Thick look of Henle
b. Distal tubules
c. Cortical collecting ducts
d. Can be partly absorbed in PCT (medullary collecting tubules?)

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38
Q
  1. What can you give to tx hyperkalemia for urethral obstruction?
A

a. If ECG changes or K > 8
i. Ca gluconate 0.5-1.5 ml/kg IV over 5-10 min
ii. Dextrose + insulin
iii. IVF diuresis the best start

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39
Q
  1. What is relative concentration of renal medullary interstitium vs cortical? Hypertonicity created by __?
A

a. 1200-1400 mOsm/L vs 300 cortex
b. Diffusion of urea into interstitium at CD (gives 50% of osmolarity)
c. Limited ability of water to diffuse into interstitium (only descending loop)
d. Active transport of Na, K, Cl from thick portion of loop of Henle

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40
Q
  1. What are the 4 phases of estrus cycle & what are the prominent hormone changes here?
A

a. Proestrus – 9 days – estrogen elevation & follicle maturity
b. Estrus – 9 days – LH surge as estrogen decreases; also progesterone starting to rise; ovulation w/I 2-3 days after LH surge
c. Diestrus – 60 days – where stays in pregnancy if fertilized; increase progesterone levels
d. Anestrus – 4.5 months – low levels of everything; slow rise of estrogen towards pro/estrus?

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41
Q
  1. Urethra blood supply & innervation?
A

a. Nerve: PS (pelvic); S (hypogastric) – smooth m
i. Pudendal – somatic – striated
b. BS: branches of internal pudendal
i. Prostate – urethral
ii. Vaginal – urethral

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42
Q
  1. What are changes seen on ECG with hyperkalemia from blocked urethra?
A

a. Spiked T to depress R wave
b. Prolonged QRS and PR intervals
c. ST segment depression
d. Smaller/ wider P with long QT interval
e. Atrial standstill
f. Wide QRS
g. Ventricular arrhythmias

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43
Q
  1. What are 3 stages of parturition and what are guidelines or concerns?
A

a. 1: Uterine contractions present ~24 hours, nesting behaviour, etc
b. 2: Expel fetus
c. 3: Expel placenta
d. Active strain <= 30 min before birth; time lab between puppies <4 hours

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44
Q
  1. 3 major types of cells of testes and roles
A

a. Spermatogenic cell – form the sperm
i. Mitosis –> spermatocytes –> meiosis to spermatids
b. Sertoli cells – “nurse or sustentacular cells”
i. Nourish and support development of spermatozoa
ii. + by FSH (from the anterior pituitary gland), produce inhibin
iii. Pituitary inhibits FSH; Inhibin inhibits FSH (negative FB)
c. Leydig cells – produce testosterone
i. Dependent on negative feedback with LH

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45
Q
  1. What are factors that help keep scrotum / testes cool?
A

a. Cremaster + tunica dartos contracts
b. Rich in sweat glands
c. Little SQ fat
d. Few hair follicles
e. Pampiniform plexus cools blood

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46
Q
  1. What is blood supply, nerves, lymph for scrotum?
A

a. External pudendal a  scrotal a
b. Scrotal V
c. Nerves: superficial perineal n – branch of pudendal (S1-S3)
i. Tunica dartos  inn by post ganglionic sympathetic trunk from superficial perineal n
1. NOT PELVIC PLEXUS
d. Lymph: Superficial inguinal LN

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47
Q
  1. Describe the muscular layer of ureter
A

a. tunica muscularis = Inner & outer longitudinal, middle circular layers
b. Pitch of muscle fibers = circular proximally
i. Oblique toward mid-length
ii. Longitudinal distally

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48
Q
  1. What are the 2 mechanisms of developing an erection?
A

a. Engorgement of cavernous bodies by expansion of arteries / contraction of veins
b. Distal penile vein compressed against ischial arch by contraction of ischiocavernosus and bulbospongiosus muscles

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49
Q
  1. Describe blood supply and lymph of bladder
A

a. Caudal vesical a – prostatic / vaginal  internal pudendal
b. Cranial vesical a – from umbilical
c. Internal pudendal v
d. Lymph: hypogastric & sublumbar LN

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50
Q
  1. Describe vascular supply of kidneys
A

a. Renal a (left +/- 2) “The left kidney is more likely to have multiple renal arteries than the right kidney. Some single renal arteries branch immediately after leaving the aorta, making it appear that the kidney has two renal arteries”
i. Renal a splits into dorsal and ventral ranches at hilus
ii. Then branch into Interlobar – arcuate (corticomedullary junction) – interlobar – afferent – efferent
iii. Small capsular a – from phrenicoabdominal / adrenal
iv. Vasa recta – wrap around nephron
b. Venous
i. Deep & superficial v within renal parenchyma – stellate – interlobar – arcuate – renal v – CdVC
ii. Left renal V also gets blood from L ovarian or L testicular V

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51
Q
  1. What are the functions of the prostatic secretions? What is it composed of?
A

a. Promote sperm motility
b. Increase uterine perfusion
c. Modulate neutrophil induced inhibition of spermatozoa attachment to uterine epithelium
d. pH 6.1-6.5, PGE2, Na, K, Cl, + Zn, acid phosphatase + esterase
e. in 3rd fraction of ejaculation

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52
Q
  1. Gestation length dogs / cats?
A

a. Dogs: 64 days
b. Cats: 66 days

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53
Q
  1. When are fetal skeleton detected on rads dogs / cats?
A

a. Dogs: day 42 (21-24 days before parturition)
b. Cats: 25-29 days before parturition

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54
Q
  1. When does attachment occur in dogs / cats?
A

a. Dogs: 21-22 days post LH surge
b. Cats: 15 days after coitus

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55
Q
  1. What are the changes in bloodwork commonly seen during pregnancy in dogs?
A

a. Anemia ~<40% at 35 days, <35% at term
b. Mild increases in WBC, cholesterol
c. Decreased protein
d. Increased glucose – insulin resistance
e. Progesterone – decreases 18-30 hours pre-partum

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56
Q
  1. Describe vascular supply to prostate
A

a. Internal pudendal – prostatic a -> arteries of ductus deferens - caudal vesical, caudal rectal
b. Anastomoses between Prostatic a – urethral a – cranial & caudal rectal a
c. Cranial / middle / caudal branch – subcapsular a -> supplies glandular tissue
d. Parenchyma, capsular, and urethra vascular zones
e. Venous:
i. Prostatic v & urethral v -> internal iliac v
ii. Prostatic urethra -> prostatic v, v of urethral bulb, ventral prostate veins

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57
Q
  1. What is the nerve supply to penis? Lymph nodes?
A

a. Pelvic & sacral plexuses; dorsal n of penis – chief sensory n
b. Superficial inguinal LN

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58
Q
  1. Describe the vascular supply, lymph centers, and nerve supply to uterus
A

a. Uterine arteries
i. Branch of vaginal – branch of internal pudendal – branch of internal iliac
b. LN: hypogastric & lumbar
c. N: pelvic plexus  S – hypogastric; PS – pelvic

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59
Q
  1. What are proposed reasons estrogen helps with BPH development?
A

a. Increased sensitivity of prostate to dihydrotestosterone by inducing nuclear dihydrotestosterone receptors
b. Inhibitory effect on rate of cell death?

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60
Q
  1. Describe the differences between glandular and complex form of BPH?
A

a. Glandular:
i. Testosterone metabolized by 5 alpha reductase  dihydrotestosterone
ii. Structure and arrangement remain orderly and organized at stage
iii. Increased androgen receptors (maybe less cell death?)
b. Complex:
i. Stromal elements – asymmetric enlargement
ii. Areas of atrophy, cystic alveoli with eosinophilic materials & inflammatory cells

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61
Q
  1. What are main differences between urethra of male / female dogs / cats?
A

a. Male dog:
i. No pre-prostatic urethra
ii. Thick circular striated surrounds long smooth in distal 2/3
iii. Long penile component
b. Male cat:
i. Distinct pre-prostatic
ii. Pre and post-prostatic urethra 2mm diameter (prostate)
iii. Bulbourethral glands 1.3 mm
iv. Penile 0.7 mm
v. 3 layers of smooth muscle fibres of preprostatic urethra
vi. Striated (urethralis) muscle short functional length
c. Female dog:
i. Short / wide 0.5 cm
ii. A lot more collagen!
iii. 3 smooth layers
iv. Interdigitate with striated muscle distal 1/3
v. Sphincter of voluntary striated mm at external urethral orifice.
d. Female cat:
i. Smaller lumen than dog
ii. Urethral wall lot more longitudinal smooth & less striated mm

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62
Q
  1. What are the origins / insertions & what are they intimately associated with?
    a. Corpora cavernosa
    b. Corpus spongiosum
    c. Bulbus glandis
A

a. Corpora cavernosa
i. Ishial tuberosity  dorsal to os penis
ii. Covered by tunica albuginea
b. Corpus spongiosum
i. Within pelvic cavity – surrounds penile urethra
ii. Also shunts blood to bulbus glandis
c. Bulbus glandis
i. Proximal part of os penis
ii. Separated from longa glandis (distal)
iii. Expands way more than long glandis for erection

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63
Q
  1. What % spays get complications?
A

a. ~7.9-19% (mostly minor)

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64
Q
  1. What are options for port locations for OVE/OVH?
A

a. Transabdominal – all midline
b. Transabdominal – midline + cranial R side
c. Transabdominal – paramedial ports (instruments)
i. All 3 or 2 port
d. Combi – transabdominal + transvaginal
e. Single port transabdominal

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65
Q
  1. Vessel sealing devices only use on uterus < __ mm
A

a. 9 mm

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66
Q
  1. When do you perform laparoscopic artificial insemination (as in bloodwork with cytology)?
A

a. Progesterone 4-8 ng/mL; when >= 80% superficial cells on vaginal cytology

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67
Q
  1. What does low serum LH in bitch indicate?
A

a. Intact status; OR ovarian remnants if spayed <10 days ago

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68
Q
  1. What does chronic increased plasma estrogen indicate?
A

a. Follicular cysts
b. Estrogen producing tumors

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69
Q
  1. What bloodwork changes come with leutinized follicular cysts?
A

a. Increased progesterone with normal estrogen conc and no signs of proestrus or estrus

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70
Q
  1. What are advantages of scrotal urethrostomy in male dogs?
A

a. More superficial, wider, less hemorrhage
b. Less urine scald / UTI / incontinence with others

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71
Q
  1. What are urethrostomy options for females?
A

a. Subpubic & prepubic

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72
Q
  1. What is complication rate for perineal urethrostomy in cats?
A

a. Newer studies 12-15%

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73
Q
  1. List surgical techniques for urethrostomy in cats
A

a. Perineal
b. Transpelvic
c. Subpubic
d. Prepubic

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74
Q
  1. Which has increased rate of complications?
A

a. Prepubic

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75
Q
  1. Prognosis for urethral R&A?
A

a. Guarded prognosis

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76
Q
  1. What is epispadias? What could happen with it?
A

a. Failure of fusion of dorsal penile urethra –> bladder exstrophy

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77
Q
  1. What breeds at risk for urethral prolapse?
A

a. Brachycephalic; English Bulldog

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78
Q
  1. What are tx options for urethral prolapse?
A

a. Castration
b. Phallopexy
c. Urethral R&A
d. Reduse + purse string
e. Treat BOAS

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79
Q
  1. Recurrence rates of urethral prolapse post sx? What should you be giving post-op to help decrease?
A

a. 50-60%; sedation with ace/butorphanol

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80
Q
  1. List suspected factors affecting causes of USMI
A

a. Urethral tone & length (shorter)
b. Bladder neck position (pelvic bladder)
c. Body size & breed (overweight, longer breeds)
d. Gonadectomy (affect collagen levels?)
e. Hormonal status (decreased estrogen)
f. Genital conformation (vestibulovaginal stenosis)

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81
Q
  1. List treatment options for USMI and their success rates
A

a. Sympathimomimetics or parasympatholytics ~50% alone
i. Estrogen ~50%
ii. Alpha agonist phenylpropanolamine
b. GnRH analogues (decrease pituitary release LH/FSH) ~50-83%
c. Colposuspension ~53-55%
d. Urethropexy / cystourethropexy 56%
e. Bulking agents
f. Transpelvic urethral sling
g. Transobturator vaginal tape
h. Artificial urethral sphincter 33-45%

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82
Q
  1. What is % continence rate for urethropexy + colposuspension?
A

a. 70%

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83
Q
  1. What is complication rate of urethropexy?
A

a. 21%

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84
Q
  1. What substance is used for a bulking agent?
A

a. Bovine collagen

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85
Q
  1. What is complication rate for transobturator vaginal tape?
A

a. 33%

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86
Q
  1. For artificial urethral sphincter, what is it made of?
A

a. Silicone

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87
Q
  1. What is the artificial urethral sphincter implant size based on?
A

a. Luminal diameter of closed cuff

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88
Q
  1. To avoid obstruction, should be __% of urethral circumference.
A

a. 50%

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89
Q
  1. What is complete continence rate for this surgery?
A

a. 36-56%

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90
Q
  1. UTI rate?
A

a. 63%

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91
Q
  1. What immunosuppression drug is not OK for dogs with renal transplants?
A

a. Tacrolimus – more severe side effects

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92
Q
  1. What method is the choice for monitoring cyclosporine concentration?
A

a. HPLC method – measures parent compound

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93
Q
  1. What is formulation of choice for cyclosporine and why?
A

a. Neoral 100 mg/ml
b. Microemulsified formulation; better GI absorption and sustained blood levels
c. More predictable
d. 1-4 mg/kg q12

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94
Q
  1. What are the goal cyclosporine target levels?
A

a. 300-500 ng/mL (eventually 250 ng/ml)

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95
Q
  1. What is current immunosuppressive protocol for canine kidney transplants?
A

a. Cyclosporine (Neoral) 2-5 mg/kg PO q12
b. Prednisolone 1 mg/kg/d PO
c. Azathioprine 3-5 mg/kg PO q48

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96
Q
  1. With the donor cat/dog (renal transplant) when is mannitol given?
A

a. At time of incision and 20 min before nephrectomy

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97
Q
  1. What drug for analgesia in dogs to avoid and why?
A

a. Morphine – concern for intussusception

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98
Q
  1. What is the kidney graft store in between procedures?
A

a. Ice cold phosphate-buffered sucrose organ preservation solution

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99
Q
  1. What are the former and newer anastomosis sites of renal transplantation in cats?
A

a. Former: External iliac a/v
b. Newer: Aorta; then CdVC

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100
Q
  1. What was the problem of former technique of renal transplantation in cats?
A

a. one report using this technique, ~12% of cats developed some form of pelvic limb complications, including pain, limb edema, hypothermia, paresis, or paralysis

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101
Q
  1. List 3 neoureterocystostomy techniques used
A

a. Intravesicular mucosal apposition
b. Extravesicular
c. Ureter + papilla excised and anastomosis with bladder (extravesicular)

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102
Q
  1. Two methods of pexy of donor kidney?
A

a. Allograft pexy to wall or musculoperitoneal flap (base ventral) suture to capsule

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103
Q
  1. What percent canines get intussusception post renal transplant?
A

a. 25%

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104
Q
  1. What is hemolytic uremic syndrome?
A

a. Side effect of cyclosporine therapy (cats)
b. Hemolytic anemia, thrombocytopenia, rapid deterioration of renal function secondary to glomerular & renal arteriolar platelet & fibrin thrombi

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105
Q
  1. What is mortality rate with hemolytic uremic syndrome?
A

a. 100%

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106
Q
  1. What is incidence of acute rejection in cats?
A

a. 13-26%

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107
Q
  1. What are methods of diagnosis of acute rejection?
A

a. AUS +/- contrast enhancement,
b. CS
c. Urine sediment  stones / minerals?

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108
Q
  1. Tx for acute rejection in cats?
A

a. IV cyclosporine, prednisolone-Na-succinate IV, IVF
b. If no improvement  evaluate for another cause
c. Newer sx? Euth?

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109
Q
  1. List complications with kidney transplants in cats vs dogs
A

a. Cats: acute rejection, chronic rejection, hemolytic uremic syndrome, Ca oxalate urolithiasis, retroperitoneal fibrosis, ureteral obstruction, infection, diabetes mellitus, neoplasia
b. Dogs: thromboemboli, intussusception, infection, graft rejection, renal dysfunction, cardiac failure, neurotoxicity, ocular toxicity, hepatotoxicity, gingival hyperplasia

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110
Q
  1. MST for renal transplants
A

a. Cats: 360-613 days
b. Dogs: 24 days (0.5-4014 d)

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111
Q
  1. Diagnostic options for ovarian remnant syndrome
A

a. Hormone – estradiol / progesterone
b. LH concentration
c. Anti-mullerian
d. AUS
e. CT

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112
Q
  1. What do you have to do with cats for evaluating progesterone?
A

a. Needs luteinization hCG or GnRH then measure 5-7 days after giving

113
Q
  1. On abdominal palpation of uterus, when are fetuses more palpable?
114
Q
  1. Progesterone causes pyometra how?
A

a. Increases endometrial glandular secretion & suppress contractions of uterus
b. Also decreases proliferative response of mononuclear cells indicating immune suppression

115
Q
  1. What might be a reason for anemia with pyometra?
A

a. Anemia – lactoferrin and others mediate iron sequestration within myeloid cells in bone marrow, withdrawing Fe from normal EPO

116
Q
  1. What % cases of pyometra get glomerular damage?
117
Q
  1. What is most common cause of dystocia
A

a. Primary inertia  72% days

118
Q
  1. Treatment for dystocia?
A

a. Oxytocin (0.2 U/5 kg) IM or SQ q30 minutes – if no progress after 2  surgery
b. Ca gluconate + glucose controversial

119
Q
  1. What is % success rate med mgmt alone for dystocia
A

a. 30-40%; 60-65% need C section

120
Q
  1. What progesterone level suggests birth happening soon?
A

a. <2 ng/ml

121
Q
  1. What is tx of secondary inertia?
A

a. Surgery, not medical mgmt.

122
Q
  1. For planned C-section, when is it planned?
A

a. 63-65 days post LH surge; or when late gestational serum progesterone <2 ng/ml

123
Q
  1. What drugs are associated (with relation to anesthesia) with increased puppy mortality rate?
A

a. Methoxyflurane or xylazine

124
Q
  1. With low fetal heart rate, what can be given? (still in womb, so giving to dam)
A

a. Atropine; glycopyrrolate – doesn’t cross placenta!

125
Q
  1. If bradycardia with fetus once delivered? What do you give?
A

a. Start with oxygen therapy!! Then epi if needed

126
Q
  1. List 2 approaches to vagina
A

a. Episiotomy
b. Ventral
c. Combined abdominal + perineal approach

127
Q
  1. List types of vestibulovaginal stenotic lesions
A

a. Focal hypoplasia
b. Imperforate hymen
c. Vertical septum
d. Double vagina

128
Q
  1. List vestibulovaginal stenosis treatment options
A

a. Episiotomy – excise septum
b. Vaginoplasty / resection
c. Vaginal R&A
d. Severe or stenosis >2cm cranial to vestibulovaginal junction – vaginectomy

129
Q
  1. What % of vaginal neoplasias are benign?
130
Q
  1. What is the surgery approach for wide resection of vaginal / vulvar / vestibular tumors? What is its limitation?
A

a. Vulvovaginectomy & perineal urethrostomy through caudal approach
b. ONLY if caudal to cervix

131
Q
  1. What test (blood) alone to rule out bilateral cryptorchid vs anorchid?
A

a. Testosterone

132
Q
  1. What age is when testes descend?
A

a. 30-40 days

133
Q
  1. When (age) can you definitively diagnose cryptorchid?
A

a. 6 months

134
Q
  1. List breeds with cryptorchidism
A

a. Chihuahua, Mini schnauzer, Pomeranian, Poodle (mini, toy, standard), Shetland sheepdog, Husky, yorkie, Cat – persians

135
Q
  1. What are primary vs secondary scrotal tumors?
A

a. Primary: MCT, melanoma, vascular hamartomas, HSA, hemangiomas, histiocytomas, papillomas, fibroma/sarcoma, SCC, adenocarcinoma, apocrine gland tumors
b. Secondary: Sertoli cell, interstitial

136
Q
  1. List breed predispositions for scrotal neoplasias
A

a. MCT: Pitties, Boxers, beagles, boston, vizslas
b. Melanoma: Schnauzers, goldens
c. Vascular hamartomas: Bassets, Boxers
d. Histiocytomas: Beagles, Boxers
e. HSA / Hemangiomas: Goldens, Boxers

137
Q
  1. List approaches for vasectomy
A

a. Inguinal
b. Open caudal midline abdominal
c. Abdominal laparoscopy-assisted
d. Prescrotal or scrotal incision (separate on test?)

138
Q
  1. What are majority complications listed for cryptorchid castrations
A

a. Prostatectomy
b. Partial prostatectomy
c. Urethral / ureteral avulsions

139
Q
  1. What has been the length of time reported for sperm persisting after vasectomy?
140
Q
  1. What is hypospadias? Breed predisposed? Treatment?
A

a. Failure of fusion of urogenital folds – incomplete formation of penile urethra & external orifice even more caudal
b. Boston
c. Recon NOT done
i. Excise preputial / penile remnant
ii. Bilateral orchiectomy
iii. Enlarge urethral orifice

141
Q
  1. What is indication for preputial shortening?
A

a. When large part of glans penis removed

142
Q
  1. What breeds seen with persistent penile frenulum?
A

a. Cocker spaniel
b. Mini poodle
c. Pekingese

143
Q
  1. Surgical options with penile tumors?
A

a. Partial penile amputation
b. Penial amp / ablation + scrotal urethrostomy

144
Q
  1. Difference between paraphimosis vs phimosis? Prognosis of each?
A

a. Paraphimosis – penis protrudes, cant replace  guarded
b. Phimosis – cant protrude penis past orifice  good

145
Q
  1. Surgical treatment options for paraphimosis?
A

a. Temp or surgical enlargement of preputial orifice
b. Phallopexy (+/- preputial advancement)
c. Partial penile amp
d. Penile amp

146
Q
  1. Surgical options of preputial hypoplasia?
A

a. Remove open prepuce, partial penile amp, scrotal / perineal urethrostomy
b. Preputial advancement (guarded)

147
Q
  1. What are tx options for prostatitis / abscesses?
A

a. Ablation of secretory function + abx
b. Stoma drainage (marsupialization)
c. Passive drainage (penrose)
d. Active drainage
e. Partial prostatectomy
f. Omentalization

148
Q
  1. What antibiotics work best to get through lipid barrier of prostate?
A

a. Enrofloxacin
b. Marbofloxacin
c. TMS
d. Chloramphenicol

149
Q
  1. What has been reported to be inserted into abscess with US guidance?
A

a. Alcohol

150
Q
  1. Describe 2 forms of carcinoma classification of prostate?
A

a. First: Glandular, urothelial, squamoid, sarcomatoid
b. Second: (growth patterns) papillary, cribiford, solid, small acinar / ductal, signet ring, mucinous

151
Q
  1. What % of prostatic carcinomas get axial mets (skeletal)?
152
Q
  1. List treatment options for prostatic carcinomas
A

a. Tube cystotomy
b. Urethral stenting +/- prazosin
c. NSAID
d. Bisphosphonates
e. Total prostatectomy
f. Partial prostatectomy
g. RT – stereotactic or intensity modulated
h. Nd:YAG laser fillet + photo dynamic therapy

153
Q
  1. What lays along the dorsal prostate to care for with surgical approaches?
A

a. Vascular supply + hypogastric / pelvic nerves

154
Q
  1. How do you open capsule if bilateral prostate abscesses?
A

a. Use hemostat to wrap gently around and bluntly to open ALL cavities

155
Q
  1. What mortality rate of ventral drainage of prostatic abscesses?
156
Q
  1. Success rate for prostatic omentalization?
A

a. Overall good as long as ALL cavities bluntly dissected

157
Q
  1. What tool is helpful to perform partial prostatectomy?
A

a. Ultrasonic aspirator

158
Q
  1. Complications of partial prostatectomy?
A

a. Recurrence, urinary incontinence, hemorrhage

159
Q
  1. What is the difference between cat and dog prostate?
A

a. Feline prostate – bilobed

160
Q
  1. Prognosis for total prostatectomy for neoplasia?
161
Q
  1. On rads, normal canine kidney is __ x length of adjacent vertebrae; normal feline is __ x length of adjacent vertebrae
A

a. Dog: 2-2.5 x , Cats: 2-3 x

162
Q
  1. List imaging modalities to evaluate kidneys
A

a. Survey radiography
b. Excretory urogram (aka IV pyelofram)
c. Pyelography (direct injection pelvis)
d. US  + Doppler US to look at resistance index
e. CT angiography
f. Dynamic CT
g. MRI angiography
h. Scintigraphy

163
Q
  1. What are 2 cautions with IV contrast studies?
A

a. Toxicity – iodine can cause renal toxicity
b. Kidneys with little functional capacity can opacify

164
Q
  1. Bolus injection – what is contrast dose?
A

a. 400 mg iodine / kg BW

165
Q
  1. Explain 3 phases of contrast execution?
A

a. 1st – renal angiographic – arterial supply to kidney (immediately after)
b. 2nd – renal phase “renal blush” – spreads through parenchyma
c. 3rd – excretory – flows collecting ducts transport to renal pelvis; then leaves/ transports to ureters

166
Q
  1. What are the times to take the images for IV pyelogram?
A

a. 5, 20, and 40 min after injection

167
Q
  1. What is equation for resistance index? What is normal value?
A

a. RI = [(peak systolic shift – minimum diastolic shift) / peak systolic shift]

168
Q
  1. What is comparison of dynamic renal scintigraphy to plasma clearance studies?
A

a. Dynamic RS  less accurate to get GFR, but shorter sampling times

169
Q
  1. What are the 2 radiopharmaceuticals and which is better for GFR in limited renal function?
A

a. 99mTC-DTPA = diethylenetriaminepentaacetic acid (no secretion or tubular absorption)
b. 99mTc-MAG3 = mercaptoacetyltriglycine (secreted by renal tubules 90%) – better option!!

170
Q
  1. For renal patients, what drugs should be given for hypotension if not responding to fluids?
A

a. Dopamine or dobutamine

171
Q
  1. What is the difference between renal agenesis and dysgenesis?
A

a. Agenesis – no presence of ureter or kidney
b. Dysgenesis – no kidney BUT has ureter

172
Q
  1. What breeds get polycystic kidney disease - Cats vs dogs?
A

a. Cats – Persian cats (37% of this population); Ragdoll. British short hair, Scottish folds, Rexes, Chartreux
b. Dogs: Bull terrier

173
Q
  1. MST for renal HSA in dogs?
A

a. 278 days

174
Q
  1. What are tx options for renal trauma?
A

a. Wrap semielastic polyglactin mesh
b. Polyglycolid acid mesh
c. Usually – unilateral ureteronephrectomy

175
Q
  1. What is tx for idiopathic renal hematuria?
A

a. Local sclerotherapy with renal pelvic infusions of povidone-iodine and silver nitrate

176
Q
  1. What is the kidney worm? Tx?
A

a. Dioctophyma renale – ureteronephrectomy (no drugs effective)

177
Q
  1. Medical management options for feline ureterolithiasis?
A

a. Diurese!!! – Ca channel blocker
b. Glucagon
c. Amitriptyline

178
Q
  1. What are other options to treat feline ureteroliths?
A

a. Lithotripsy
b. Ureteral stent
c. SUB
d. Ureterotomy (?) – mortality – 18-21 so not really done
e. Ureteral resection + implantation

179
Q
  1. With SUBs, what is outcome?
A

a. 92% remain patent long term

180
Q
  1. What % SUBs get occluded from uroliths?
181
Q
  1. What dog breeds are at higher risk with ureteral ectopia?
A

a. UK – Skye terrier, Goldens, labs
b. USA – Husky, Newfie, Bulldog, Westie, fox terrier, mini / toy poodles

182
Q
  1. Imaging options for diagnosing ectopic ureters?
A

a. Excretory urography
b. CT
c. US
d. Endoscopy
e. Fluoroscopy excretory urethrography

183
Q
  1. What are sx options for extramural vs intramural urethral ectopic ureters?
A

a. Intra – neoureterocystostomy (side to side)
b. Extra – ligate distal and reimplant (end to side neoureterocystostomy) = mucosal apposition technique
c. Both – cystoscopic laser treatment

184
Q
  1. What is success rate for surgical correction of ectopic ureter?
A

a. Resolution incontinence 22-72% (newer reports ~70-90%); another 7-28% with med mgmt

185
Q
  1. What is an alternative approach to do cystoscopic approach for ureteral ectopia in males?
A

a. Perineal approach to cystoscope placement

186
Q
  1. What are the types of ureterocele?
A

a. Orthotopic or intravesicular – if orifice in normal position and entire ureterocele within bladder
b. Ectopic – any portion within bladder neck/ urethra

187
Q
  1. Tx of ureterocele?
A

a. Urinary incontinence (UI) with ectopic – ureterocelectomy with or without neoureterocystostomy
b. If urethral obstruction without ureteral ectopia (& UI)
i. Ureterocelectomy without ureteral repositioning indicated

188
Q
  1. What are 2 methods of ureteral re-implantation (end to side neoureterocystotomy) – describe difference
A

a. Intravesicular – pull detached ureter into apex and spatulate, suture along inner bladder mucosa (knots intravesicular)
b. Extravesicular – place ureter (splatulated) along outer apex – place external knots to lumen
c. Also – papilla technique

189
Q
  1. What time frame does bladder mucosal defect regain 100% tissue strength?
A

a. 100% at 14-21 days

190
Q
  1. What is infection rate of bladder surgery?
191
Q
  1. What are suitable empiric abx for bladder sx?
A

a. Clavamox, 3rd gen cephalosporins, enrofloxacin

192
Q
  1. With respect to anesthesia, what are 2 issues with azotemia?
A

a. Can affect pharmacokinetics of drugs
b. Can interfere with platelet function

193
Q
  1. Which bladder stones are radiopaque?
A

a. Struvite, Ca oxalate, silicate

194
Q
  1. What are pHs (acid vs alk) of urine for struvite vs Ca oxalate vs urate vs cystine?
A

a. Struvite – alkaline
b. Ca oxalate – acid
c. Urate – acid
d. Cystine – acid

195
Q
  1. What are shapes of struvite vs Ca Oxalate?
A

a. Struvite – smooth, round, ellipsoid
b. Ca oxalate – jagged edges, sharp

196
Q
  1. List types of imaging studies to evaluate bladder
A

a. Positive contrast cystogram
b. Retrograde urethrocystogram
c. Double contrast cystogram
d. IV urogram
e. CT excretory urography
f. MRI

197
Q
  1. Where does mucosal regeneration come from in the bladder?
A

a. Trigone – so don’t resect!

198
Q
  1. For large bladder resections, what are augmentation techniques to assist in closure and bladder capacity?
A

a. Seromuscular colonic augmentation
b. Ileocystoplasty
c. Rectus abdominus flap
d. Diversion to prepuce or vagina
e. Porcine intestinal submucosa

199
Q
  1. What are options for cystostomy tubes recommended (short vs long term)
A

a. Foley / Mushroom-tipped catheters (de Pezzer) = short term
b. Low profile silicone human gastrostomy tube

200
Q
  1. List examples of congenital bladder abnormalities
A

a. Vesicourachal diverticula
b. Patent urachus
c. Bladder hypoplasia
d. Genitourinary dysplasia (cats)

201
Q
  1. What volume is infused and for how long for peritoneal dialysis?
A

a. 20 ml/kg – 45 min

202
Q
  1. What is a risk factor for getting Ca oxalate?
A

a. Hypercalcemia

203
Q
  1. What % plain films get false negative for presence of stones?
204
Q
  1. List tx options for cystoliths
A

a. Med mgmt:
i. Catheter assisted retrieval
ii. Transurethral cystoscopic retrieval
iii. Voiding hydropulsion
iv. Lithotripsy
v. Laparoscopic assisted or percutaneous cystotomy
b. Surgery: cystotomy

205
Q
  1. What should you test before doing lap assisted?
A

a. Urine culture! Don’t want leakage of infected urine

206
Q
  1. For lithotripsy, what type of laser used?
207
Q
  1. What breeds are predisposed to lower UT tumors?
A

a. Airedale terriers
b. Beagles
c. Shelties
d. Collies
e. Scottish terriers

208
Q
  1. List associated factors with development of TCC
A

a. Female
b. Obesity
c. Older topical insecticides
d. Phenoxy herbicines
e. Nitrosamine exposure
f. Cyclophosphamide exposure
g. Live in area of industrial activity

209
Q
  1. List tx options for TCC
A

a. Chemo
b. NSAIDS (piroxicam)
c. Low-dose metronomic chemo chlorambucil
d. Palliative cystostomy tube
e. Partial cystectomy
f. Transurethral cystoscopic laser ablation
g. RT
h. Urethral stent

210
Q
  1. What is met rate to TCC?
A

a. 10-40% (not sure where these are from.. Tobias has different # for diff areas)

211
Q
  1. What are ECG changes for hyperkalemia?
A

a. Spiked T waves and depressed R waves
b. Prolonged QRS and PR intervals
c. ST segment depression
d. Smaller and wider P waves with prolonged QT intervals
e. Atrial standstill
f. Wide QRS complex and ventricular arrhythmias

212
Q
  1. How long is urinary diversion recommended for after urethral R&A?
A

a. 3-5 days

213
Q
  1. What is different between closure method options of prepubic and perineal vs prescrotal?
A

a. Prescrotal – option of 2nd intention healing

214
Q
  1. What are the 3 branches of the artery of the penis and what do they supply?
A

a. All from internal pudendal
b. Artery of bulb – corpus spongiosum, urethra, pars longa glandis
c. Deep a of penis – corpus cavernosum
d. Dorsal a of penis – corpus spongiosum, bulbus glandis, pars longa glandis

215
Q
  1. What are the 4 veins of the penis and what do they drain and where to?
A

a. Dorsal v of penis – drains bulbus glandis –> internal pudendal
b. Deep / superficial v of glans – drains pars longa –> external pudendal
c. Deep v of penis – drains corpus cavernosum
d. V of urethral bulb – drains corpus spongiosum
e. –> both go to internal pudendal

216
Q
  1. Briefly describe histo differences between immature / mature dog prostates
A

a. Young
i. Acini not developed, no secretory function
ii. High N-C ratio
iii. First activity at 4 months
iv. Cuboidal / flat epithelium
b. Adult
i. Compound tubuloalveolar glands
ii. Alveolar structure
iii. 1. Simple dilatation (no compression of the adjacent acini)
2. Focal glandular ectasia (w compression of the adjacent prostatic parenchyma)
iv. Secretion present

217
Q
  1. What are consequences of spaying discussed around the world?
A

a. Tumors = TCC, OSA (Rottie spayed <1 year), heart tumors, HSA (Vizslas)
b. Diabetes mellitus cats
c. Hypothyroid dog
d. USMI (up to 20% bitch)
e. Obesity
f. UTI

218
Q
  1. With anesthesia for spay (young dogs), why at <5 mo age careful with drug dosing?
A

a. Cytochrome P450 enzyme not mature and lower plasma concentration

219
Q
  1. Which of epithelial ovarian tumor is the only one that is occasionally bilateral?
A

a. Papillary

220
Q
  1. Granulosa cell tumors make up __ % of ovarian tumors? Met rate?
A

a. 50% of ovarian tumors
b. 20% met rate

221
Q
  1. List differentials for ovarian tumors
A

a. Papillary adenoma / adenocarcinoma
b. Cystadenoma
c. Undifferentiated carcinoma
d. Granulosa cell tumor
e. Dysgerminomas
f. Teratomas
g. Teratocarcinomas

222
Q
  1. Overall prognosis with ovarian tumors
A

a. Single, no mets – good
b. Chemo may lengthen survival with metastatic disease

223
Q
  1. For feline ovarian tumors, what is most common?
A

a. Sex cord stromal; > 50% of granulosa cell tumors are malignant

224
Q
  1. With functional cysts – 2 types of them and have what hormonal effects?
A

a. If lined w granulosa cells
i. Secrete estrogen – prolonged proestrus
ii. If also progesterone – prolonged estrus

b. Luteinized cysts – only progesterone – prolonged Diestrus

225
Q
  1. How to diagnose functional cysts?
A

a. Vaginal cytology - >80% superficial cells on vaginal smear, increased serum estrogen
b. Hormones – progesterone >2 ng/mL; estrogen >20 pg/ml

226
Q
  1. List medical mgmt options for pyometra
A

a. PGF2a
b. Cloprostenol
c. Dopamine agonists, Cabergoline
d. GnRH antagonist (acyline)
e. Progesterone receptor antagonist (aglepristone)
f. Antibiotics
g. IVF etc

227
Q
  1. Mortality rate pyometra with surgery
228
Q
  1. What is associated with increased risk of mortality with pyometra?
A

a. Low central venous oxygen sat & higher base deficits

229
Q
  1. What are 2 types of cystic endometrial hyperplasia?
A

a. 1 – part of progesterone dependent disease complex + pyometra
b. 2 – induced by uterine irritation - deciduoma

230
Q
  1. What dog breeds usually seen with dystocia? Cats?
A

a. Dogs – chihuahua, pom, pugs, irish wolfhounds, great dane
i. Bostons, Bulldogs > 80%
b. Cats – Siamese, Persian, Devon rex

231
Q
  1. What is survival rate of C-section?
232
Q
  1. Does spay affect milk production?
A

a. Prolactin released centrally and independent of ovarian hormoes – no effect

233
Q
  1. How long does it take to involute uterus?
A

a. 12-15 weeks

234
Q
  1. What is most common uterine tumors? Dog vs cat and prognosis of each
A

a. Leiomyoma – 90% (dogs) – excellent
b. Adenocarcinoma – guarded

235
Q
  1. What is an anovulvar cleft?
A

a. Failure fusion between dorsal urogenital folds leave midline defect in perineal skin and separates anus and dorsal vulvar commissure

236
Q
  1. Treatment of anovulvar cleft?
A

a. Inverted V perineoplasty along mucocutaneous junction of perineal defect – dissect from skin and then appose

237
Q
  1. What % of patients with recessed vulva have urinary incontinence?
238
Q
  1. What is O satisfaction rate for episioplasty?
A

a. Excellent

239
Q
  1. What % dogs had neoplastic transformation with cryptorchidism?
A

a. 9-13.6%

240
Q
  1. What are concurrent diseases with increased rates with cryptorchid dogs?
A

a. Hip dysplasia, patellar luxation, defects penis / prepuce, umbilical hernia

241
Q
  1. What are concurrent diseases with increased rates with cryptorchid cats?
A

a. Patellar luxation, shortened / kinked tail, tetralogy of Fallot, tarsal deformities, microphthalmia, upper eyelid agenesis

242
Q
  1. Palpation to locate undescended testicle accurate in __% cats?
243
Q
  1. List 3 types of testicular tumors
A

a. Sertoli cell tumor
b. Seminoma
c. Interstitial cell tumor

244
Q
  1. List secondary changes seen with testicular tumors (if listed)
A

a. Sertoli – feminization syndrome
b. Interstitial cell tumor – increased testosterone – perineal hernia, perineal adenoma

245
Q
  1. What are components of feminization syndrome? What % Sertoli cell tumors have it?
A

a. Bilateral symmetric alopecia
b. Squamous metaplasia of prostate
c. Pendulous prepuce
d. Galactorrhea
e. Penile atrophy
f. Gynecomastia

246
Q
  1. List non surgical sterilization techniques
A

a. Testosterone and LH releasing hormone (LH-RH) agonist injection
b. Chlorhex digluconate
c. Gonadotropin-RH
d. Glycerol
e. Zine gluconate

247
Q
  1. List options / techniques for feline castration
A

a. Overhand
b. Figure of eight
c. Ligation
d. Square knot technique

248
Q
  1. What are treatment options for BPH? What is chosen tx?
A

a. Castration – choice
b. Antiandrogens (Delmadinone acetate)
c. Luteinizing Hormone Inhibitors (megestrol acetate)
d. Gonadotropin-Releasing Hormone agonists/ anologue (aka LH releasing hormone agonist)
e. 5 alpha reductase inhibitor (Finasteride) – decrease conversion of testosterone to dihydrotestosterone
f. Estrogens

249
Q
  1. Prognosis for BPH with tx?
A

a. With castration – excellent – CS resolve within a few days

250
Q
  1. What dog breeds more commonly get Ca oxalates? Cat breeds?
A

a. Dogs = Bichon Frise
b. Cats = Siamese

251
Q
  1. List tx options for kidney stones
A

a. Medical dissolution
b. Extracorporeal shock wave therapy (lithotripsy)
c. Nephrotomy
d. Pyelolithotomy
e. Endoscopic nephrolithotomy (intracorporeal lithotripsy)
f. Nephrectomy (most severe situation)

252
Q
  1. Most common renal tumor cats? Dogs?
A

a. Cats – lymphoma
b. Dogs – Renal cell carcinoma

253
Q
  1. What breeds get renal cystadenocarcinoma? What is met rate?
A

a. GSD – met rate 50%

254
Q
  1. What is met rate to abdominal cavity for feline renal tumor?
A

a. 36% met to abdominal cavity

255
Q
  1. List paraneoplastic syndromes of renal neoplasia
A

a. Hypercalcemia
b. Hypoglycemia
c. Leukocytosis
d. Peripheral neuropathy
e. Rarely – hypertrophic osteopathy

256
Q
  1. List contraindications of renal biopsy
A

a. Uncontrolled coagulopathy or hypertension
b. Large or multiple renal cysts or abscesses
c. Extensive pyelonephritis
d. Ureteral obstruction
e. Severe hydronephrosis
f. Interference or obstruction of site by other organs / masses

257
Q
  1. List methods of kidney biopsies
A

a. Percutaneous biopsy
b. US-guided biopsy
c. Keyhole biopsy
d. Laparoscopic biopsy
e. Wedge or incisional biopsy

258
Q
  1. Major complication rate of renal biopsies? Most common?
A

a. 8.9%, severe hemorrhage

259
Q
  1. What are 2 nephrotomy options
A

a. Bisectional nephrotomy (incise pole to pole)
b. Intersegmental (bluntly separate)

260
Q
  1. With partial nephrectomy, what can be done to augment if apposition not reasonable?
A

a. Preserve capsule to suture over
b. Tack omentum to exposed surface
c. Wrap kidney in absorbable mesh
d. Hemostatic sealants

261
Q
  1. Why is it recommended to remove ureter with kidney?
A

a. Concern for ureteral reflux or possible UTI

262
Q
  1. What are examples of nephrostomy tubes?
A

a. Swan-Ganz, Dawson-Mueller catheter or red rubber

263
Q
  1. Explain the pathophys of ureteral obstruction
A

a. First pressure increase, peak 5 hours, lessen (but still inc) over 12-24 hours
b. Renal blood flow decreases to 40% of normal over first 24 hours
c. Decrease to 20% of normal by 2 weeks
d. Increase pressures / decreased BF – decreased GFR - leads to increased GFR in contralateral kidney
e. Inflammatory cells and fibroblasts come in – fibrosis etc

264
Q
  1. What is complication rate of nephrostomy tube in cats?
265
Q
  1. Post-op uroabdomen more common with use of __% nephrostomy tubes then without __%?
A

a. Indwelling nephrostomy tubes (24%) then without (12%)

266
Q
  1. For ureter R&A, what do you need to remove?
A

a. Clear periureteral fat

267
Q
  1. What are methods to decrease tension? For ureteral reimplantation
A

a. Shift kidney caudally (renal descensus)
b. Pexying apex bladder to caudal pole of kidney or iliopsoas
c. Ureteral R&A

268
Q
  1. What are listed risk factors associated with survival with kidney transplants?
A

a. Age
b. Severity of disease
c. Blood pressure
d. Weight

269
Q
  1. List drug options for immunosuppression for feline transplants
A

a. Cyclosporine
b. Prednisolone
c. Azathioprine
d. Tacrolimus
e. Mycophenolate
f. Sirolimus
g. Leflunomide
h. Abatacept / belatacept
i. +/- ketoconazole

270
Q
  1. What % of nephrotomy patients get decreased GFR long term?
A

a. 10-20% (variable literature)

271
Q
  1. What is % persistent ureteral obstruction with ureteral reimplantation vs ureterotomy?
A

a. Ureteral reimplantation 11%
b. Ureterotomy 3%

272
Q
  1. Ureteral R&A – takes __ weeks to get coordinated peristalsis return?
A

a. 3-4 weeks

273
Q
  1. List tx options for urethral duplication
A

a. Open sx removal
b. Cyanoacrylate
c. Coil embolization
d. (of accessory urethra)

274
Q
  1. For palliative care of urethra for TCC, what is the preferred stents now?
A

a. Self-expanding metallic stents

275
Q
  1. With stents, what is rate of successful resolution UTO? MST?
A

a. 98%, MST 251 days

276
Q
  1. What % get urinary incontinence?
277
Q
  1. What are most common cause of dog vs cat urethral trauma?
A

a. Cat – urethral catheter
b. Dog - HBC

278
Q
  1. With urethral strictures, what location should you NOT do urethrostomy for treatment?
A

a. Proximal intrapelvic

279
Q
  1. List tx options for urethral stricture
A

a. Urethrostomy
b. R&A
c. Balloon dilatation
d. Stent placement
e. Urethral replacement (ileum, aortic stent graft)
f. Stem cells + synthetic biodegradable scaffold
g. Oral mucosal grafts

Phase II 2023 flashcards (26 decks)

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