Surgery Final (Part 1) - Spring 2Nd Year

Front 1

Which of the following are common approaches for abdominal surgery in the horse?
a) Ventral Midline
b) Paramedian
c) Paralumbar Fossa
d) Parainguinal
e) Inguinal

Back 1

a) Ventral Midline is most common (although the others are used sometimes)

Front 2

Which of the following are common approaches for abdominal surgery in the cow?
a) Ventral Midline
b) Left paralumbar fossa
c) Right paralumbar fossa
d) Caudal paramedian
e) Right paramedian

Back 2

b) Left paralumbar fossa
c) Right paralumbar fossa
e) Right paramedian

Front 3

Which approach is useful for rumenotomy? Abomasopexy? C-section?

Back 3

Rumenotomy (Left paralumbar fossa)
Abomasopexy (L. paralumbar fossa; R. paramedian)
C-section (L. paralumbar, R. paramedian, Caudal paramedian, ventral midline)

Front 4

T or F:
In equine abdominal surgery, you always exteriorize the cecum.

Back 4

True!

Front 5

Which structures should be exteriorized in ruminant abdominal surgery?

Back 5

Only what is abnormal

Front 6

Choose simple vs. strangulating obstruction...
...enterolith

Back 6

simple

Front 7

Choose simple vs. strangulating obstruction...
...lumenal obstruction without vascular compromise.

Back 7

simple

Front 8

Choose simple vs. strangulating obstruction...
...simultaneous vascular and lumenal occlusion.

Back 8

strangulating

Front 9

Which type of strangulating obstruction involves complete loss of blood supply?

Back 9

Ischemic strangulating bowel obstruction (ISO)

Front 10

Which type of strangulating obstruction involves thickening of bowel wall?

Back 10

Hemorrhagic strangulating bowel obstruction (HSO)

Front 11

Intravascular obstruction of the bowel without bowel incarceration is known as...

Back 11

...Nonstrangulating infarction

Front 12

What are parameters used to clinically assess bowel wall integrity?

Back 12

Color of bowel wall
Color of mucosa
Palpation of arterial pulse
Presence of intestinal motility
Return of normal bowel wall color

Front 13

What are some ancillary methods for evaluating bowel integrity?

Back 13

Histopath
Fluorescein dye
Surface oximetry
Doppler ultrasound
Luminal pressure

Front 14

What procedure is used when removing material from an impacted cecum? How would this be closed to provide the best blood supply to edges of incised tissue?

Back 14

Typhlotomy;
Closed w/appositional followed by inverting (Lembert is best for blood supply)

Front 15

What is the strongest layer of bowel wall?

Back 15

SUBMUCOSA

Front 16

Which of the following procedures DOES NOT prevent abdominal contamination?
a) change gown/gloves before closing
b) exteriorize segment to be incised or resected
c) lavage before anastomosis to remove all surface contamination
d) use separate instruments for clean and dirty portions of procedure

Back 16

c) lavage before anastomosis to remove all surface contamination is NOT correct. Lavage should be done AFTER anastomosis

Front 17

What is the most common approach to a c-section in cattle? In horses? In camelids?

Back 17

Cattle (left paralumbar fossa)
Horses/camelids (ventral midline)

Front 18

What is the linea alba?

Back 18

where aponeurosis of transverse, internal, and external oblique muscles connect to midline

Front 19

Which structure must ALWAYS be included when closing a linea alba incision?

Back 19

External sheath of the rectus abdominus

Front 20

Which two monofilament suture materials are NOT recommended in abdominal closure?

Back 20

Gut
Monocryl (poliglicaprone)

Front 21

T or F:
Subcutaneous fat has little effect on suture integrity when closing a linea alba incision.

Back 21

False! You should clean the linea of fat first!

Front 22

What are the borders of the epiploic foramen?

Back 22

Vena cava
Portal v.
Hepatic a.

Front 23

What are indications for tearing the omentum when performing an exploratory laparotomy?

Back 23

To visualize the left limb of pancreas, splenic vessels, some lymph nodes

Front 24

Which organs are in the gutter?

Back 24

Kidneys
Vessels to the gonads
adrenals
Ureters

Front 25

What do you use as your "handle" to examine the right gutter? The left gutter?

Back 25

Right (mesoduodenum)
Left (descending colon)

Front 26

Choose decerebrate, decerebellate, or Schiff-Sherrington...
...extension of thoracic limbs.

Back 26

Decerebellate AND Schiff-Sherrington

Front 27

Choose decerebrate, decerebellate, or Schiff-Sherrington...
...extension of all limbs.

Back 27

Decerebrate

Front 28

Choose decerebrate, decerebellate, or Schiff-Sherrington...
...paralysis of pelvic limbs.

Back 28

Schiff-Sherrington

Front 29

Choose decerebrate, decerebellate, or Schiff-Sherrington...
...associated with a T2/T3 lesion.

Back 29

Schiff-Sherrington

Front 30

What is the nerve associated with the following reflexes? From which segments does each arise?
Patellar
Gastrocnemius
Bicipital
Triceps
Cutaneous trunci

Back 30

Patellar (Femoral; L4-L6)
Gastrocnemius (Tibial/Sciatic; L7-S1)
Bicipital (Musculocutaneous; C6-C8)
Triceps (Radial; C7-T2)
Cutaneous trunci (lateral thoracic n.; C8-T1)

Front 31

If you shine a light into a patients left eye and there is a lesion affecting the AFFERENT fibers of CN III, what happens? How about if the efferent fibers are affected?

Back 31

Afferent (no pupillary constriction)
Efferent (contralateral pupillary constriction)

Front 32

What is the TLC of cancer surgery?

Back 32

Tumor type
Location of tumor
Condition of patient

Front 33

Regarding surgery (or most anything)...."Proper Planning Prevents ________ _________ ________."

Back 33

Piss Poor Performance!

Front 34

Which drug inhibits osteoclasts?

Back 34

Bisphosphonates

Front 35

What is the difference between single-modal and multi-modal surgical oncology?

Back 35

Single-modal (cut big, cut wide, live forever)
Multi-modal (cytoreduction and chemo)

Front 36

Which procedure is best to diagnose a round cell tumor?
a) biopsy
b) FNA
c) Skin scrape

Back 36

b) effin' A!

Front 37

What are some examples of things NOT to biopsy?

Back 37

Masses in the brain, testis, lung, spleen, thyroid

Front 38

A biopsy in which the entire mass is removed is called a(n) _____________ biopsy.

Back 38

EXCISIONAL

Front 39

What anatomic structures are natural barriers to cancer?

Back 39

Fascial layers!

Front 40

When should drains be placed during a biopsy?

Back 40

NEVA!

Front 41

Which tool is good for deep, ultrasound-guided biopsies? Which is good for superficial tumors? For bone biopsies?

Back 41

Deep (needle-core; tru-cut instrument)
Superficial (punch)
Bone (Jamshidi)

Front 42

What are the goals of the histological exam of a biopsy sample?

Back 42

Neoplasia vs. non-neoplasia
Benign vs. malignant
Histologic type
Grade
Status of margin

Front 43

Identify the following as neuro or ortho signs (or both)!

Shortened stride
Ataxia
Limb circumduction
Head bob
Weakness
Toeing in/out
Crepitus

Back 43

Shortened stride (both)
Ataxia (neuro)
Limb circumduction (ortho)
Head bob (ortho)
Weakness (both)
Toeing in/out (ortho)
Crepitus (ortho)

Front 44

Choose AAEP lameness grade 1 - 5...
...constant lameness only under certain conditions.

Back 44

Grade 2

Front 45

Choose AAEP lameness grade 1 - 5...
...very obvious lameness.

Back 45

Grade 4

Front 46

Which of these images displays "sickle hock"? What is the cause of this?

Back 46

Image C; caused by crushing of cuboidal bones

Front 47

Which of these displays "cow hocks"? What is the medical term for this?

Back 47

B and C are both cow-hocked (C is worse); bilateral tarsal valgus

Front 48

Which nerves are blocked in a heel block? In an abaxial sesamoid block?

Back 48

Palmar/plantar digital nerves (heel)
Palmar/plantar digital + lateral/medial brs. of metacarpal/tarsal nerves (sesamoid)

Front 49

Which nerves are blocked in a low 4-point block? In a high 4-point block?

Back 49

Low (palmar/plantar nn., palmar/plantar metacarpal/tarsal nn.)
High (same as low but just higher up; can get it with one stick by getting the palmar n. near accessory carpal)

Front 50

Which ligament do you wanna miss when performing an intra-articular fetlock joint block?

Back 50

collateral sesamoidean ligament

Front 51

In the horse, flexing the stifle without flexing the hock indicates a ruptured ________________.

Back 51

Peroneus tertius

Front 52

T or F:
There is no such thing as veterinary physical therapy.

Back 52

True! Stupid human medicine has trademarked or copyrighted this or something retarded like that...

Front 53

What does articular cartilage depend on for nutrition?

Back 53

Synovial fluid

Front 54

Compare/contrast heat and cold therapy.

Back 54

Both reduce swelling; cold better for acute (post-op every 4-6hrs for 48hrs) while heat is better for chronic

Front 55

What happens if a cold pack is applied for too long?

Back 55

Hunter's reflex. Cyclical rebound vasodilation; can change temp by 10 to 15 degrees C!!

Front 56

What are advantages of passive range of motion exercises?

Back 56

Maintains joint mobility
Prevents muscle shortening
Increase joint nutrition
Stimulate cartilage regeneration

Front 57

T or F:
TENS units stimulate the muscles in their natural progression of fast twitch followed by slow twitch.

Back 57

False!
While TENS does stimulate fast b4 slow, normal muscle has slow before fast!

Front 58

What are some specific tendon injuries where ultrasound therapy is indicated?

Back 58

Bicipital tenosynovitis
Flexor tendon contractions
Tendon calcifications

Front 59

How does pulsed ultrasound and continuous wave ultrasound differ?

Back 59

Pulsed (no heat, increases cell membrane permeability, used for chronic conditions)
Continuous (heat, used for acute injury)

Front 60

Water buoyancy at the level of the epicondyle reduces apparent body weight of a dog by what factor?
a) 5%
b) 9%
c) 12%
d) 15%
e) 62%

Back 60

d) 15%

Front 61

What stretching regimen improves canine spinal flexibility and is a great warm-up for sporting dogs?

Back 61

Cookie stretch

Front 62

T or F:
Acupuncture cannot be practiced without a veterinary degree.

Back 62

True

Front 63

What are the major resident bacteria that can be opportunistic pathogens of dogs and cats?

Back 63

Staph aureus for both;
penicillin-resistant in dogs usually

Front 64

What are the major resident bacteria that can be opportunistic pathogens of cattle and horses?

Back 64

Strept zooepidemicus for both

Front 65

T or F:
If you are performing surgery on a dog and it ends up with a surgical site infection with S. aureus, it is YOUR FAULT!!

Back 65

False. Dogs and humans both have S. aureus (but it doesn't mean it WASN'T you)

Front 66

T or F:
If you are performing surgery on a cow and it ends up with a surgical site infection with S. aureus, it is YOUR FAULT!!

Back 66

True!

Front 67

T or F:
Unlike most S. aureus, the S. aureus found in cats is coagulase positive.

Back 67

False! Nearly all S. aureus is coagulase positive (including that of cat skin). Yeah dumb question, I know....

Front 68

Describe tendon structure histologically:

Back 68

type 1 collagen arranged in parallel bundles

Front 69

What are the two types of tendons? What are examples of each?

Back 69

Vascular (triceps, deep gluteal tendons)
Avascular (tendon sheath; eg: digital flexors, biceps tendons)

Front 70

What are the 3 types of tendon dysfunctions and how are they often diagnosed?

Back 70

Tendinosynovitis
Tendonitis
Tenosynovitis
(dx: w/ultrasound)

Front 71

What are the 3 phases of tendon healing? What is the approximate timeline for each?

Back 71

Inflammatory (0-4d)
Repair (4-30d)
Remodeling (20-365d)

Front 72

What is critical to regaining and maintaining collagen strength in tendon healing?

Back 72

MOVEMENT

Front 73

Which of the following is true:
a) injured flexor tendons should be mobilized in extension
b) injured extensor tendons should be immobilized in extension
c) large animals tolerate a gap in tendon healing better than small animals
d) the myotendinous junction is one of the most challenging sites of surgical repair.

Back 73

b) injured extensor tendons should be immobilized in extension
d) the myotendinous junction is one of the most challenging sites of surgical repair.

Front 74

What are the 4 factors influencing tendon healing?

Back 74

Cause
Location of injury
Gap (or no gap)
Mobilization vs. immobilization

Front 75

An immobilized tendon is _____% weaker after just 6 weeks of immobilization.

Back 75

50%

Front 76

Describe a 3-loop pulley for tendon repair.

Back 76

Near-far; middle-middle; far-near
120 degrees apposition to next

Front 77

What suture pattern is used to repair flat tendons?

Back 77

Locking loop

Front 78

inflammation of the ligament is called...

Back 78

Desmitis