Acvr - Special Procedures - Specific

Front 1

For esophagrams, what form of barium should be used if suspecting a mass or FB?

Back 1

barium paste

Front 2

What weight-to-volume suspension is advised for esophagrams?

Back 2

60% w/v

Front 3

List two contraindications to the use of barium during an esophagram.

Back 3

1. perforation

2. esophagoscopy

Front 4

In what portion of the esophagus can a normal "herringbone" appearance be seen in the cat and why?

Back 4

the caudal third exhibits this pattern due to obliquely-oriented smooth muscle

in the distal 1/3.

the cranial 2/3 are skeletal muscle.

Front 5

What sedative has the least impact on GI transit times in cats?

Back 5

Ace

Front 6

What recumbency is advised for esophagrams?

Back 6

right lateral

Front 7

During a dynamic esophagram, how many events should be evaluated at the cricopharynx, and how many events should be followed down the esophagus?

Back 7

5 @ cricopharynx

3-4 @ esophagus

Front 8

In addition to the cat, which species has skeletal and smooth muscle along its esophagus?

Back 8

Horse

Front 9

Name two species in which the esophagus is entirely skeletal muscle.

Back 9

Dog and ruminant

Front 10

For an upper GI series, how should iohexol be diluted and why?

Back 10

1:3

will cause vomiting otherwise

Front 11

What is the dose of barium for an upper GI study?

Back 11

13 mL/kg

Front 12

For upper GI studies, when should radiographs be taken and when is the study considered complete?

Back 12

1. Survey rads (4-views)

2. 15m, 30m, 1hr, 2hr, 4hr (2-views)

3. Continue until barium clears the SI

Front 13

During an upper GI study, when does the stomach begin to empty?

Back 13

almost immediately

Front 14

When does the duodenum become filled?

Back 14

15-30 minutes

Front 15

When is most of the jejunum filled?

Back 15

1 hour

Front 16

When does barium reach the cecum?

Back 16

1.5 - 2 hours

Front 17

When should barium be seen filling the colon?

Back 17

3-4 hours

Front 18

In dogs, what is the answer for the following?

a. gastric emptying time

b. SI transit time

c. SI emptying time

Back 18

a. 30 minutes - 2 hours

b. 30 minutes - 2 hours

c. 3-5 hours

Front 19

What is the complete gastric emptying time of barium in cats?

Back 19

15 minutes - 2 hours

(usually 30 minutes)

Front 20

What is the iohexol dose used for upper GI studies in cats?

Back 20

10 mL/kg (diluted 1:3)

Front 21

Name a sedative that will often increase gastric contractions (especially in cats).

Back 21

Ketamine

Front 22

What weight-to-volume suspension, barium dose, and dose of air are advised for double-contrast gastrography?

Back 22

1. 30% w/v (via orogastric tube)

2. 1.5-3 mL/kg barium

3. 20 mL/kg air

Front 23

Which study is the best choice (offers the greatest sensitivity and specificity) if a gastric mucosal lesion is suspected?

Back 23

double-contrast gastrography

Front 24

List two indications for negative-gastrography.

Back 24

1. gastric wall evaluation

2. gastric contents evaluation

*NOT mucosal lesions

Front 25

What dose of air is used for a pneumocolon?

Back 25

1-3 mL/kg

Front 26

What is the dose of contrast media for excretory urography?

Back 26

880 mgI/kg

Front 27

Which media is more toxic to renal tubules?

iohexol or iopamidol

Back 27

iohexol

Front 28

What are the indications for excretory urography?

Back 28

Evaluate renal structure

and the collecting system

Front 29

List the 4 phases of urography and when they occur.

Back 29

1. Arteriogram - instantaneous

2. Nephrogram - < 20 seconds

3. Pyelogram - < 3 minutes

4. Cystogram - < 40 minutes

Front 30

Nephrogram phase duration is dependent upon what factors?

Back 30

1. GFR

2. contrast dose

3. renal concentrating ability

4. patency of renal outflow tract

5. patency of renal vessels

6. systemic BP and hydration

Front 31

In a normal patient, over what time-frame should the nephrogram phase decline?

Back 31

steady decrease

over the course of 3 hours

Front 32

Regarding the following nephrogram appearance, list all potential associated renal diseases.

good opacification but filling defects in the parenchyma?

Back 32

1. neoplasia

2. infarcts

3. cysts

4. calculi

Front 33

Regarding the following nephrogram appearance, list all potential associated renal diseases.

poor initial with progressively decreasing opacity?

Back 33

1. polyuric renal failure

2. inadequate contrast dose

Front 34

Regarding the following nephrogram appearance, list all potential associated renal diseases.

poor initial with progressively increasing opacity?

Back 34

1. acute extra-renal obstruction

2. renal ischemia

3. hypotension

Front 35

Regarding the following nephrogram appearance, list all potential associated renal diseases.

poor initial followed by persistent opacification?

Back 35

1. acute pyelonephritis

2. primary glomerular dysfunction

3. severe generalized renal disease

Front 36

Regarding the following nephrogram appearance, list all potential associated renal diseases.

fair-to-good initial followed by persistent opacity?

Back 36

1. acute renal tubular necrosis

2. hypotension

Front 37

Regarding the following nephrogram appearance, list all potential associated renal diseases.

fair-to-good initial followed by progressive increase?

Back 37

1. hypotension

2. acute renal obstruction

3. contrast-induced renal failure

Front 38

Regarding the following nephrogram appearance, list all potential associated renal diseases.

complete failure of opacification?

Back 38

1. traumatic avulsion

2. occlusion of renal artery

3. severe chronic hydronephrosis

4. renal aplasia

Front 39

At what point is the pyelogram phase considered delayed?

Back 39

> 3 minutes

Front 40

What defines the beginning of the pyelogram phase?

Back 40

after contrast has passed thru the tubules and enters the collecting system

Front 41

What condition can create the appearance of irregular/distorted pelvic recesses?

Back 41

pyelonephritis

Front 42

If the patient is azotemic, how should this affect your dose?

Back 42

It should be increased by 10%

Front 43

With regard to the pyelogram phase, what disease causes pelvic dilation?

Back 43

hydronephrosis

Front 44

With regard to the pyelogram phase, what disease causes short, blunted pelvic recesses?

Back 44

chronic pyelonephritis

Front 45

With regard to the pyelogram phase, what diseases can cause ureteral dilation?

Back 45

pyelonephritis and hydronephrosis

Front 46

What is one, valid, proposed explanation for contrast-induced renal failure and what is the proposed first line of treatment?

Back 46

renal vasoconstriction

Dopamine

Front 47

What potential abnormality could a urinalysis reveal from a patient within 24 hours after his excretory urogram?

Back 47

proteinuria

Front 48

What would the appearance of contrast-induced renal failure be on excretory urography?

Back 48

a positive nephrogram phase but no pyelographic opacification after 20 minutes

Front 49

List a few indications for positive-contrast cystography.

Back 49

bladder leaks/rupture!

Front 50

What is the contrast dose for positive-contrast cystography in the dog and cat?

Back 50

dog = 5 mL/kg

cat = 3 mL/kg

Front 51

In the case of double-contrast cystography, what protocol reduces the likelihood of bubble formation?

Back 51

administer air before positive-contrast

Front 52

What dose of air is recommended for negative or double-contrast cystography and how should the patient be positioned?

Back 52

LEFT LATERAL!

dog = 5 mL/kg

cat = 3 mL/kg

Front 53

List two indications for negative-contrast cystography.

Back 53

1. evaluate wall thickness

2. detect structural abnormalities

NOT for mucosal lesions or small luminal defects.

Front 54

If you suspect an air embolism, you should...

Back 54

1. suck it out of the bladder

2. clamp off the catheter

3. do not remove the catheter

4. place in left lateral recumbency*

5. elevate their butt 45 degrees*

*(to trap air in the right ventricular apex and prevent it from entering pulmonary circulation)

Front 55

In the case of double-contrast cystography, what dose of contrast should be given to dogs and cats?

Back 55

dog = 5-10 mL total

cat = 3 mL total

Front 56

For positive contrast urethrography, what is the dose of contrast for the dog and the cat?

Back 56

dog = 10-30 mL total

cat = 5 mL total

Front 57

During positive-contrast urethrography, will paraprostatic cysts become opacified?

Back 57

No.

(they do not communicate with the urethra)

Front 58

True or False:

All of the following outcomes of urethrography are common.

a. hemorrhage into the urinary bladder

b. urethral submucosal hemorrhage

c. vesiculoureteral reflux

d. small, linear contrast reflux into prostate

Back 58

all true

Front 59

For myelography, what type of contrast media is advised?

Back 59

non-ionic only

(iohexol)

Front 60

Answer the following questions

re. myelographic dosage:

a. what concentration of media is advised?

b. dose for cisternal injection?

c. dose for lumbar injection?

Back 60

a. 200-300 mg/mL (usually 240 mg/mL)

b. 0.3 mL/kg

c. 0.45 mL/kg

Front 61

Did you touch your myelography needle with your gloves? Why do you need a new needle?

Back 61

talcum powder can cause arachnoiditis

Front 62

Where should your needle be placed for a cisternal puncture?

Back 62

cerebellomedullary cistern

(bevel forward)

Front 63

Where should your needle be placed for a lumbar puncture?

Back 63

L5-6

sub-arachnoid space

Front 64

What is one form of myelographic evidence that a patient has an intradural-extramedullary lesion?

Back 64

"golf-tee" sign

Front 65

In the rare case of seizure activity secondary to myelography, when is it typically expected to occur?

Back 65

~2 hours later

Front 66

During myelography, what type of injection is suspected if you see a sharp, dorsal contrast margin and an undulating ventral margin that 'drapes' over the cord?

Back 66

subdural

Front 67

During myelography, what type of injection is suspected if you see wavy dorsal and ventral contrast columns?

Back 67

epidural

Front 68

For angiography, what is the proposed dose per injection and per study?

Back 68

~400 mgI/kg

~1000 mgI/kg

Front 69

List 4 indications for a right ventricular injection.

Back 69

1. tricuspid insufficiency

2. pulmonic stenosis

3. heartworm disease

4. right-to-left PDA

Front 70

List 3 indications for a left ventricular injection.

Back 70

1. mitral insufficiency

2. sub-aortic stenosis

3. VSD (left-to-right)

Front 71

List 3 indications for an aortic injection.

Back 71

1. PDA

2. aortic insufficiency

3. anomalous coronary artery

4. Ao aneurysms

Front 72

In addition to non-selective angiography, what is one sort of injection that yields non-specific results?

Back 72

right atrial

however...

1. ASD

2. right atrial tumor

3. tricuspid stenosis

Front 73

List several indications for non-selective angiocardiography.

Back 73

1. aortic stenosis

2. reverse PDA

3. persistent right aortic arch (PRAA)

4. PPDH

5. pericardial disease

6. Tetralogy of Fallot

Front 74

What diagnostic is required to differentiate Tetralogy of Fallot from Eisenmenger's Syndrome?

Back 74

pulmonary arterial pressures

(*they are normal in Tetralogy)

Front 75

What defines Eisenmenger's Syndrome?

Back 75

left-to-right VSD that reverses ->

becoming a right-to-left VSD

*The reversal is secondary to

pulmonary hypertension*

Front 76

What is the recommended dose for

non-selective angiocardiography?

Back 76

200 mgI per 0.45 kg

Front 77

On a VD view,

where does gas accumulate in the stomach?

Back 77

the body

Front 78

During mesenteric portography, where must a part of the shunt be found in order to be considered most likely extrahepatic?

Back 78

at or caudal to T13

Front 79

What must the cholesterol : triglyceride ratio be in cases of chylothorax?

Back 79

< 1

Front 80

Regarding hepatofugal flow, with what shunt type is it most commonly found and what is it secondary to?

Back 80

Multiple acquired portosystemic shunts (MPSS)

portal hypertension

Front 81

Where are MPSS commonly found?

Back 81

adjacent to the left kidney

*flow will extend caudal to the cranial renal pole

Front 82

What must the systolic gradient exceed to warrant balloon valvuloplasty in patients with pulmonic stenosis?

Back 82

50 mmHg

Front 83

In what case is balloon valvuloplasty contraindicated and why?

Back 83

sub-valvular pulmonic stenosis

due to the potential presence of an aberrant left coronary artery (encircling the RVOT just below the pulmonic valve) arising from a single right coronary artery

Front 84

If your patient is a Bulldog and/or if there is any suspicion of an aberrant left coronary artery, what angiographic procedure would be strongly advised prior to balloon valvuloplasty for a stenotic lesion?

Back 84

coronary angiography

Front 85

With regard to positive-contrast arthrography of the shoulder, when should radiographs be acquired?

Back 85

< 5 minutes (dogs)

(in horses, take immediately)

Front 86

Do any equine carpal joints communicate and if so, which ones?

Back 86

carpometacarpal and intercarpal

(rarely radiocarpal)