Block 3 +4 Flashcards
(370 cards)
1
Q
What needs to be done for extravasation of doxorubicin?
A
Cold compress
Zineguard (dexrazoxane)
2
Q
What is the primary downside to doxorubicin?
A
Cardio issues
Toxic does is additive
3
Q
What is primary downside to Tanovea?
A
Pulmonary fibrosis
West Highland terriers, its bad!!
Must radiograph lungs first
4
Q
What is primary downside to cisplatin?
A
No cats
5
Q
What happens with extravasation of vincristine
A
Warm compress
DMSO (antioxidant)
Hyaluronic acid
6
Q
What are 4 drugs in CHOP?
A
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
7
Q
What is median remition time for CHOP in lymphoma?
A
12 m
8
Q
What are 4 drugs in LOPP?
A
Lomustine
Vincristine
Procarbazine
Prednisone
9
Q
What is percent chance to remission with rescue protocol?
A
50%
10
Q
What is an indolent lymphoma?
A
Histologically low grade
11
Q
What do you stage?
A
A patient
12
Q
What do you grade?
A
a tumor
13
Q
What is substage A?
A
No clinical signs of disease
14
Q
What is substage B?
A
Clinical signs of disease
15
Q
What is CD3?
A
T-cell indicator
16
Q
What is median survival time or CD3 (-)
A
12m
17
Q
What is median survival time of CD3(+)
A
6m
18
Q
What is prognosis of monotherapy with lymphoma?
A
6-8m
19
Q
What is median survival time of A substage?
A
12m
20
Q
What is median survival time of B substage?
A
1-2m
21
Q
How is leukemia initially broken down into?
A
Lymphoid or myeloid
22
Q
How is leukemia further broken down?
A
Acute or chronic
23
Q
What type of cell is acute and chronic respectively
A
Large cell, small cell
24
Q
What does AML stand for?
A
Acute myeloid leukemia
25
is acute leukemia common?
No
26
What is usually seen in CBC of ALL?
Very high WBCs
27
How is chronic leukemia diagnosed?
Market lymphocytosis persistently
28
What are clinical signs of CLL?
Vague and nonspecific lethargy, reduced appetite
29
What type of cell is CLL usually?
T cell
30
Do cats with lyphoma present with peripheral lymphadenopathy?
No
31
What is the most common site of feline lymphoma?
GI tract
32
What is the most common recommendation for treatment of feline lymphoma?
Chemo
33
What is the exception to this recommendation?
Localized nasal lymphoma
34
What is the multimodal treatment for feline lymphoma and what does it stand for?
COP
Cyclophosphamide
Vincristine
Pred
Doxorubicin isnt as effective in cats
35
What is the 1/3, 1/3, 1/3 rule in feline lymphoma?
1/3 complete response
1/3 partial response
1/3 don't respond
36
What is the single treatment option for feline lymphoma?
Lomustine + pred
37
What is the most common side effect of COP in cats?
GI
Generally better tolerated than dogs
38
Do FeLV + cats or FeLV- cats respond better to treatment
FeLV-
39
Do fatter cats do respond better to therapy?
Yes
40
Where would Stage 1 nasal lymphoma be?
Still in nasal cavity
41
Nasal lymphoma is prognostically the best high grade lymphoma
42
What is a huge prognostic factor for mediastinal lymphoma?
FeLV status 3m vs 1 year
43
What are 2 chemo drugs that can be used with CNS lymphoma that cross BBB?
Lomusine and cytarabine
44
What is the best anatomical place to have lymphoma if youre a cat?
Nasal cavity
45
Should you still use doxorubicin if you can?
Yeah, not really a down side
46
Is surgery often indicated in lymphoma in cats?
No except biopsies or intestinal obstruction
47
What cancer has the pseudo capsule that look like tendrils?
Soft tissue sarcoma
48
Where do soft tissue sarcomas most commonly spread?
Lungs through hematogenous spread
49
What is the most important factor in staging soft tissue sarcomas?
3 view chest rads
50
What are the margins for STS?
3cm laterally and 1 fascial plane deep
51
What is a radical excision?
Removal of whole organ or compartment (limb)
52
What is a wide surgical excision?
3cm + 1 fascial plane
53
What is a marginal excision
Essentially just the tumor is excised (aim to remove macroscopic disease not microscopic)
54
Tumors below the _____ and _______ can have a lower rate of recurrence <25%
Knee and elbow
55
If just doing marginal excision of STS, what is the ideal follow up?
RT
56
What are 4 options with STS if you have incompletely excised margins after surgery?
Surveillance: see what happens
Scar revision: Take out more
RT: Treats microscopic dx
Electrochemo: less expensive than RT
57
Is STS a good prognosis?
Yes if excised and adjunctive RT
One of few cancers that cure can be reached
58
What should the monitoring of STS look like?
Every month for 3 months
Every 3 months for 1 year
Every 6 months for 2 years
59
What are the 2 vaccines that are most common with feline injection site sarcomas?
Rabies and FeLV
60
What are the 3 indications to get a biopsy after a injection site mass
Increase in size 1 month after injection
Larger than 2cm
Persistence after 3 months
61
What is metastatic rate of feline injection site sarcomas?
25%!
62
Should FISS be referred?
Yes
Unless can get really large margins
63
Should you do an excisional biopsy for FISS?
NO!!
64
What are the margins for FISS?
3-5cm plus 2 fascial planes
65
Is the risk of metastasis with FISS low or high?
Low 25%
66
Because risk of metastasis is relatively low, systemic treatment is not normally recommended
67
"If its not a tail FISS, refer"
Monitoring timeline for FISS is same as Canine STS
68
What is neoadjunctive therapy?
Before surgery to decrease tumor size
69
What is induction therapy?
Treatment with intent to cure
70
What is rescue therapy?
Used after tumor fails to respond
71
What is the maximum tolerated dose?
Highest dose that can be administered in the abscence of unaccepatble or irreversible side effects
72
What is the nadir?
When the side effects of a certain drug have the maximal effect on the patient (lowest neutrophils, lowest platlets)
73
At what point does the cell cycle become self directed?
When it passes (r) restriction point
74
What do cell cycle non specific drugs kill?
Actively dividing cells and resting cells
75
What do cell cycle specific drugs kill?
Just actively dividing cells
76
How are chemo drugs calculated?
With body surface area
77
What do you have to be cautious with using doxorubicin and vincristine with collies and shepherds?
Lower threshold due to MDR1 mutation
78
Which drug is released unchanged in urine?
The Platinum agents (carboplatin)
79
What is nadir for vincristine?
7 day
80
What is nadir for carboplatin?
7 and 21 day
81
What is nadir for lomustine in dog?
21 day
82
What is nadir for lomustine in cat?
42 days
83
What is a side effect of doxorubicin?
Nephrotoxicity
84
Which drug is nephrotoxic to dogs?
Cisplatin
85
What is the chelator for doxorubicin called?
Zinecard
86
What drug is contraindicated in cats?
Cisplatin - pulmonary edema
5FU - Neurotoxicity
87
What drug is contraindicated in West Highland White Terriers?
Tanovia - pulmonary fibrosis
88
What is a way to assess response of lymph node (in lymphoma) to chemo?
Measure the lymph node size
CR: normal size
PR: >30%
SD=stable disease = <30%
PD = Progressive disease = >20%
89
What anatomical location is uncommonly affected by high grade lymphoma in cats?
Peripheral lymph nodes
90
Cat who are FeLV positive are likely to be younger whne they develop lymphoma than cats who are FeLV negative
91
What type of radiation does RT utilize?
Ionizing radiation
92
What are teh 2 ways that ionizing radiation damages DNA?
Indirect - 70%
Direct - 30%
93
What is 1 gray equal to?
1 joule/kg of tissue
94
What is fractionation?
Dividing total dose of radiation into small fractions given over several weeks
95
Is palliative fraction size large or small
Large but not given nearly as often
96
When are RT side effects usually at their peak for definitive treatment?
1 week after RT
97
What is a common side effect of acute RT?
Desquamation (pealing and drying of skin
Halitosis
Alopecia
Nasal discharge
Uveitis
Basically anything "itis"
98
How often do chronic RT side effects occur?
<5%
99
What is a common late side effect?
Leukotrichia (white hair)
100
What is the difference between intensity modulated RT and 3D conformal RT?
3D = uniform dose distribution
IMRT = Non-uniform dose
IMRT can really avoid critical organs to minimize side effects
101
What is GTV
gross tumor volume
102
what is ctv
clinical target volume
103
what is ptv
planning target volume
104
What are teh 5 steps of RT in order?
Diagnosis/staging
Planning CT
RT plan creating
Verification of plan
Patient treatment
105
What technique is used for deep, superficial RT?
Photons are deep
Electrons are superficial
106
What is the long term control of tumor size called in RT?
Definitive RT
107
What is good local control for early stage gross tumor with minimal treatment and time in hosptital?
Steotactic RT
108
What is the most common oral tumor of dogs?
Oral malignant melanoma
109
What is the metastatic rate?
60-80%
110
What are the margins for oral malignant melanomas?
2-3cm bone and 1cm soft tissue
111
What is the reoccurence rate for oral malignant melanomas?
50% local reoccurence
112
What is stage 1 for oral malignant melanomas?
<2 cm, no LN, no mets
113
what is stage 2 for oral malignant melanomas?
2-4 cm, no LN, no mets
114
what is stage 3 for oral malignant melanomas?
>4, LN involvement, no mets
115
what is stage 4 for oral malignant melanomas?
Any size, LN involvement, mets
116
What is the intrralesional chemo for oral malignant melanomas?
cisplatin
117
What is the systemic chemo for oral malignant melanomas?
carboplatin
118
What is an additional promising area of research for treatment of oral malignant melanomas?
immunotherpay (Oncept vaccine)
119
What is electrochemotherapy?
Electrical pulses to allow greater influx of chemo agent into cells
120
What is prognosis of tonsillar SCC?
45 d
Sx is palliative
Chemo is inneffective since it is already mets
121
What are 2 Tx options in cat SCC?
RT + Chemo
122
Is mouth OSA better prognostically than appendicular OSAs?
Yes
123
Does adjunctive therapy help mouth OSAs?
No
124
What is stage 1 lymphoma?
Stage I: 1 LN
125
What is stage II lymphoma?
Stage II: Multiple nodes in a region
126
What is stage III lymphoma?
Stage III: Generalized (everywhere)
127
What is stage IV lymphoma?
Stage IV: Spleen and liver involvement
128
What is stage V lymphoma?
Stage V: Bone marrow (anemic present maybe)
129
What is a common benign lesion of the mouth?
Canine acanthomatous ameloblastoma
130
What are the treatments (3) for CAA?
Mandibulectomy/Maxillectomy
Can also RT but will often recur in RT field
Intralesional bleomycin is an optional injection
131
What is an odotoma full of?
Teeth
132
What are the margins on an intestinal tumor?
3-5 cm of grossly normal tissue orad and aborad
133
What are of the small intestine is easiest to resect from?
Jejunum
134
What is something that needs to be done on resection and anastomosis of intestinal tumors?
Leak test
135
What is typhlectomy?
Resection of the cecumW
136
What is colectomy?
Resection of a segment of colon
137
What is colorectal resection?
Resection of variable portions of both descending colon and rectum. Rectal pull-through procedure
138
How large is the exision of normal tissue in each direction for rectal tumors?
1-2cm
139
How large is teh excision of normal tissue in each direction for colonic masses?
2-5cm
140
What is a surgical technique for small, single, and superficial tumors in caudal-midrectum?
Rectal eversion
141
What are the 5 principles of treating IMHA in order?
1. Prevent hemolysis with immosuppressive therapy
2. Treat tissue hypoxia
3. Deter formation of thromboembolic disease
4. Provide supportive care
5. Treat associated cause
142
How do you treat the immunosuppressive therapy?
Pred (2-3mg/kg/day) or dex
143
What is the mechanism of action of immunospressors?
Decreases macrophage phagocytosis of Ab-coated RBCs
Reduces macrophage cytokine production
Reduces effective antigen presentation to T cells
Long term: minimizes autoantibody production by B cells
144
How fast does pred work?
See results in 3-7 days
145
What is the most common cause of death in dogs with IMHA?
Thromboembolic disease
146
What is something owners need to be aware of with steroids in IMHA?
Steroid withdraw takes 2-4 months minimum
147
What are 4 principles of treatment for ITP?
1. Prevent platelet destruction with steroids
2. treat hypoxia
3. Supportive care
4. Treat associated cause
148
What is the mechanism of anemia in IMHA?
hemolysis
149
What is the mechanism of anemia in ITP?
Hemorrhage
150
What is long term therapy for IMHA and ITP?
Decrease steroids by 25% every 2-4 weeks
151
What is IMHA + ITP at same time?
Rare: Evan's Syndrome
152
Why do a lot of people think they have a patient with Evan's syndrome?
They have an ITP patient with anemia but really anemia is from hemorrhage
153
What are survival times for local therapies for thyroid tumors?
2-3 years
154
What do bigger thyroid tumors mean?
Worse (palpate thyroid glands during physical)
155
What si teh gold standard for feline thyroid tumor treatment?
Radioiodine
156
Are Pituitary tumors or pituitary tumors more common?
Pituitary tumors
157
What is the treatment for pituitary macroadenomas?
RT
158
Do insulinomas metastasize?
Yes 90-95%!
159
Where do insulinomas mostly metastasize?
Liver
160
What is Stage I for insulinoma?
Just pancreas 2 year MST
161
What is Stage II for insulinoma?
LN mets 1.5 year MST
162
What is Stage III for insulinoma?
Distant mets 0.75 MST
163
How do you medically manage insulinomas?
Smaller more frequent feedings
Diets with complex carbs, no simple carbs, lots of fiber
Avoid strenous exercise
Pred
Diazoxide: Inhibits insulin release
164
What are 6 sources of pain in cancer patients?
Visceral stretching
Invasion of cancer cells into surrounding cells
Organ distension/obstrcution
Neuropathic Pain
Release of chemical mediators
Poor circulation
165
What are the 3 levels of WHO recommendations for controlling pain?
Mild pain - NSAIDs
Moderate pain - weak opioids
Severe pain - strong opioids
166
What tumors do NSAIDs have anti-tumor effects in?
Carcinomas
167
How can you decrease the calcium (hypercalcemia)?
Bisphosphonates
168
What is paraneoplastic syndroms?
Produces chemicals or hormones like calcium
169
How often should you consider rechecks for QOL?
1-2 months
170
what is the most common cutaneous tumor in dogs?
Mast cell
171
What are the most common sites of metastasis for mast cell tumors?
LNs, liver, spleen
172
What is a rare place for mast cells to metastasize?
Lungs
173
What are the margins for Mast cell?
2-3cm lateral and 1 fascial plane deep
174
What is an adjunctive therapy that can be injected into MSTs?
Stelfonta is injected causing tissue necrosis
175
Where can you inject stelfonta SQ?
Distal to elbow and hock
176
What is the response rate with stelfonta?
75% with one injection
177
What do you still need to do with stelfonta?
Sedate the animal so you dont stick yourself
178
What is another interesting treatment for MST?
Oral pred can help reduce tumor size prior to surgery
179
How many levels of grade are there for MCT?
1-3 AND high vs low
180
What is HN0
Non-metastatic
181
What is HN1
Pre-metastatic
182
What is HN2
Early metastatic
183
What is HN3
overt metastatic
184
What does monitoring look like?
Exam every month for 3 months then every 3 months for a year then every 6 months
185
Up to 70% of incompletely excised low grade MCTs will not recur
186
What are some palliative options for MCTs?
H1 antagonistis (diphenhydramine)
H2 Antagonists (famotidine and omprazone)
Steroids
187
What is the average age of AGASACA patients?
9-11
188
What is the most common clinical sign of AGASACA?
PU/PD - hypercalcemia
189
What is the most common malignant neoplasia to cause hypercalcemia?
T cell lymphoma
190
What are the most common sites of metastasis for AGASACA?
Medial and internal iliac LNs
191
Lungs are uncommon sites of metastasis
192
What is the staging of the clinical AGASACA?
o 1: <2.5cm mass, no LN, no distant mets
o 2: >2.5cm mass, no LN, no distant mets
o 3: any tumor, <4.5cm node metastasis, no distant mets
o 4: Any tumor, >4.5cm node metastasis, no distant mets
o 5: Any tumor, any node met, distant mets
193
What is prognosis of AGASACA dogs?
Multiple years
194
What is treatment for AGASACA?
Surgery
Adjunctive is usually RT
195
What are the margins for surgical excision of sarcoids?
at least 1cm+
196
What is the gold standard for sarcoids in horses?
Radiation therapy
197
What horses get melanoma the most?
Grey horses!
198
Where are horse melanomas usually located?
Under the tail
199
What percentage of grey horses over 17 were melanoma free?
6%
200
What is staging of equine melanomas?
o 1. <0.5cm nodule
o 2. Several <0.5cm nodules or single >2cm
o 3. One or several of >5cm or SQ at typical locations
o 4. Extensive SQ nodules with necrosis or metastasis
o 5. Exophytic tumor growth with wet surface and ulceration, metastasis to organs with clinical signs
201
What are the treatment options for equine SCC?
Surgery: excisional, cryosurgery, adjunctive treatments
Chemo: Intralesional (cisplatin, carboplatin) Topical (5-FU, mitomycin-C ophthalmic)
RT
202
What are margins of SCC surgery?
5mm
203
What are the common sites for SCC surgery?
3rd eyelid removal
Penis and prepuce
204
What are the best options for topical SCC chemo
5-FU
Mitomycin-C
Intralesional - injection of beads
205
What is the most common bone tumor?
Osteosarcoma
206
What is teh most common metastatic site for osteosarcomas?
Lungs!!
207
With amputation, how do dogs die?
Systemic, not local disease
208
BOTTOM LINE IS THAT CHEMO AFTER SURGERY DOUBLES SURVIVAL TIME!! WITH OSA
209
What chemo drug choice is best for OSA?
Carboplatin
210
What is teh Popcorn ball of the skull?
Multilobular osteochondroma (MLO)
211
Good or bad: OSA in foot
good
212
Good or bad: OSA in radius or femur
bad
213
Good or bad: OSA in scapula humerus
Ugly
214
Good or bad: OSA in extra-skeletal
Ugly
215
Good or bad: OSA in rib
Ugly
216
Good or bad: OSA in vertebrae
Ugly
217
What dogs have really bad prognosis?
Younger dogs or obvious metastasis at diagnosis
218
What percent of dogs undergoing splenectomy develop arrhythmias?
25%
219
What is teh MST of hemangiosarcoma with sx alone?
1-3m
220
What is the drug used for metronomic chemo?
Cyclophosphamide
221
What is a side effect of metronomic chemo with cyclophosphamide?
Sterile hemorrhagic cystitis
222
Is there a benefit in hemangiosarcoma patients to supplements?
No
223
What may cause dermal HSAs?
UV light exposure
224
How do you protect patients from further staging dermal HSA?
Prevent exposure to UV light
225
What is teh most common cardiac site for HSA to show up?
Right auricle
226
What percent of hemoperotineum is neoplasia in cats?
46%
227
What percent of those neoplasias are HSA?
60%
228
Surgery now baby half way there I think...
229
What is the extrinsic pathway for coagulation cascade?
VII
230
What is the epinephrine concentration for vasoconstriciton?
1:10
231
How many mLs does a fully soaked sponge hold?
15mL
232
What are the forceps from smallest to largest
Mosquito>Kelly>Crile>pean>Carmault
233
What suture size should be used for SQ bleeder?
3-0 or 4-0
234
Which direction do you point you forceps using the tip clamping technique?
Tip of clamp is pointing down
235
What are the 2 techniques for hemostasis?
Tip clamp
Jaw clamp
236
Which direction do you clamp using the jaw clamp technique?
Curvature facing up
237
What vessels usually need transecting hemostatsis?
Prepuscial artery and vein
238
How do you clamp and transect larger vessels?
Use 2 hemostats and point them toward each other
Then cut between them with Metzenbaum scissors
239
How are hemostats handed to surgeon via the assisstant?
With curve positioned AWAY from the palm of the surgeons hand
240
During hernia repair, what is an option if the local region is inadequate for closure?
Bring in muscle flaps or use synthetic mesh
241
What do you close a hernia with?
PDS
242
What is the most common hernia?
Umbilical hernias
243
Do umbilical hernias resolve spontaneously sometimes?
Yes
Will repair early in shelter dogs to get them adopted
244
What is the most common cause of acute incisional hernias?
Surgeon's error
245
What can be mistaken as an inguinal hernia in obese cats?
Caudal fat pad
246
How many hiatuses are in teh diaphram
3
247
What is an important position doe diaphragm surgery?
Reverse Trengelenburg's
248
What is the most dangerous part of anesthesia in diaphragm surgery?
Induction
249
What is overall prognosis of diaphragmatic hernias?
82-89% survival
250
What needs to be done before surgical intervention of perineal hernias?
Appropriate medical management of constipation adn obstipation
251
What can be done to medically manage constipation or obstipation?
Enemas
Lactulose
Miralax
252
What is a surgical emergency for perineal prolapse?
Bladder prolapse with obstruction
253
What is the most commonly utilized method for surgical treatment?
Transposition of the internal obturator
254
What is the most common complication of surgical repair?
Temporary surgical incontinence
255
What is first step in removing a LN?
Determinign the sentinel lymph node with contrast CT
256
What is the gold standard in determining if metastasis is present?
LN biopsy
257
What are 2 commonly removed LNs?
Mandibular and popliteal
258
How should you position for a popliteal LN removal?
Hanging limb
259
What is a concern with LN removal?
Seeding of cancer cells
260
What is something to look out for in mandibular LNs?
2-5 nodes in the area, remove them all
261
Which direction are LNs excised?
In longitudinal direction
262
What is a tool that is very useful for LN excision?
electrocaudery
263
Where does the liver get teh majority of the blood? oxygen?
80% from portal vein
20% from hepatic artery
Both provide 50% of oxygen
264
What dogs typically get extra-hepatic PSS?
Toy breed dogs
265
What is gold standard diagnosis of PSS?
CT
266
What are 2 medical managements for PSS?
Lactulose
Restrict protein
(Maybe antibiotics and omeprazole)
267
What is MST with medical management?
3 years
268
What is MST with surgery?
11 years
269
Where do you amputate for a total caudectomy?
Sacrococcygeal joint
270
What is sterile definition?
Removal of ALL microbial life
271
What is asepsis?
Inhibition of microbial growth
Bacteriostatic NOT bactericidal
272
What is a disinfectant?
Bactericidal agents intended for inanimate objects
Bactericidal!
273
Is an ultrasonic cleaner antibacterial?
No!
274
What temp do autoclaves reach?
13 minutes at 120C (250)
275
What temp do flash sterilizations occur?
3 minutes at 131C (270F)
276
What chemical is used for chemical sterilization?
Ethylene oxide
277
What much occur after ethylene oxide sterilization?
Aeration (take 24 hours)
278
How are items sensitive to heat sterilized?
Radiation
279
How many microbes does 1 person bring into a room?
10^3-10^4
280
What are antiseptics?
Chemicals which are applied to living tissues to suppress or eliminate bacterial growth and development on living tissues
281
How long must skin be in contact with antiseptic?
5 minutes
282
Is Chlorohex a better Gram + or Gram -
Game +
283
Explain the dirty scrub
Antiseptic scrub applied for 5 minutes
Scrub until sponges are visually clean
284
How much of the skin is exposed with draping?
2cm
Fold is placed DOWN
285
When do you put on the light handles?
Only after the top drape is in place
286
What is capillarity?
Process by which fluid and bacteria are carried into the interstices of a multifilament suture
287
What is relative knot security?
Force required to untie or break a knot as compared to the force required to break an untied strand of suture (knots weaken suture up to 50%!)
288
What is the accepted rule of knot tensile strength?
Should not need to exceed tensile strength of tissue
289
What are the 3 primary properties of suture material?
Absorbable v non absorbable
Natural v synthetic
Monofilament v multifilament
290
How does natural suture break down?
Phagocytosis
291
How does synthetic suture break down?
Hydrolysis
292
What is monocryl?
Poliglecaprone
293
What is PDS?
Polydioxinone
294
Where is braided suture never place?
Below the skin
295
What is chatter?
Tissue drag from multifilament suture
296
What is the slowest healing tissue?
Fascia
297
What is the only tissue that returns to 100% strength?
Bladder
298
Whats the general rule for highly collagenous tissue?
50% strength in 50 days
299
What is the general rull for parenchymal tissue?
>80% strength in 14-21 days
300
Should you resterilize?
No
301
Where should you grasp a needle?
2/3rds
302
When do you use a cutting needle vs tapered?
In tougher collagenous tissue (Skin and intradermal)
303
When do you use a taper needle?
Soft tissues (parenchymal tissue)
304
What is the most common mass in the perianal region?
Adenoma
305
Are adenomas or adenocarcinomas more superficial/pedunculated in perianal masses? Which have a poorer prognosis?
adenomas
Adenocarcinomas
306
What is treatment for perianal fistulas?
Cyclosporine and tacrolimus
307
What are the 4 classification of surgery sterility?
Clean
Clean/contaminated
Contaminated
Dirty
308
What is a clean surgery?
Elective, no breaks in aseptic technique: TPLO, spay/neuter
309
What is clean/contaminated
Entry into a hollow viscus without gross contamination
Minor breaks in aseptic technique (head hits light)
310
What is contaminated
Traumatic wounds (penetrating wound, laceration)
Major breaks in aseptic technique (glove tears while holding something)
311
What is dirty?
Purulent material encountered
Perforated viscus
312
What is the time frame for giving antibiotic for surgery?
90 minutes
OR if there is an implant
OR contaminated Sx
OR dirty Sx
313
What is cefazolin given for?
Skin 47min half life
314
What is unasyn given for?
GI 60 min half life
315
How do you redose antibiotics in surgery?
Based on half life
316
What are the 3 goals for onco surgical intent?
Curative intent
Palliative intent
Cytoreductive intent
317
What is intralesional surgical dosing?
Just removing part of the tumor to potentially allow movement of a limb
Most of macro and micro dx will be left behind
318
What is marginal surgical dosing?
Tumor excised just outside capsule
Micro dx likely left behind
319
** YOU ARE ONLY AS WIDE AS YOUR NARROWEST MARGIN
320
What are 2 primary tumor sampling methods?
FNA
Biopsy
321
What is the difference between incisional and excisional biopsy?
Incisional just removes a piece for diagnosis, excisional removes the whole thing
322
What do you put a mass into for pathology review? What the ratio of sample to formalin?
Formalin
1:10
323
What do you ink on a sample?
Lateral margins, areas of special interest, and deep margin
324
What is the residual tumor classification?
R0 = no tumor at inked edge
R1 = micro dx at inked edge
R2 = macro dx at inked edge
325
****What is the major blood supplies of the spleen
All arise from celiac artery
Splenic artery
Left gastroepiploic artery
Short gastric
326
What is a tool that cuts and seals vessels up to 7mm?
Ligasure
327
Where do you ligate the splenic artery?
Distal to pancreatic arteries as to not disrupt blood flow to pancreas
328
What has an increased risk in splenectomies?
GDV (5.3x)
329
How many layers of closure is there for pinnectomy?
Just one
DONT INCLUDE CARTILAGE IN CLOSURE
330
How do you close the dead space of the ear with sutures?
4-0 Nonabsorbable mattress pattern through both layers of cartilage!
331
How long do you need to bandage the incision and drain?
2weeks with concave surface facing up!
332
Is bandage required for punch biopsy repair?
No
333
What does TECA stand for?
Total ear canal ablation
334
What must be performed with every TECA?
Removal of tympanic bulla (TECA +LBO)
335
What important nerves are in this area?
Fascial nerve
VIII (vestibulococclear)
336
With TECALBO, who is much more likely to get Horner's?
Cats
337
What is goal of ventral bulla osteotomy?
Removal of aural poly via ear canal
338
What is the most common indication for ventral bulla osteotomy?
Nasopharyngeal polyp cats>dogs
339
How do you prep a limb for toe amputation?
Towel clamp through nail hanging
340
How do you do a bier block?
Toes up to remove blood
Place tourniquet
Middle of dorsal paw to block superficial branches of radial nerve
341
Where is the toe amputated?
Proximal phalangeal joint
342
What are the 4 mechanisms of wounding?
Friction
Shear
Tension
Compression
343
What are the 4 phases of wound healing
Hemostasis
Inflammation
Proliferative
Remodeling
344
What are the primary cell types of phase 2 healing?
Neutrophils and macrophages
345
What is primary cell type in phase 3 of healing?
Fibroblasts
346
What is something that increases the risk of wound healing complications?
Endocrinopathies (diabetes mellitus, cushings)
Steroids
Hypoproteineinemia
347
What is the difference between contaminations, colonizations, and infection
Class 1:Contamination: Microbes are present
Class 2: Colonization: Microbes are replicating but not invading
Class 3: Infection: Microbes are invading and replciating
348
How mich infection is required to cause an actual infection?
10^5
349
What should be performed at the debridement step of wound healing?
Deep tissue culture
350
Should you forefully close a wound?
NO! when in doubt, wait it out
351
What bandage is good for the limbs?
Modified Robert Jones
352
What bandage is good for thoracic or abdominal wounds?
Cross your heart
353
What bandage is good for basically all others?
Tie over
354
What 3 things about a primary layer should you consider?
Debridement, moist wound healing, topical antimicrobial
355
How do you apply adherent primary layer?
Under sedation
356
What can be used for all wound types?
Non-adherent moist wound healing types
357
How often do you need to change adherent primary layers?
Every 24 hours
358
What is primary wound closure?
Direct apposition of wound edges
359
What is delayed primary wound closure?
within 3-5 days post-wounding
360
What is second intention healing?
Healing via contraction and reepithelialization
361
What is secondary wound closure?
Appositional closure of a wound >3-5 days post wounding
362
What suture should you use on fascia closure?
0, 2-0. or 3-0
363
How can you fix dog ears on suture?
Elliptical incision
364
How to fix a step defect?
Suture no perfectly opposed
365
With an advancement flap. how long can the length be?
No more than 2x the width
366
Where should you exit a passive drain?
Never through the incision, always a separate stab incision
367
If incision is dorsal, what type of drain do you use?
Suction drain
368
What should you never do to a drain?
NEVER flush any drain
ON EXAM: NEVER EXIT A DRAIN THROUGH THE WOUND OR SURGICAL INCISION
369
How long should a patient have a drain?
1-14 days
3-5 is most common
370
youre done
