Mid-Term 2 Flashcards
(125 cards)
1
Q
What are characteristics of congenital brachycephalic airway syndrome (BAS)?
A
- Stenotic nares
- Aberrant turbinates
- Soft palate elongation and hyperplasia
- Tracheal hypoplasia
2
Q
What are characteristics of secondary brachycephalic airway syndrome (BAS)?
A
- Everted laryngeal saccules
- Laryngeal collapse
- Mucosal Edema
- Gastroesophageal reflux
3
Q
What are some clinical signs of brachycephalic airway syndrome?
A
- Heat, stress, and exercise intolerance
- Snoring, inspiratory dyspnea
- GI signs: vomiting and regurgitation
4
Q
What anatomical configuration do pugs have that causes BAS?
A
- Dorsal rotation of the maxillary bone
- Severely underdeveloped/absent frontal sinuses
- Ventral orientation of olfactorial bulb
5
Q
What are two causes of BAS?
A
- Anatomic changes leading to increased inspiratory resistance
- Secondary conditions contributing to clinical signs
6
Q
What 3 structures are debated to be the greatest contributors of BAS?
A
Soft palate, nose, and rima glottidis
7
Q
What do you need to diagnose BAS?
A
History, Physical Exam, Diagnostic imaging (rads, CT, fluoroscopy, endoscopy)
8
Q
What type of imaging is needed to help you diagnose the causes of BAS?
A
Thoracic rads, head and cervical CT, and endoscopic evaluation of upper airway
9
Q
How do you treat an animal with BAS that is in acute respiratory distress?
A
- Cooling, oxygen, corticosteroids, if GI signs (gastric acid reduction and prokinetics)
10
Q
What are some indications for surgical therapy of BAS?
A
Stenotic nares, hyperplastic/elongated soft palate, turbinectomy, laryngeal conditions
11
Q
If a dog with BAS has stenotic nares, what surgical procedure should you perform?
A
Obliteration of the nares via Alaplasty with wedge excision approach
DIRECT PRESSURE FOR HEMOSTASIS
12
Q
An abnormal soft palate extends how many mm beyond the epiglottis?
A
> 1-3 mm
13
Q
When completing a staphylectomy for an elongated soft palate, what is VERY important?
A
Gentle, meticulous tissue handling
14
Q
What are the landmarks of a staphylectomy?
A
Tip of epiglottis and middle to caudal palatine tonsils/crypt
15
Q
What is another procedure you can do that corrects excessive length and thickness of an elongated soft palate?
A
Folded flap palatoplasty
16
Q
For everted laryngeal saccules and aberrant turbinates, how do you treat them?
A
Remove them (not sure if treatment actually helps)
17
Q
What 3 procedures are you going to consider for a patient with BAS?
A
Alaplasty, Staphylectomy, or Folded flap palatoplasty
18
Q
What is the most important thing to remember for surgically recovering BAS patients?
A
Maintain ET tube for reintubation if needed
19
Q
With patients diagnosed with BAS, when do you recommend surgical correction?
A
As soon as possible
20
Q
What are the 3 stages of laryngeal collapse?
A
- Stage I: laryngeal saccule eversion
- Stage II: medial displacement of cuneiform process
- Stage III: collapse of corniculate process
21
Q
How do you treat laryngeal collapse?
A
Treat primary disease and do an arytenoid lateralization (if needed!)
Can do permanent tracheostomy if needed
22
Q
What is the most common cause of hindlimb lameness in dogs?
A
CCL Rupture
23
Q
What are the 3 types of CCL rupture?
A
Complete tear, Partial tear, Avulsion
24
Q
What are the 3 types of movement that the stifle joint is capable of?
A
Axial rotation, Flexion/extension, and translation
25
What are the functions of the CCL?
- Limits cranial translation of the tibia with respect to the femur
- Prevents hyperextension of the stifle joint
- Limits internal rotation of the tibia
- Limited degree of valgus-varus support to the flexed stifle
- Mechanoreceptors —> proprioceptive feedback
26
What is the co-contraction theory in relation to CCL injuries?
The quadriceps starts losing some of its force and the gastrocnemius being a stronger muscle keeps pulling the tibia in caudal translation which damages the CCL
27
What are the muscles surrounding the CCL?
Caudal belly of sartorius, gracilis, and semitendinosus
28
What are the functions of the surrounding musculature of the CCL?
- Stifle flexion and internal rotation
29
What is the external rotator of the tibia?
Biceps femoris
30
The cranial and caudal cruciate ligaments, medial and lateral meniscus, and medial and lateral collateral ligaments are considered what type of restraint of the stifle?
Passive restraint
31
What are the 3 etiologies of CCL rupture?
Chronic degenerative changes, acute trauma, and conformation
32
What is the biggest conformational etiology of CCL ruptures?
Obesity
33
When diagnosing CCL ruptures, what is the difference in history of acute vs chronic injury?
Acute - sudden, onset non-weight bearing lameness
Chronic - prolonged weight bearing lameness
34
A “click” during walking or on stifle flexion and extension is suggestive of what?
Meniscal injury
35
With CCL rupture, what should you be able to palpate on physical exam?
Joint effusion
36
This is excessive craniocaudal movement of the tibia relative to the fetus as a result of cruciate ligament injury?
Cranial drawer motion
37
When performing a cranial drawer test, in what ways should you perform it?
Extension, Standing angle of 135 degrees, 90 degrees of flexion
38
Which test can diagnose complete AND partial tears with CCL ruptures?
Cranial drawer motion test
39
Which test can ONLY diagnose complete tears with CCL ruptures?
Tibial thrusts
40
With complete and partial tears, when will you have a drawer?
Partial - no drawer in extension and a drawer in flexion
Complete - drawer in flexion AND extension
41
This test will show cranial movement of the tibial tuberosity in the cranial cruciate ligament-deficient stifle when the hock is flexed and the gastrocnemius muscle contracts
Cranial Tibial Thrust
42
(T or F): You can have positive tibial thrust and a negative cranial drawer
False
43
(T or F): You can have a positive cranial drawer and a negative tibial thrust
True
44
(T or F): You can have both negatives and both positives of a cranial drawer and tibial thrust tests
True
45
This test is performed standing or in lateral recumbency with the foot in moderate extension and should be repeated in different degrees of stifle flexion
Tibial compression test
46
With a positive tibial compression test, you will feel what?
Cranial advancement of the tibial crest as the hock is flexed
47
What are some things you will see in radiographs of a CCL rupture?
- Articular cartilage degeneration
- Periarticular Osteophytes development
- Capsular fibrosis
- Joint effusion
- Subchondral sclerosis
- Thickening of medial fibrous joint capsule
- Evidence of avulsion
48
What is the main goal of arthroscopy?
To evaluate the meniscus
49
Which meniscal injury is more common?
The medial meniscus
50
What are the reasons medial meniscus injury is more common?
- Firm attachment to tibial plateau
- No femoral attachment
- Caudal pole often wedges between medial femoral condyle and tibial plateau
51
What are the reasons lateral meniscus injury is less common?
- More mobile
- Femoral attachment
52
What are the functions of the menisci?
- Load transmission across the stifle
- Energy absorption
- Rotational and varus-valgus stability
- Lubricate joint
- Joint congruity
53
In the medial meniscus, a longitudinal tear in the caudal body is most common and also known as?
Bucket handle tear
54
What are the two types of diaphragmatic hernias?
Traumatic and Congenital
55
What are the two types of congenital hernias?
Pleuroperitoneal and Peritoneopericardial
56
What is the most common source of trauma causing diaphragmatic hernias?
Vehicular trauma
57
What is the most common diaphragmatic trauma?
Diaphragmatic costal muscle rupture
58
What organ most commonly herniates from diaphragmatic trauma?
Liver
59
What is the mechanism of action that is an indirect injury with diaphragmatic trauma?
Acute increase in intraabdominal pressure
60
What is the most common clinical sign with traumatic hernias?
Dyspnea
Other signs: Hypovolemic shock (acute trauma), GI signs, lethargy and difficulty lying down, or no clinical signs at all
61
This patient has the following PE:
- Muffled heart and lung sounds
- Thoracic borborygmi
- “Tucked up” abdomen
OR PE presents normally
What do you suspect?
Diaphragmatic hernia
62
What are the most useful diagnostics for a diaphragmatic hernia?
Ultrasound and radiographs
63
What are 3 anesthetic considerations for diaphragmatic hernia patients?
Poor ventilation, poor gas exchange, and poor perfusion
64
When in surgery for a diaphragmatic hernia, what should be placed in the patient?
Thoracostomy tube
65
What surgical approach is taken for diaphragmatic hernias?
Ventral midline celiotomy
66
What are some considerations when dealing with chronic hernias?
Mature adhesions, fibrosis, reperfusion injury, re-expansion of pulmonary edema, loss of domain, primary apposition not possible
67
Acute relief of obstruction with reperfusion injuries leads to what?
- Free O2 radicals
- Inflammatory cytokines
- SIRS
68
What are 3 alternative closure methods for diaphragmatic hernias?
Muscle flaps, autogenous grafts, exogenous graft
69
If a patient survives the peri operative period of the diaphragmatic hernia, what is their prognosis?
Excellent
70
Name the 4 laryngeal cartilages
Epiglottis, Arytenoid, Thyroid, Cricoid
71
This is the opening of the larynx
Glottic inlet
72
What is the muscle of the larynx and what is it innervated by?
Cricoarytenoid muscle innervated by the recurrent laryngeal nerve
73
What are the functions of the larynx?
- Prevent aspiration
- Controls airway resistance
- Voice production
74
Is this congenital or acquired laryngeal paralysis?
- Seen in: bouvier des flandres, Dalmatians, huskies, Rottweilers
- Onset of clinical signs: <1 year old
- Progressive neurologic degeneration
Congenital
75
Is this congenital or acquired laryngeal paralysis?
- Seen in: Labs and Goldens, St. Bernard’s, Irish setters
- Median age of onset: 9 years
Acquired laryngeal paralysis
76
What are some associated etiologies for acquired laryngeal paralysis?
Idiopathic, neoplasia, endocrine polyneuropathy, immune-mediated polyneuropathy, iatrogenic
77
What are two EARLY signs of laryngeal paralysis?
Voice change and gagging/coughing with food and water intake
78
What are some clinical signs of laryngeal paralysis?
Voice change, gagging/coughing when eating food/water, exercise intolerance, inspiratory stridor, acute respiratory distress, peripheral polyneuropathy
79
What diagnostics would you run on a patient with laryngeal paralysis?
- CBC/Chem, UA
- T4 and TSH
- Thoracic and cervical rads
- Esophagram/ swallow studies
80
In patients with LARPAR, what are they also at risk of and what can PRE-treat with?
Aspiration pneumonia; metoclopramide
81
How do you DEFINITIVELY diagnose LARPAR?
Laryngeal Exam
82
How do you medically manage a LARPAR emergency?
- Cool environment + water/ice bath
- O2 and IVC
- IV sedation and corticosteroids
- Intubation, surgery
- Temporary tracheostomy
83
What is the goal of surgery for LARPAR and what is the standard technique?
Decrease airway resistance; arytenoid lateralization
84
What is the surgical approach to LARPAR and the incision is parallel and ventral to what vein?
Left lateral cervical approach; incision parallel and ventral to JUGULAR vein
85
What type of needle do you want to AVOID using for LARPAR surgery?
Reverse cutting
86
(T/F): LARPAR is common in cats
FALSE, LARPAR is NOT common in cats
87
What are the 4 principle biomechanical forces?
Bending, Torsional, Compressional, Distraction
88
What are the initial AO priniciples?
- Anatomical reduction
- Stable fixation
- Preservation of blood supply
- Early active movements
89
What are some disadvantages of non-locking plates?
- Reliance on bone-to-plate friction
- Stability, micro-motion, and fretting
90
What are some advantages of locking plates?
Rigid construct, stronger screw-bone interface, monocortical, lock if at all possible
91
Regarding bone displacement, what part of the bone do you use to identify the displacement?
Distal segment
92
What are some disadvantages of monocortical locking?
- Compromise in torsional stability
- Risk of screw pullout in thin cortices, metaphyseal
93
What are some advantages of monocortical locking?
- Reduced vascular damage
- Versatility (double plating and plate rod combination)
94
What is the equation of stress and strain?
- Stress = Force/Unit area
- Strain = Change in length/Original length
95
What is the equation for bending moment?
Bending moment = Force x Distance
96
What are the two primary blood supplies for skin flaps?
- Subdermal Plexus
- Direct Cutaneous artery and vein
97
Elliptical incisions should be ______ to tension lines
Parallel
98
Skin sutures are for _______ only and not for _______ relief
Apposition; tension
99
This is the elongation of skin with a constant load over time
Mechanical creep
100
What is an example of biological creep?
Stomach stretching from pregnancy
101
This tension relieving technique is done by separating the skin from the underlying tissue
Undermining
102
With what do you not want to undermine?
Tumors
103
What is a tension relieving technique that can be done before or after surgery?
Skin stretching
104
What tension relieving suture uses a cruciate pattern?
Subcutaneous sutures
105
What pattern are you using with strong subcutaneous sutures in reconstructive surgery?
- Far, near, near, far
- Far, far, near, near
106
What is purpose of far sutures versus near sutures?
- Far = relieve tension
- Near = appose tissue
107
Name the tension-relieving sutures
- Strong subcutaneous
- Mattress sutures
- Walking sutures
- Vertical Mattress
- Bolsters
108
What are two types of relaxing/releasing incisions?
Single relaxing and Mesh relaxing incisions
109
What are 3 types of subdermal plexus flaps?
Advancement flaps, rotation flaps, and transposition flaps
110
What is the blood supply for the axial pattern flaps?
Direct cutaneous artery and vein
111
What are the two types of axial pattern flaps?
Peninsular flaps and island flaps
112
What is the blood supply for free skin grafts?
From wound bed
113
What is the process of engraftment for free skin grafts?
- Adherence
- Plasmacytic imbibition
- Inosculation
- Vascular ingrowth/revascularization
114
What are some complications of reconstruction?
Necrosis, Dehiscence, Seroma, Infection
115
Remember this slide
116
Who created the TPLO surgery?
Slocum
117
TPLO moves the ______ to meet the forces
Plateau
118
TTA moves the ____ to meet the plateau
Forces
119
TPLO _____ joint force and TTA ______ joint force
Increases; decreases
120
What is the external rotator of the CCL?
Biceps
121
What is the internal rotator of the CCL?
Popliteus, semitendinosus, gracilis, and semimembranosus
122
All but the ______ are strongly affected by extension of the CCL
Popliteus
123
The TPLO is not influenced by what?
Cranial tibial subluxation
124
For TTAs, sagittal plane? Torsional plane?
Sagittal plane = yes
Torsional plane = NO
125
For TPLOs, sagittal plane? Torsional plane?
Sagittal plane = yes
Torsional plane = yes
