Veterinary Surgery

Question 1

Surgical checklists have become standard practice in human operating theatres. According to Bergstrom et al, 2016, which of the following is true regarding use of surgical checklists in small animal patients?
A. The frequency of re-operation was significantly lower in the group in which surgical checklists were employed prior to surgery than in the group in which a surgical checklist was not used.
B. The frequency of mortality was significantly lower in the group in which surgical checklists were employed prior to surgery.
C. The frequency of surgical site infection was significantly lower in the group in which surgical checklists were employed prior to surgery.
D. The frequency of wound complications was significantly higher in the group in which surgical checklists were employed prior to surgery.

Answer 1

C. The frequency of surgical site infection was significantly lower in the group in which surgical checklists were employed prior to surgery.

Ref: Bergstrom et al, Vet Surg 2016, 45:571-576.

Question 2

Blocked nasolacrimal ducts can result in continuous epiphora in horses. Brink and Schumacher (2016) described a procedure for resolution of chronic epiphora in horses with blocked nasolacrimal ducts. Which of the following statements is true regarding this procedure?
A. Canaliculosinostomy involves diversion of lacrimal secretions into the frontomaxillary sinuses via placement of temporary tubing through the lacrimal sac, into the sinus and out through the skin.
B. Canaliculosinostomy can only be performed under general anaesthesia in horses.
C. Canaliculosinostomy involves diversion of lacrimal secretions into the frontomaxillary sinuses via placement of permanent tubing through the lacrimal sac, into the sinus and out through the skin.
D. Resolution of epiphora occurs in approximately 50% of horses that undergo canaliculosinostomy.

Answer 2

A. Canaliculosinostomy involves diversion of lacrimal secretions into the frontomaxillary sinuses via placement of temporary tubing through the lacrimal sac, into the sinus and out through the skin.

Ref: Brink and Schumacher, Vet Surg 2016, 45:110-114.

Question 3

In a retrospective study of horses undergoing nephrosplenic space ablation through laparoscopic placement of a prosthetic mesh (Burke and Parente, 2016) what was the rate of post-operative complications? What complications were reported?

Answer 3

Answer: There were no complications related to mesh ablation. 3/26 had mild, self limiting colic after surgery.

Ref: Burke and Parente, Vet Surg 2016, 45:201-207.

Question 4

Select the correct landmarks, needle and minimum volume of injection from the list below which have been shown to allow for accurate perineural injection of the ethmoidal nerve (Caruso et al, 2016):
A. A notch at the caudolateral aspect of the supraorbital fossa where the caudal aspect of the zygomatic process of the frontal bone emerges from the frontal bone, rostral and lateral to the orbit; 18 gauge 8 cm spinal needle inserted at 160 degrees to the long axis of the head; 5ml.
B. A notch at the caudolateral aspect of the supraorbital fossa where the caudal aspect of the zygomatic process of the frontal bone emerges from the frontal bone, rostral and lateral to the orbit; 20 gauge 6 cm spinal needle inserted at 110 degrees to the long axis of the head; 0.5ml.
C. A notch at the rostromedial aspect of the supraorbital fossa where the caudal aspect of the zygomatic process of the frontal bone emerges from the frontal bone, caudal and medial to the orbit; 18 gauge 8 cm spinal needle inserted at 160 degrees to the long axis of the head; 5ml.
D. A notch at the rostromedial aspect of the supraorbital fossa where the caudal aspect of the zygomatic process of the frontal bone emerges from the frontal bone, caudal and medial to the orbit; 20 gauge 6 cm spinal needle inserted at 110 degrees to the long axis of the head; 0.5ml.

Answer 4

D. A notch at the rostromedial aspect of the supraorbital fossa where the caudal aspect of the zygomatic process of the frontal bone emerges from the frontal bone, caudal and medial to the orbit; 20 gauge 6 cm spinal needle inserted at 110 degrees to the long axis of the head; 0.5ml.

Ref: Caruso et al, Vet Surg 2016, 45:494–498

Question 5

Which of the following antibacterial preparations was the most effective in reducing bacterial loads pre-surgery (two preparations) and post-surgery (one preparation) in veterinary students scrubbing for surgery at a university hospital in Canada (Chou et al, 2016)?

i) 4% chlorhexidine gluconate (CH).
ii) Hand rub with a mixture of 30% 1-propanol and 45% 2-propanol solution (MPS).
iii) 70% 2-propanol solution (IPS).
iv) 61% ethanol solution with 1% chlorhexidine gluconate (ES/CH).

Answer 5

After surgical hand preparation, CH and ES/CH provided significantly higher log CFU reduction and lower positive culture rate for Gram-positive and spore-forming bacteria compared to MPS and IPS. At the end of surgery, ES/CH provided significantly higher log CFU reduction and lower positive culture rate.

Ref: Chou et al, Vet Surg 2016, 45:515-522.

Question 6

Compagnie et al (2016) described a novel method for arthroscopic removal of osteochondral fragments from the proximal intertarsal joint (PIJ) using a direct approach without resection of the membrane between the tarsocrural joint and the PIJ. This method involved creation of 3 portals, with the third being a direct portal into the PIJ. What structures are at risk of damage in creation of this additional portal?
A. Long digital extensor tendon and cranial tibial artery.
B. Lateral digital extensor tendon and peroneus tertius.
C. Peroneus tertius and cranial tibial tendon.
D. Cranial tibial tendon and and dorsal metatarsal artery.

Answer 6

C. Peroneus tertius and cranial tibial tendon.

Ref. Compagnie et al, Vet Surg 2016, 45:182–186.

Question 7

Describe the surgical technique described by Compagnie et al (2016) for arthroscopic removal of large extensor process fragments occupying >25% of the joint surface of
the distal interphalangeal joint in Friesian horses. List the outcomes reported in this case series.

Answer 7

Methods: Arthroscopic examination of the DIJ was performed in dorsal recumbency
with the affected foot in extension using routine portals. Visualization of the fragment
was improved using motorized synovial resectors. A dissection plane between the
common digital extensor tendon and the extensor process fragment was created using
sharp lever instruments, in some cases aided by motorized burrs and radiofrequency
ligament dissection. The fragment was removed piecemeal using Ferris-Smith rongeurs.
Results: removal of the large fragment was successful in all 18 horses. 14/17 horses used as intended, 3/17 had some lameness. The angle between the remodelled extensor process and the dorsal surface of the distal phalanx was increased and subchondral bone remodeling at the fragment bed was noted on postoperative lateromedial radiographs.

Ref: Compagnie et al, Vet Surg 2016, 45:536-541.

Question 8

Amikacin is frequently used for local therapy in horses with infected synovial structures. In an experimental wound-healing model (Edwards-Milewski et al, 2016), what effect did intravenous regional limb perfusion with amikacin have on healing of surgical wounds?
A. Increased mononuclear cell infiltration in healing wound beds.
B. Wound healing rate was delayed.
C. Wound healing rate was accelerated.
D. Increased polymorphonuclear cell infiltration in healing wound beds.

Answer 8

A. Increased mononuclear cell infiltration in healing wound beds.

Ref. Edwards-Milewski et al, Vet Surg, 2016, 45:125-132.

Question 9

Describe the complications associated with intra-arterial injection of mesenchymal stem cells into the median artery of standing horses as identified by Espinosa et al, 2016.

Answer 9

A risk of periarterial injection was identified but can be reduced with proper sedation, local anesthesia, and increased experience. Partial venous thrombosis was observed as a complication in the medial and lateral palmar veins at the level of the distal metacarpal area and the medial palmar digital vein at the level of the fetlock, mid pastern and distal pastern. These thrombi, did not cause changes of clinical importance, other than rare transient swelling. 1 horse that developed mild distal limb edema 1 day after the injection. This resolved in 2 days after applying a sweat bandage and coldtherapy to the distal limb.

Ref: Espinosa et al, Vet Surg, 2016, 45:619–624.

Question 10

What was the purpose of arthroscopic guided needle placement during surgery to remove mineralised material from the palmar/plantar annular ligament (PAL) in ponies as described by Garvican et al, 2016?
A. To facilitate lavage of the flexor tendon sheath.
B. To help identify the division between the deep digital flexor tendon and the PAL.
C. To instil local anaesthetic agents into the PAL prior to resection.
D. To help identify the division between the superficial digital flexor tendon and the PAL.

Answer 10

D. To help identify the division between the superficial digital flexor tendon and the PAL.

Ref: Garvican et al, Vet Surg, 2016, 45:602-608.

Question 11

Jann et al, 2016, created lesions in the forelimb superficial digital flexor tendons of 5 horses and then compared healing via serial ultrasounds and scanning electron microscopy and histology following euthanasia in one control limb versus a limb treated with cross-linked, modified hyaluronic acid gel. What were their major findings?

Answer 11

Ultrasound assessment demonstrated a significant decrease in mean lesion size of treated (0%) compared to control (30%) tendons at 84 days. Mean (“SD) cumulative histologic tendon scores for control tendons (17.7”2.7) were significantly higher than treated tendons (13.6”1.9), indicating less advanced healing in the control group. Tendon cell density was increased and neovascularization, intensity of inflammation, and uniformity of fiber diameter were increased in control compared to treated tendons. There were no differences in fibroblast shape, levels of Intralesional hemorrhage, linearity of collagen fibers, or collagen fiber diameter or distribution between treated and control tendons

Ref: Jann et al, Vet Surg, 2016, 45:231-249.

Question 12

Which of the following options correctly identifies the dimensions and volume of the bicipital bursa of adult horses (Grabski et al, 2016)?
A. Length 11.32 cm (11.09-11.96 cm), width 8.14 cm (7.72-8.93 cm), volume 65 ml (59-71 ml).
B. Length 9.02 cm (8.48–9.45 cm); width 7.06 cm (6.71–8.01 cm); and volume 51 ml (45–58 ml).
C. Length 6.02 cm (5.78–6.36 cm); width 6.06 cm (5.71–7.12 cm); and volume 41 ml (33–49 ml).
D. Length 8.66 cm (7.79–9.05 cm); width 7.10 cm (6.91–7.53 cm); and volume 55 ml (49–62 ml).

Answer 12

B. Length 9.02 cm (8.48–9.45 cm); width 7.06 cm (6.71–8.01 cm); and volume 51 ml (45–58 ml).

Ref: Grabski et al, Vet Surg, 2016, 45:523-528.

Question 13

Larde et al, 2016, described a dorsal arthroscopic approach to the bovine antebrachiocarpal and middle carpal joints. List the structures which they were able to identify and the structures which were not able to be assessed using this approach.

Answer 13

Structures visualised: distal radius, proximal aspect of the radial, intermediate and ulnar carpal bones, and a palmar ligament located between the radius and the intermediate carpal bone. The approach to the middle carpal joint allowed visualization of the distal aspect of the radial, intermediate, and ulnar carpal bones, the proximal aspect of the fourth and fused second and third carpal bones and an interosseous ligament.
Structures not able to be assessed: The most lateral articular structures i.e. lateral glenoid cavity of the distal radius, ulnar carpal and fourth carpal bones.

Ref: Larde et al, Vet Surg 2016, 45:609-618.

Question 14

Septic joints can be treated a number of different ways. Loftin et al, 2016, compared needle arthroscopic lavage (dorsomedial arthroscope and dorsolateral egress cannula) and needle (3 x 14 g needles dorsomedial ingress, dorsolateral, and plantarolateral egress) of the tarsocrural joints in cadaver specimens in which coloured microspheres had been injected post-mortem. What did they find?
A. The number of microspheres recovered in the first litre of lavage fluid was significantly higher in the needle lavage group than in the arthroscopic lavage group.
B. The number of microspheres recovered in the first litre of lavage fluid was significantly higher in the arthroscopic lavage group than in the needle lavage group.
C. Significantly more microspheres were recovered in the 3rd than the 2nd litre of fluid in both groups.
D. Significantly more microspheres were recovered in the 2nd litre than the 1st litre of fluid in the arthroscopic lavage group.

Answer 14

Answer. A. The number of microspheres recovered in the first litre of lavage fluid was significantly higher in the needle lavage group than in the arthroscopic lavage group.

Ref. Loftin et al, Vet Surg, 2016, 45:240-245.

Question 15

Marchionatti et al, reported 39 cases of omphalophlebitis in calves managed surgically. List:

i) The two most common concurrent disease entities present in these calves,
ii) The two surgical approaches used,
iii) The different prognoses associated with the surgical approaches.

Answer 15

i) Liver abscess (18/39) and septic arthritis (11/39).
ii) Complete surgical en bloc resection (18/39) and umbilical vein marsupialization (21/39).
iii) 100% survival with en bloc resection; 74% survival with umbilical vein marsupialisation; septic arthritis had significant negative effect on survival.

Ref: Marchionatti et al, Vet Surg 2016, 45:194-200.

Question 16

Markwell and Mueller (2016) evaluated a Zipfix implant for prosthetic laryngoplasty in horses. When they tested these implants ex vivo what did they find?
A. This implant offers considerable advantages over Ticron and is suitable for clinical application.
B. 4/18 cricoid cartilages fractured on implant placement.
C. Cricoid-Zipfix and arytenoid-Zipfix stiffness where significantly greater than Cricoid-Ticron and arytenoid-Ticron stiffness.
D. Under cyclic load, arytenoid-Zipfix distraction was significantly greater than arytenoid-Ticron distraction.

Answer 16

C. Cricoid-Zipfix and arytenoid-Zipfix stiffness where significantly greater than Cricoid-Ticron and arytenoid-Ticron stiffness.

Ref: Markwell and Mueller, Vet Surg 2016, 45:450-455.

Question 17

Munsterman et al (2016) performed a meta-analysis of horses undergoing exploratory celiotomy and subsequent laparoscopy or euthanasia to determine the efficacy of adhesion barriers in preventing abdominal adhesions. Which of the following findings resulted from the meta-analysis?
A. The odds of developing abdominal adhesions was not significantly different between treatment and control groups.
B. The odd of developing abdominal adhesions was significantly lower for horses in which carboxymethylcellulose solution or sodium hyaluronate/carboxymethylcellulose membranes were used than for control horses in which no adhesion barrier was used.
C. The odd of developing abdominal adhesions was significantly lower for horses in which hyaluronate and fucoidan solutions were used than for control horses in which no adhesion barrier was used.
D. The odds of developing abdominal adhesions was significantly higher in treated horses than in control horses in which no abdominal barrier was used.

Answer 17

B. The odd of developing abdominal adhesions was significantly lower for horses in which carboxymethylcellulose solution or sodium hyaluronate/carboxymethylcellulose membranes were used than for control horses in which no adhesion barrier was used.

Ref. Munsterman et al, Vet Surg 2016, 45:587-595.

Question 18

In a study of the influence of infusate volume on therapeutic drug concentrations achieved in the metacarpophalangeal joint following intravenous regional limb perfusion with 2g amikacin performed by Oreff et al (2016), which of the following was true?
A. No adverse effects were noted in horses receiving 30ml or 60ml perfusate volumes; 3/7 horses in the 100ml perfusate group developed minor local reactions to RLP (mild swelling and pain on palpation of the cephalic vein).
B. The mean amikacin concentrations in synovial fluid at 30 minutes after perfusion was not significantly different following perfusate volumes of 100ml (579ug/ml) and 60ml (498ug/ml) but results in both these groups were significantly higher than for horses receiving perfusate volumes of 30ml (282ug/ml).
C. The mean amikacin concentrations in serum at 30 minutes after perfusion was not significantly different following perfusate volumes of 100ml (12ug/ml) and 60ml (11ug/ml) but results in both these groups were significantly higher than for horses receiving perfusate volumes of 30ml (4ug/ml).
D. The only test group in which 100% of horses reached the synovial therapeutic threshold of 160ug/ml was the 100ml perfusate group.

Answer 18

D. The only test group in which 100% of horses reached the synovial therapeutic threshold of 160ug/ml was the 100ml perfusate group.

Ref. Oreff et al, Vet Surg 2016; 45:625-630.

Question 19

Ruzickova et al evaluated 4 suture materials for laparoscopic bladder closure in cadaveric equine bladders. With regards to the performance of knotless, barbed suture in the equine bladder wall, which of the following is true?
A. Bursting strength is significantly increased in the bladder following placement of knotless, barbed suture compared to control, intact bladders.
B. Bursting strength is significantly greater in bladders repaired with 2-0 poliglecaprone versus 2-0 polyglyconate suture.
C. The time taken to repair a ruptured bladder laparascopically was significantly faster when laparascopic needle holders and forceps were used than when an automated suture device was used.
D. The time taken to repair a ruptured bladder laparascopically was significantly slower when laparascopic needle holders and forceps were used than when an automated suture device was used.

Answer 19

D. The time taken to repair a ruptured bladder laparascopically was significantly slower when laparascopic needle holders and forceps were used than when an automated suture device was used.

Ref. Ruzckova et al, Vet Surg 2016; 45:374-379.

Question 20

Surgical intervention is capable of inducing local and systemic inflammatory responses which can potentially cloud interpretation of post-surgical diagnostic tests. In a paper by Sanchez-Teran et al (2016) comparing the inflammatory response in horses for 120 hours following arthrocentesis (control group) or arthroscopic lavage (treatment group) of the middle carpal joint, which of the following responses were observed?
A. Systemic and synovial serum amyloid A concentrations did not increase from baseline in either group and were not significantly different between treatment groups.
B. Total protein concentrations were significantly increased in control horses at all time points (except 96 hours post arthrocentesis).
C. Synovial fluid neutrophil percentage was significantly increased in the treatment group for 72 hours post-arthroscopy and was increased in the control group for 24 hours post-arthrocentesis.
D. Nucleated cell counts decreased significantly from baseline in both the treatment and control group at all time points.

Answer 20

A. Systemic and synovial serum amyloid A concentrations did not increase from baseline in either group and were not significantly different between treatment groups.

Ref: Sanchez-Teran et al, Vet Surg 2016; 45:223-230.

Question 21

Displaced abomasum is a common disorder requiring surgical repair in ruminants. In cattle both abomasopexy via a right paramedian approach and blind and laparoscopic-guided toggle placement have been reported to correct the condition successfully. What was the influence of surgical model on outcome in sheep undergoing abomasopexy in a study by Thomas et al (2016)?
A. The mortality rate was significantly greater for sheep undergoing right paramedian suture abomasopexy than sheep undergoing abomasopexy via laparoscopic toggle placement.
B. Chromic cat gut induced wider and longer adhesions between the abomasum and the body wall than polydioxanone.
C. The sutured technique created wider and longer adhesions between the abomasum and the body wall than the toggle technique.
D. Laparoscopic toggle placement took a longer time than the sutured techniques.

Answer 21

C. The sutured technique created wider and longer adhesions between the abomasum and the body wall than the toggle technique.

Ref: Thomas et al, Vet Surg 2016; 45:488-493.

Question 22

Bovine Spastic Paresis is a progressive neuromuscular disease of cattle that results in economic loss for cattle producers. A retrospective study of cattle presenting to the University of Ghent between 2009 and 2013 for Bovine Spastic Paresis (De Vlamynck et al) compared surgical and conservative medical management of this condition. Which of the following is correct regarding this results?
A. Mixed muscle involvement (gastrocnemius and quadriceps femoris) is the most common presentation of this disease.
B. 33.3% of the calves in which the gastrocnemius only was involved spontaneously improved without surgical intervention.
C. 86% of calves with mixed muscle involvement had complete resolution of clinical signs following surgery.
D. The prognosis is poorer for calves with bilateral clinical signs as opposed to unilateral clinical signs.

Answer 22

A. Mixed muscle involvement (gastrocnemius and quadriceps femoris) is the most common presentation of this disease.

Ref: De Vlamynck et al, Vet Surg 2016; 45:187-193.

Question 23

Identify the challenges of surgical repair of type III distal phalynx fractures in horses and identify the advantages and disadvantages of a more distal screw position compared to the conventional screw position in repairing these fractures as described by Bindler et al, 2015.

Answer 23

Challenges of internal fixation of type III distal phalanx fractures include limited access to the bone inside the hoof capsule, challenges in accurate screw positioning across the fracture plane, potential to disrupt adjoining structures including the articular surface and solar canal, potential for disruption of the blood supply if the solar canal is penetrated and consequent patient morbidity, anaesthetic complications and surgical site infection.

The conventional screw position (group 1) is insertion halfway between the proximal border of the solar
canal (SC) and the subchondral bone surface on a line parallel to the dorsal cortex. The more dorsal position (group 2) involves the screw being inserted more palmar/plantar, where a perpendicular line drawn from the group 1 position reached the palmar/plantar cortex. Group 2 isolated distal phalanges had a significantly more rigid fixation compared with group 1 (maximum point at failure 31%, bending stiffness 41% higher). Lumen reduction of the SC was observed in 13/52 specimens (all from group 2), of which 9 were forelimbs. More distal screw positioning compared with the conventionally recommended screw position for internal fixation of type III distal phalangeal fractures allows placement of a longer screw and renders a more rigid fracture fixation. The novel screw position, however, carries a higher risk of SCP

Ref: Bindler et al, Vet Surg 2015; 44:829-837.

Question 24

Platelets and plasma products can be injected intralesionally to accelerate repair of musculoskeletal injury in horses. Clot formation is an important component of the action of such products. Which of the following statements can be made regarding the clotting efficiency of platelet-rich plasma (PRP), concentrated platelet-poor plasma (cPPP) and citrated whole blood after activation by autologous thrombin, bovine thrombin, or calcium chloride (CaCl2) (Ghasseb et al, 2015)?
A. cPPP has the greatest clot strength, quickest clot rate, and shortest clot initiation time.
B. CaCl2 resulted in the shortest clot initiation time and quickest clot rate.
C. PRP had the greatest clot strength and quickest clot rate.
D. Bovine thrombin resulted in the lowest clot strength.

Answer 24

C. PRP had the greatest clot strength and quickest clot rate.

Ref: Ghassab et al, Vet Surg 2015; 44:970-975.

Question 25

Discuss whether or not locking compression plate (LCP) fixation is an appropriate therapy for repair of tarsal subluxations in horses with reference to the retrospective case study performed by Keller et al, 2015.

Answer 25

LCP fixation of tarsal subluxations resulted in stable fixation and allowed adequate healing. All horses survived and were discharged from the hospital. Short-term complications included mild laminitis (n.1) and peroneus tertius rupture (2). At longterm follow up, both ponies were sound and used as intended, whereas all horses showed mild to moderate lameness at the trot and were used for pleasure riding only. Radiographic signs of osteoarthritis developed in the joint affected by subluxation in all cases and in adjacent small tarsal joints in 2 horses and 1 pony. Ref: Keller et al, Vet Surg 2015; 44:949-956.

Question 26

Plummer et al (EVJ, 2007) reported the prognosis for survival to discharge and long term survival following caecal impactions to be good in horses, regardless of type of treatment of administered (medical vs surgical). Were these findings supported by the recent study performed by Aitken et al (Vet Surg, 2015)? If not, what differences were identified in the latter study?

Answer 26

Aitken et al, identified a lower survival rate in their population of 150 horses with caecal impactions than in Plummer’s work, and additionally identified decreased survival in horses treated medically. In Aitken et al’s study 25% of horses had caecal perforation at admission and 2% were euthanised without treatment. 61% of horses managed medically survived to discharge as opposed to 82% of those undergoing surgery. Similarly, only 57% of horses managed medically were alive 1 year post-discharge as opposed to 70% of horses undergoing jejunocolostomy and 73% of horses undergoing typhlotomy alone. Ref: Aitken et al, Vet Surg 2015; 44: 540-546.

Question 27

The modified Forssell’s procedure has long been accepted as the method of choice for surgical treatment of cribbing behaviour. More recently a laser modification of this procedure has been described. Which of the following statements is true regarding the modified laser-assisted Forssell’s procedure according to Baia et al, 2015? A. The success rates for resolving cribbing behaviour (22.2%) are poor with procedure. B. The complication rate is relatively low (32.6%). Complications include change in voice, haematoma, seroma, incisional infection and prolonged drainage. C. Preoperative cribbing duration of >3 years is significantly associated with an unsuccessful outcome following the procedure. D. In horses that resume cribbing the median relapse time is 11 months.

Answer 27

C. Preoperative cribbing duration of >3 years is significantly associated with an unsuccessful outcome following the procedure. Ref: Baia et al, Vet Surg 2015; 44:156-151.

Question 28

You have a horse which is an Olympic prospect which has successfully competed at 3* eventing level. During training it develops an upper airway noise. You diagnose right recurrent laryngeal neuropathy and recommend a prosthetic laryngoplasty. The owner listens to your wise advice and complies. Six months after surgery the horse develops a rarely reported complication (Barakzai et al, 2015)! What do you tell the owner? A. This complication occurred due to reintroduction to dry hay too soon in the post-operative period. B. This complication occurred due to the use of an inappropriately large suture by the surgeon. C. This complication is likely secondary to iatrogenic damage to the caudal pharyngeal constrictor muscles, the intrinsic musculature of the upper oesophagus, or their innervation, or damage to the peri‐oesophageal fascia or oesophageal adventitia, sustained during surgery. D. This complication is likely secondary to iatrogenic damage to the intrinsic musculature of the upper larynx, or their innervation, or damage to the peri‐tracheal fascia or tracheal adventitia, sustained during surgery.

Answer 28

C. This complication is likely secondary to iatrogenic damage to the caudal pharyngeal constrictor muscles, the intrinsic musculature of the upper oesophagus, or their innervation, or damage to the peri‐oesophageal fascia or oesophageal adventitia, sustained during surgery. Ref: Barakzai et al, Vet Surg 2015; 44: 150-155.

Question 29

Which of the following patients in which admission examination findings are reported, is most like to have entrapment of the small intestines by the gastrosplenic ligament, as per the research by Bergren et al? A. 7 year old Paint Horse gelding; heart rate = 78bpm, 2L net nasogastric reflux, peripheral lactate 4.5mmol/L. B. 12 year old American Quarter Horse gelding; heart rate = 58bpm, 6L net nasogastric reflux, peripheral lactate 1.5mmol/L. C. 17 year old Arabian stallion; heart rate = 52bpm, 12L net nasogastric reflux, peritoneal fluid lactate 7.3mmol/L. D. 4 year old Warmblood mare; heart rate = 48bpm, 3L net nasogastric reflux, peritoneal fluid lactate 5.9mmol/L.

Answer 29

B. 12 year old American Quarter Horse gelding; heart rate = 58bpm, 6L net nasogastric reflux, peripheral lactate 1.5mmol/L. Ref: Bergren et al, Vet Surg, 2015; 44:535-539.

Question 30

Describe factors associated with postoperative reflux, postoperative colic, repeat celiotomy, and survival in horses after end‐to‐side (E2S) or side‐to‐side (S2S) jejunocecostomy (Brown et al, 2015).

Answer 30

Method of anastomosis was not significantly associated with development of postoperative reflux or colic, repeat celiotomy, whether the horse was alive at hospital discharge or 12 months after discharge. The number of years that the principal surgeon was boarded by the ACVS significantly affected whether the horse was discharged from the hospital alive (P..003). Age (P..006) was significantly associated with 12‐month survival. Increased age (P..013) and administration of prokinetic medication (P..0006) were significantly associated with development of postoperative reflux. Sixty‐eight (76%) horses with S2S and 52 (87%) horses with E2S were discharged alive. Ref: Brown et al, Vet Surg, 2015; 44:527-533.

Question 31

``` Which of the following drugs, when infiltrated subcutaneously and intra-testicularly, is most likely to decrease heart rate, respiratory rate, mean blood pressure and response to surgical stimulus in alpacas undergoing castration under field anaesthetic conditions, compared to untreated controls (Nickell et al, 2015)? A. Bupivacaine. B. Mepivacaine. C. Ketamine. D. Lidocaine. ```

Answer 31

Answer: A. Bupivacaine. Ref: Nickell et al, Vet Surg, 2015; 44:168-173.

Question 32

Describe risk factors, clinical signs, treatment and prognosis for horses that develop haemoperitoneum following emergency exploratory celiotomy for gastrointestinal disease (Gray et al, 2015).

Answer 32

In the retrospective study by Gray et al, 23/4520 horses develop haemoperitoneum following emergency celiotomy i.e. there was an incidence of 0.5%. Horse signalment approximated the colic population, although Thoroughbreds were significantly overrepresented. Haemoperitoneum was significantly associated with intestinal resection. Postoperative haemoperitoneum was recognized a mean (+/- SD) of 1.0 +/- 0.7 days after surgery and associated with tachycardia, decreasing haematocrit, incisional drainage, or ultrasonographic identification of swirling, echogenic abdominal fluid. Primary treatments included intravenous fluid therapy, colloid support, blood transfusion and antifibrinolytic agents. 65% of horses survived to discharge, which was associated with admission lactate and days of hospitalisation. Prognosis is guarded because of potential sequelae of septic peritonitis and adhesion formation. Ref: Gray et al, Vet Surg, 2015; 44:379-385.

Question 33

Milly, a 23 year old Australian Stock Horse mare, presents to your hospital for evaluation of acute colic. Following clinical examination you recommend an exploratory celiotomy. The owner can afford surgery but is concerned that at her age Milly will not pull through surgery as well as a younger horse and asks for your advice to help make the decision. What do you tell her (Gazzerro et al, 2015)? A. Milly is more likely to develop thrombophlebitis, fever and laminitis post-operatively than a non-geriatric horse, but her chances for survival and discharge from hospital are just as good as a non-geriatric horse. B. Milly is at no more risk than a non-geriatric horse of developing short term complications post-colic surgery, but is more likely to develop long term complications e.g. incisional hernia, repeat colic episodes. C. The risk of incisional infection is higher for Milly than for non-geriatric horses, however the risk of incisional dehiscence is no greater, so this is not a big problem as she is retired and no longer ridden and if she ends up with a hernia or scar it is only a cosmetic issue. D. The risk of developing short term complications and chance of surviving to discharge are the same for Milly as a non-geriatric horse undergoing an emergency exploratory celiotomy.

Answer 33

D. The risk of developing short term complications and chance of surviving to discharge are the same for Milly as a non-geriatric horse undergoing an emergency exploratory celiotomy. Ref: Gazzerro et al, Vet Surg 2015; 44:256-264.

Question 34

Asymmetric dorsoventral obstruction of the nasopharynx during poll flexion is reported as a cause of poor performance in dressage horses (Barton et al, 2014). Which of the following is the proposed mechanism of this disorder? A. Presence of an overly long soft palate. B. Impingement of the C1-2 dorsal nerve rootlets following hyperflexion of the poll during training (‘rolkur’). C. Impairment of the guttural pouch opening mechanism. D. Paresis of the glossopharyngeal nerve.

Answer 34

C. Impairment of the guttural pouch opening mechanism. Ref: Barton et al, Vet Surg, 2014; 43:418-424.

Question 35

List the complications and prognosis for return for function for horses that undergo subtotal ostectomy of diseased dorsal spinal processes of the caudal thoracic vertebrae, as described by Brink, 2014.

Answer 35

No serious complications occurred. Outcome was obtained for 22/23 horses. At <1 year, 19 horses (86%) returned to full athletic function, 2 horses (9%) improved but had failed to return to full function, 1 horse had no improvement. At >1 year, 2 horses that had returned to full athletic function were unable to function at full capacity; 1 was considered improved, but the other had not improved. Athletic function in 1 horse improved 6 months after surgery, but at 2.5 years was no better than before surgery. Ref: Brink, Vet Surg, 2014; 43:95-98.

Question 36

Which of the following interventions decreases the risk of post-operative complications in horses undergoing peroneal urethrotomy (Kilcoyne et al, 2014)? A. Post-operative indwelling urinary catheter. B. Post-operative cystoscopy and bladder lavage. C. Peri-operative systemic antimicrobial and anti-inflammatory therapy. D. Fragmentation of urinary calculi to facilitate removal prior to urethrotomy.

Answer 36

B. Post-operative cystoscopy and bladder lavage. Ref: Kilcoyne et al, Vet Surg, 2014; 43:691-696.

Question 37

Describe clinical signs, radiographic signs and surgical treatment of sinonasal cysts in cattle, as identified by Schmid et al, 2014.

Answer 37

Common presenting clinical signs were abnormal respiratory noise, nasal discharge, and abnormal respiratory effort. Mean age of affected cattle was 21.7 months. In 9/15 animals, cysts were identified by endoscopy. Radiographic signs included a mass in the paranasal sinuses or conchae (13), nasal septum deviation (12), fluid lines (10), and bone atrophy (5). Ten cattle were treated surgically with osteoplastic flap techniques to gain access to the frontal or maxillary sinus (5), nasal extraction of the cyst under endoscopic control (3) or a combination of both techniques (2). Ref: Schmid et al, Vet Surg, 2014; 43:190-198.

Question 38

Is plain radiography useful for diagnosis, surgical management and post-operative treatment of obstructive urolithiasis in small ruminants, as per the findings of Kinsley et al, 2013?

Answer 38

In regions where radiopaque calculi (calcium carbonate, calcium oxalate, silica) are commonly encountered in small ruminants, plain radiographs are useful to determine the appropriate surgical approach(es) and to confirm resolution of the obstruction. Radiopaque urinary calculi were detected in 23 (85%) plain radiographic studies. Location of uroliths determined by plain radiography included: cystic only (n ¼ 5), distal to the sigmoid flexure and cystic (5), subischial (5), distal to the sigmoid flexure only (3), sigmoid flexure (3), and subischial and cystic (2). In 8 of these animals, postoperative radiographs revealed residual calculi in the urethra and were essential for their targeted removal by urethrotomy in 7 animals. Ref: Kinsley et al, Vet Surg, 2013; 42:663-668.

Question 39

You book a horse in for surgical excision of granulation tissue produced by infection with Pythium isidiosum (which btw would be a fabulous Harry Potter incantation!) The owner tells you she has heard something about intravenous antifungal treatment of this disease. You tell her you will perform intravenous regional perfusions (IRLP) with amphotericin B following surgery, and that according to Doria et al, 2012: A. This combined course of therapy results in cure in 100% of cases. B. Adverse effects occur in 23% of horses following amphotericin B IRLP and include thrombosis of the vein, sloughing of skin and acute renal failure. C. Three IRLP repeated at 48 hours intervals will be necessary to achieve maximum success. D. Adverse effects are common with this treatment, however are minor and resolved within 14 days in all reported cases.

Answer 39

D. Adverse effects are common with this treatment, however are minor and resolved within 14 days in all reported cases. IRLP induced limb edema and pain during regional palpation in 42%, and inflammation of the injection site in 33% of horses. Ref: Doria et al, Vet Surg 2012; 41:759-765.

Question 40

``` You are asked to give a talk to local practitioners about the importance of infection control measures in the surgical environment. You quote the study by Singh et al, 2013, and inform them that the following is a common carrier of methicillin resistance Staphylococcus aureus and methicillin resistant Staph. Intermedius in veterinary hospitals: A. Otoscopes. B. ‘Wet kit’ surgical instruments. C. Scrubs. D. Instrument trays. ```

Answer 40

C. Scrubs. Ref: Singh et al, Vet Surg, 2013; 42:643-648.

Question 41

``` A horse presents to your clinic for colic. You make a diagnosis of right dorsal displacement and recommend surgery, however the owner declines on financial grounds. You institute medical therapy (analgesia, intravenous fluid therapy, gentle exercise). What is the prognosis for resolution of the displacement according to McGovern et al, 2012: A. 64%. B. 68%. C. 76%. D. 79%. ```

Answer 41

A. 64%. Ref: McGovern et al, Vet Surg 2012; 41:399-403.