BCSE Veterinary Surgical Principles 4 — Questions and Answers
Question 1: When performing a lateral thoracotomy in a dog, between which intercostal spaces is the incision most commonly made to access the caudal lung lobes and esophagus?
- 2nd–3rd intercostal space
- 4th–5th intercostal space
- 8th–9th intercostal space (Correct answer)
- 11th–12th intercostal space
Correct answer: 8th–9th intercostal space
The 8th–9th intercostal space provides optimal access to the caudal lung lobes, caudal esophagus, and caudal mediastinal structures in dogs.
Question 2: Which of the following is a TRUE statement about the use of drains in surgical wounds?
- Passive drains prevent all surgical site infections
- Active closed-suction drains (e.g., Jackson-Pratt) are preferred over passive drains for most wounds (Correct answer)
- Drains should routinely exit through the primary incision
- Drains should be left in place for a minimum of 14 days regardless of output
Correct answer: Active closed-suction drains (e.g., Jackson-Pratt) are preferred over passive drains for most wounds
Active closed-suction drains provide controlled negative pressure, reduce fluid accumulation more effectively, and lower infection risk compared to passive open drains.
Question 3: A horse undergoing general anesthesia in dorsal recumbency is at risk for which muscle condition that can result in postoperative myopathy?
- Rhabdomyolysis due to prolonged pressure on muscle groups (Correct answer)
- Tetany due to hypocalcemia
- Hypokalemic periodic paralysis
- Malignant hyperthermia
Correct answer: Rhabdomyolysis due to prolonged pressure on muscle groups
Horses in dorsal recumbency experience compression of large muscle groups, reducing perfusion and causing ischemic myopathy (postanesthetic myopathy) if prolonged.
Question 4: Which of the following best describes the mechanism of action of nonsteroidal anti-inflammatory drugs (NSAIDs) used for perioperative analgesia in veterinary patients?
- Block sodium channels in peripheral nerves
- Inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis (Correct answer)
- Bind opioid receptors in the CNS
- Block NMDA receptors to prevent central sensitization
Correct answer: Inhibit cyclooxygenase enzymes, reducing prostaglandin synthesis
NSAIDs inhibit COX-1 and/or COX-2 enzymes, thereby reducing prostaglandin production and decreasing peripheral and central sensitization to pain.
Question 5: During intestinal anastomosis, a surgeon performs a leak test. Which method is most commonly used intraoperatively to check for anastomotic leakage?
- Inject methylene blue through a nasogastric tube
- Occlude the bowel on both sides of the anastomosis and gently milk intraluminal air toward the site while submerging in saline (Correct answer)
- Apply fluorescein dye under UV light
- Request intraoperative endoscopy
Correct answer: Occlude the bowel on both sides of the anastomosis and gently milk intraluminal air toward the site while submerging in saline
The air-leak test involves occluding the bowel on each side, injecting air or milking intraluminal gas toward the anastomosis submerged in saline, and watching for bubbles indicating a leak.
Question 6: A cat is diagnosed with a diaphragmatic hernia following blunt trauma. Which organ is most commonly herniated into the thorax in cats?
- Spleen
- Kidney
- Liver and small intestine (Correct answer)
- Stomach
Correct answer: Liver and small intestine
In cats with traumatic diaphragmatic hernia, the liver and small intestine are the most frequently herniated organs due to their proximity to the diaphragm.
Question 7: Which principle of surgical technique is described by the term 'atraumatic tissue handling'?
- Using the largest suture size possible to ensure closure strength
- Minimizing unnecessary trauma to tissues by using sharp dissection, gentle retraction, and avoiding crushing instruments on delicate structures (Correct answer)
- Applying electrocautery liberally to control all bleeding
- Closing all wounds under maximum tension to eliminate dead space
Correct answer: Minimizing unnecessary trauma to tissues by using sharp dissection, gentle retraction, and avoiding crushing instruments on delicate structures
Atraumatic technique minimizes tissue damage through precise sharp dissection, gentle handling, and avoiding crush injury, which reduces necrosis and promotes healing.
BCSE Veterinary Surgical Principles 4
When performing a lateral thoracotomy in a dog, between which intercostal spaces is the incision most commonly made to access the caudal lung lobes and esophagus?