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VTNE

Terms in this set (1986)

"Zoe", a 40 kg Labrador Retriever is recovering after a liver mass resection. The doctor asks you to start "Zoe" on a fentanyl constant rate infusion at 4 micrograms per kilogram per hour (ug/kg/hr). The concentration of fentanyl is 0.05mg/mL. The fluid rate is currently set at 100 mL/hour. How much fentanyl will you add to a liter of Normosol-R?

14 mL
32 mL Correct Answer
61 mL
8 mL
Explanation
Constant rate infusions are not something that an entry level technician would typically perform. However, the VTNE may have some questions on CRI and it will benefit you to know how to do these calculations. To solve this problem, break down the basic parts to make it less overwhelming:

1) Convert pounds to kilograms- Note that in this problem the units are already in kg so no conversion is necessary. Make sure to pay attention to this.
2) Calculate the number of hours an infusion will last by dividing the volume in the bag (1 Liter, or 1,000 mL) by the rate per hour: 1,000 mL/100mL/hr = 10 hours
(If the problem asks for a dose per minute, you will need to multiply the hours by 60 to convert to minutes, but since this problem asks for ug/kg/HOUR, you do not need to further convert)
4) Now plug into the equation: 4 ug/40kg/10 hours= 1600 ug
5) Now convert the ug into mg by dividing by 1,000: 1600/1,000 = 1.6 mg

6) Calculate the quantity of fentanyl to add by now dividing the 1.6 mg by the concentration of the drug (0.05 mg/mL) : 1.6mg/0.05mg/mL = 32 mL

To be truly accurate when adding drugs to a bag like this, you should discard 32 mL of fluids from the bag prior to adding the 32 mL of fentanyl.
"Zoe", a 40 kg Labrador Retriever is recovering after a liver mass resection. The doctor asks you to start "Zoe" on a fentanyl constant rate infusion at 4 micrograms per kilogram per hour (ug/kg/hr). The concentration of fentanyl is 0.05mg/mL. The fluid rate is currently set at 100 mL/hour. How much fentanyl will you add to a liter of Normosol-R?

14 mL
32 mL Your Answer
61 mL
8 mL
Explanation
Constant rate infusions are not something that an entry level technician would typically perform. However, the VTNE may have some questions on CRI and it will benefit you to know how to do these calculations. To solve this problem, break down the basic parts to make it less overwhelming:

1) Convert pounds to kilograms- Note that in this problem the units are already in kg so no conversion is necessary. Make sure to pay attention to this.
2) Calculate the number of hours an infusion will last by dividing the volume in the bag (1 Liter, or 1,000 mL) by the rate per hour: 1,000 mL/100mL/hr = 10 hours
(If the problem asks for a dose per minute, you will need to multiply the hours by 60 to convert to minutes, but since this problem asks for ug/kg/HOUR, you do not need to further convert)
4) Now plug into the equation: 4 ug/40kg/10 hours= 1600 ug
5) Now convert the ug into mg by dividing by 1,000: 1600/1,000 = 1.6 mg

6) Calculate the quantity of fentanyl to add by now dividing the 1.6 mg by the concentration of the drug (0.05 mg/mL) : 1.6mg/0.05mg/mL = 32 mL

To be truly accurate when adding drugs to a bag like this, you should discard 32 mL of fluids from the bag prior to adding the 32 mL of fentanyl.
5. An anthelmintic is used for treating which of the following?

A. Ticks
B. Intestinal parasites
C. Mange
D. Fleas

Explanation B
Anthelmintics are drugs used for expulsion of intestinal worms. Ivermectin, praziquantel, fenbendazole, pyrantel, etc. are a few examples of anthelmintics.


6. Clomipramine is a veterinary approved drug used most commonly to treat which condition?

A. Epilepsy
B. Allergies
C. Urinary incontinence
D. Separation anxiety

Explanation D
Clomipramine (Clomicalm) is most often used to treat generalized anxiety or separation anxiety in small animals. It is also approved for obsessive compulsive behaviors in dogs.

Chlorpheniramine sounds similar, and is an anti-histamine used in treating allergies. The most commonly prescribed medication for urinary incontinence is phenylpropanolamine. Potassium-bromide and phenobarbitol are commonly used medications for epilepsy.

7. Flunixin meglumine is sometimes used in horses, cattle, and pigs for which purpose?

A. For constipation
B. For tapeworm infestation
C. For analgesia
D. For acid reflux

Explanation C
Flunixin meglumine (Banamine) is a non-narcotic, non-steroidal anti-inflammatory drug used to provide analgesia and to reduce inflammation. It may also be used as a fever reducer.



8. What purpose is the administration of the drug Guaifenesin typically used for in horses?

A. Muscle relaxation
B. Antimicrobial
C. Intestinal Prokinetic
D. Anti-inflammatory
E. Expectorant

Explanation A
Guaifenesin is administered intravenously to horses to provide relaxation of skeletal muscles during induction of general anesthesia. The exact mechanism of action is unknown but believed to be related to central depression of nerve impulse transmission. Although guaifenesin is administered orally in some species as an expectorant, this is not the typical reason for its administration in horses.

9. Which of the following routes of administration would give a drug the highest bioavailability?

A. Subcutaneous
B. Intramuscular
C. Intravenous
D. Oral

Explanation C
Absorption of a drug is the movement of the drug from the site of administration into the systemic circulation. The route of administration directly affects how bioavailable the drug is. When a drug is given IV (intravenous), there is no absorption phase because it is injected directly into the systemic circulation. So drugs given IV have 100% bioavailability.

Drugs given intramuscularly (IM) have a high bioavailability as well, but not as high as the IV route. Drugs given subcutaneously (SQ) and orally (P.O.) must pass several barriers and thus will usually have a lower bioavailability.



10. A 6-month old puppy has presented to the hospital with a history of severe straining to defecate. A fecal float identifies a severe parasitic infection. An abdominal ultrasound was performed, and the doctor identified that one of the loops of intestine was telescoping into another segment of intestine. What is this called?

A. Intussusception
B. Evisceration
C. Strangulation
D. Hydrometra

Explanation A
This question is describing an envagination of intestine into an adjacent segment of intestine. The part which prolapses into the other is called the intussusceptum, and the part which receives it is called the intussuscipiens.

Evisceration refers to the removal of organs from body, usually from the abdomen. A hydrometra is the word used to describe fluid in the uterus. If the uterus were filled with pus, it would be referred to as a pyometra. Strangulation of a loop of intestine results in a point of constriction which then impedes circulation.


1. What is the permanent dental formula for a dog?

A. 2(I3/3 C1/1 P3/4 M1/3)
B. 2(I3/3 C1/1 P3/2 M1/1)
C. 2(I3/3 C1/1 P4/4 M2/3)
D. 2(I3/3 C1/1 P2/4 M3/3)

Explanation C
The correct answer is 2(I3/3 C1/1 P4/4 M2/3). Remember the dog has 42 teeth total.



1. The tooth crown is covered with which of the following?

A. Cementum
B. Pulp
C. Enamel
D. Dentin

Explanation C
Enamel is the hard mineralized surface of the tooth. It is made up of hydroxyapatite, or calcium phosphate.

The cementum is the thin calcified layer of tissue that covers the dentin of the tooth root.

The tooth itself is made up mostly of dentin. The dentin is covered by the enamel on the crown and by cementum on the roots.

The pulp is the center part of a tooth that is made up of living connective tissue and is the softest part containing nerve fibers.


1. The Triadan numbering system is commonly used in human and veterinary dentistry to specify a tooth. What is the correct number of the permanent right maxillary canine tooth of a dog or cat?

A. 301
B. 104
C. 201
D. 501
E. 404

Explanation B
In this system, the first numeral denotes the quadrant of the tooth and if it is permanent or deciduous. They are numbered starting at the right maxilla and moving counter-clockwise:
1 = Right maxilla (5 = deciduous)
2 = Left maxilla (6 = deciduous)
3 = Left mandible (7 = deciduous)
4 = Right mandible (8 = deciduous)

The next two digits indicate how many teeth over from the midline.
For example, in the dog:
701 is the deciduous mandibular left first incisor.
104 is the permanent right maxillary canine.
409 is the permanent mandibular right first molar.


1. Which of the following correctly defines the term stomatitis?

A. Inflammation of the oral mucosal surfaces
B. Inflammation of the region housing the tonsils
D. Inflammation of the tongue
E. Inflammation of the periodontal ligament and alveolar bone

Explanation A
Stomatitis describes inflammation of the oral mucosal surfaces. It can be subdivided by region, such as buccal stomatitis (inflammation of the cheek mucosa). Inflammation of the tongue is known as glossitis. Inflammation of the glossopalatine folds around the area housing the tonsil is known as faucitis. Inflammation of the periodontal ligament and alveolar bone fall under the category of periodontitis.

1. Which technique is needed to produce quality intra-oral radiographs?

A. Maxillary angle technique
B. Occlusal angle technique
C. Bisecting angle technique
D. Oblique angle technique

Explanation C
In the bisecting angle technique, the film is placed next to the tooth; the primary x-ray beam is aimed perpendicular to the plane that bisects the angle created by the plane of the central tooth axis to the plane of the dental film.

1. Name this dental instrument (see photo).


A. Curette
B. Probe
C. Polisher
D. Luxator

Explanation B
The instrument pictured is a periodontal probe. It is marked and used to measure depth of periodontal pockets.



1. You perform a dental prophylaxis on a dog that has all of his teeth. How many adult teeth are in the dog's mouth?

A. 24
B. 28
C. 32
D. 42

Explanation D
The adult dog has 42 teeth. Cats have 30 teeth. Most cats and dogs have all of their permanent teeth by 6 months of age.


1. Water comes from the ultrasonic scaler for which purpose?


A. It helps cool the instrument tip
B. It prevents introduction of bacteria into the gumline
C. It smoothes the surface of the tooth
D. It prevents dulling of the instrument

Explanation A
The ultrasonic scaler uses water to cool the instrument tip and to flush debris from the tooth as it is scaled away. By cooling the instrument tip, the water helps to prevent thermal damage to the tooth. The polisher is the instrument used to help smooth the tooth surface.

1. Periodontal disease can refer to processes affecting which of the following?

A. Gingiva
B. Tongue
C. Enamel
D. Hard palate
E. Dentin

Explanation A
Periodontal disease is one of the most common conditions seen. The periodontum includes the gingiva, the alveolar bone, the periodontal ligament and cementum of the tooth. Gingivitis is usually the first sign of periodontal disease.



1. Which of the following terms describes the something that is closer to the root of a tooth relative to another structure?

A. Apical
B. Coronal
C. Caudal
D. Buccal
E. Distal

Explanation A
The following terms are used in veterinary dentistry to describe different positions in the mouth and aspects of the tooth:
Rostral - Any structure closer to the front of the head relative to another structure
Caudal - Any structure closer to the back of the head relative to another structure
Buccal - The tooth surface that faces the cheek
Labial- The tooth surface that faces the lips
Vestibular- surface of a tooth that is directed outward toward the vestibule of the mouth which includes the buccal (cheek) and labial (lip) surfaces
Facial - The surface of the tooth visible from the front (same as the vestibular surface but applies mainly to the incisor teeth)
Lingual - The surface of the mandibular teeth that is adjacent to the tongue
Palatal - The surface of the maxillary teeth that is adjacent to the palate
Mesial - The portion of the tooth that is in line with the dental arcade and closest to the rostral midline of the dental arch
Distal - The portion of the tooth that is in line with the dental arcade and closest to the most caudal aspect of the dental arch (the opposite side of mesial)
Apical - The portion of the tooth closer to the tip of the root relative to another structure
Coronal - The portion of the tooth closer to the crown relative to another structure


1. Which species regurgitates food for remastication?

A. Lagomorphs
B. Horses
C. Cats
D. Pigs
E. Cattle

Explanation E
Cattle chew their "cud", which is food that they regurgitate for remastication.

When a cow chews her cud, she regurgitates a food bolus into her mouth, which is then re-chewed and re-swallowed. While cattle are chewing their cud, they produce saliva which acts as a natural antacid that helps to buffer and protect the rumen. Cows sometimes spend up to 8 hours a day chewing their cud.


1. When referring to teeth, which of the following terms describes the portion of the tooth that is in line with the dental arcade and closest to the rostral midline of the dental arch?

A. Apical
B. Buccal
C. Lingual
D. Mesial
E. Distal

Explanation D
The following terms are used in veterinary dentistry to describe different positions in the mouth and aspects of the tooth:
Rostral - Any structure closer to the front of the head relative to another structure
Caudal - Any structure closer to the back of the head relative to another structure
Buccal - The tooth surface that faces the cheek
Labial- The tooth surface that faces the lips
Vestibular- surface of a tooth that is directed outward toward the vestibule of the mouth which includes the buccal (cheek) and labial (lip) surfaces
Facial - The surface of the tooth visible from the front (same as the vestibular surface but applies mainly to the incisor teeth)
Lingual - The surface of the mandibular teeth that is adjacent to the tongue
Palatal - The surface of the maxillary teeth that is adjacent to the palate
Mesial - The portion of the tooth that is in line with the dental arcade and closest to the rostral midline of the dental arch
Distal - The portion of the tooth that is in line with the dental arcade and closest to the most caudal aspect of the dental arch (the opposite side of mesial)
Apical - The portion of the tooth closer to the tip of the root relative to another structure
Coronal - The portion of the tooth closer to the crown relative to another structure

1. Which of the following correctly defines the term stomatitis?

A. Inflammation of the region housing the tonsils
B. Inflammation of the tongue
C. Inflammation of the periodontal ligament and alveolar bone
D. Inflammation of the oral mucosal surfaces

Explanation D
Stomatitis describes inflammation of the oral mucosal surfaces. It can be subdivided by region, such as buccal stomatitis (inflammation of the cheek mucosa). Inflammation of the tongue is known as glossitis. Inflammation of the glossopalatine folds around the area housing the tonsil is known as faucitis. Inflammation of the periodontal ligament and alveolar bone fall under the category of periodontitis.
1. Periodontal pockets are measured by which dental instrument?

A. Elevator
B. Scaler
C. Probe
D. Curet

Explanation C
The probe is used to check pocket depth. The scaler is used to remove plaque and calculus from the teeth. In dentistry, the curet is a spoon-shaped instrument used for removing necrotic cementum and calculus from the teeth and can be used supragingival and subgingival. The elevator is used to wear down the periodontal ligament to aid in extracting teeth from the oral cavity.


1. A 60-lb patient is to go home on Clavamox after his dental cleaning. The dose is 14 mg/kg. What size tablet should the patient be sent home with?

A. 375 mg
B. 62.5 mg
C. 250 mg
D. 125 mg

Explanation A
After converting the body weight to kilograms the dose needs to be multiplied by the body weight.

60 lb / (2.2 lb/kg) = 27 kg (Notice the pounds cancel out)

27 kg x 14= 378 mg

Many medications are available in different concentrations to accommodate different sized patients. This is particularly the case with oral medications so that owners don't have to worry about trying to halve or quarter medications.


1. The 4th upper premolars are connected with which structure in dogs?

A. Pharynx
B. Maxillary Sinus
C. Frontal Sinus
D. Nasal cavity

Explanation B
The 4th upper premolars (carnassial teeth) communicate directly with the maxillary sinus. In the case of a carnassial tooth that becomes infected, an abscess builds up around the affected root just under the skin below and in front of the eye.

1. Which of the following is the best description of an epulis?

A. A gingival lesion caused by trauma
B. A developmental tooth disorder
C. A gingival lesion caused by inflammation
D. A non-malignant oral tumor

Explanation D
An epulis is a non-malignant tumor of the periodontal ligament. These tumors do not metastasize but can be locally invasive. The most aggressive form of this condition, an acanthomatous epulis, can invade and destroy bone.


1. Which of the following species have teeth that only grow for a limited time during development and do not continually erupt or grow throughout the life of the animal?

A. Horses
B. Pigs
C. Rabbits
D. Rats

Explanation B
Cats, pigs, humans and other carnivores have all brachyodont teeth. This means that they have a small crown relative to the size of the roots, and the apex of the each tooth root is only open for a brief period during development and does not continue to erupt. Horses, rodents, and lagomorphs have hypsodont teeth, which means that they have a relatively large amount of crown that is beneath the gingival margin as well as a root structure that allows for continued eruption during most of the animala's lifetime.

Hypsodont teeth can be further categorized as radicular hypsodont teeth, such as the cheek teeth of horses. These have apices that eventually close and stop growing, but continued eruption offsets attrition from occlusion. Aradicular hypsodont teeth (such as the incisors of rabbits) lack a true root structure, allowing for lifelong growth of the tooth itself.



1. In regards to rabbit anesthesia, which of the following best explains why the use of sedative premedications should be given prior to inducing anesthesia using a mask or induction chamber to deliver gas agents such as Isoflurane?

A. Allows intubation prior to induction
B. To help prevent breath holding
C. Anesthesia in rabbits can not be achieved by gas agents alone
D. To cause an increase in heart rate

Explanation B
Because rabbits often hold their breath and struggle when exposed to gas anesthetics, premedications such as dexmeditomidine, diazepam, or midazolam will facilitate smoother inductions.


1. What is the major concern when a patient has a long recovery post-op and is laterally recumbent for an extended period of time?

A. Atelectasis
B. Hypovolemia
C. Anemia
D. Pericardial effusion

Explanation A
Atelectasis is collapse of all or part of a lung. In a patient who is recumbent for a long period of time, there is increased risk that the lung could collapse (usually the lung that is down). This is why it is so important to turn the patient every 15 to 20 minutes after recovery. Turning the patient will help them to recover more quickly and will help to prevent atelectasis.


223. Padding is extremely important when a horse is under general anesthesia. When the animal is placed in dorsal recumbency, how much padding is required between the surgical table and the horse?

A. Two to four inches
B. At least twelve inches
C. Twelve to fourteen inches
D. At least six inches

Explanation D
At least six inches of padding should be used to prevent neuropathies of the head, shoulder, and hip.




1. A patient is hypoventilating and the end-tidal CO2 is rising. The doctor instructs you to give the patient a breath. The pressure on the manometer to which you ventilate the patient is:

A. 20 cm H2O
B. 5 cm H2O
C. 60 cm H2O
D. 40 cm H2O

Explanation A
When inflating the lungs, the pressure should reach but not exceed 20 cm H2O.


1. Which of the following components of an anesthetic machine needs to be replaced regularly?

A. Barium lime
B. Vaporizer
C. One-way valves
D. Breathing tubes

Explanation A
Barium lime is a carbon dioxide absorber that can become exhausted (lose its ability to absorb carbon dioxide) and must be replaced. The other components listed can be re-used.


1. Certain drugs may cause a rapid rise in temperature during anesthesia. This is known as malignant hyperthermia. Which species is at greatest risk for this condition?

A. Caprine
B. Porcine
C. Equine
D. Canine

Explanation B
Pigs are at greatest risk for malignant hyperthermia. It is thought that this condition may be hereditary. During anesthesia in pigs, this must be monitored very closely as early detection is essential to prevent fatality. Cooling measures, Dantrolene, and oxygen are all implicated in treatment.




1. Myositis in a horse can occur as a result of which of the following?

A. Administration of nonsteroidal anti-inflammatories prior to anesthesia will result in myositis
B. Intraoperative hypertension will result in myositis
C. A blood lactate level of 1.0 mg/dl and higher will result in myositis
D. Prolonged recumbency during anesthesia

Explanation D
Prolonged recumbency puts a horse at a high risk for developing myositis. It is extremely important for the anesthesia team to provide appropriate padding by means of rubber pads, inflatable tubes, or even an inflatable water bed to help decrease the pressure exerted on muscles as result of recumbency. Intraoperative hypotension can contribute to myositis due to lack of blood flow and subsequent ischemia at the level of the muscle. Myositis can result in extreme muscle pain and soreness. In severe cases, horses can develop myoglobinuria which can cause renal damage. The blood lactate level of 1.0 mg/dl is actually in the normal range; however, an increasing blood lactate level is a sign of anaerobic metabolism, which may be secondary to poor muscle oxygenation; the cause should be investigated and addressed.


1. You are monitoring a 2 kg kitten being spayed at the humane society; she is intubated and is on isoflurane gas for maintenance. She is on IV fluids at 10 mL/hr. Her blood pressure starts to drop during the procedure. You have already given her a bolus of fluids. Which of the following should you do first to try to increase her blood pressure?

A. Give a 90 ml/kg bolus of a crystalloid fluid intravenously
B. Give a dose of atropine
C. Turn down the anesthetic gas
D. Turn off the heat support to prevent peripheral vasodilation, which decreases blood pressure

Explanation C
Anesthetic gas is a potent vasodilator and causes profound hypotension, especially in small patients. Decreasing the vaporizer setting in addition to crystalloids and colloids can help to facilitate raising the blood pressure. If the pressure cannot be managed by these simple measures, drugs such as dobutamine may be needed to help with blood pressure during the procedure. A dose of atropine will not increase blood pressure directly; it will only increase the heart rate. Good heat support actually helps to keep blood pressure more stable and is especially important in small patients to prevent hypothermia. A 90 ml/kg bolus would be a "shock dose" of fluids for a dog but is too much for a cat, and this cat is hypotensive for other reasons.


1. For which species is it most common to clip and clean the surgical site prior to anesthetic induction?

A. Cat
B. Ferret
B. Dog
D. Horse

Explanation D
Out of the species listed, the horse is most amenable to being clipped and cleaned prior to surgery. Clipping and cleaning prior to anesthesia will help reduce the amount of total anesthesia time.

1. Which of the following is the best approximation of the typical tidal volume of a 20 kg dog?

A. 8 L per minute
B. 4 L
C. 300 ml
D. 100 ml
E. 800 ml

Explanation C
The tidal volume is volume of air that is normally displaced during inspiration and expiration.

Typical tidal volume for a dog is about 15 ml/kg (slightly more for smaller dogs and slightly less for large dogs). Tidal volume can be used to help estimate minute volume and the necessary fresh gas flow rates with various gas anesthesia machines.


1. You are asked to recover a patient after surgery. When should you pull the endotracheal tube?

A. After the patient's temperature has reached at least 100.0
B. After the eyes are alert and the dog is aware of its surroundings
C. After the patient has an adequate swallowing reflex
D. After the patient is able to move its limbs

Explanation C
The endotracheal tube should be pulled when the animal has an adequate swallowing reflex. Brachycephalic breeds should have their tube kept in as long as possible due to their predisposition for respiratory problems.


1. Which of the following is the "minute volume" of a patient under anesthesia?

A. Respiratory rate multiplied by tidal volume
B.Tidal volume divided by lung capacity
C. Respiratory rate multiplied by lung capacity
D. Oxygen consumption multiplied by tidal volume

Explanation A
Minute volume is the volume of air that is inspired by a patient in one minute. It is calculated by multiplying tidal volume by the number of breaths per minute. The tidal volume is the volume of air that is inspired on each breath. The respiratory rate is the number of breaths per minute. Tidal volume is usually considerably smaller than the total lung capacity.


11. A thoracotomy procedure would Skullinvolve an incision made into the:

A. Forelimb
B.
C. Tympanic membrane
D. Abdomen
E. Chest

Explanation E
A thoracotomy is opening of the chest. Thora = thorax (chest), -otomy (opening into)

12. During surgery, which is NOT considered sterile?

A. Surgical instruments
B. Back of surgical gown
C. Surgical gloves
D. Surgical drape

Explanation B
The back of the surgical gown is not considered sterile. Surgeons should pass each other face to face or back to back if needed to maintain sterility of the front of the gown.

13. You are assisting during surgery, and the surgeon is about to close the incision. She needs a pair of Olsen-Hegar needle holders. What is a fundamental difference between this type of needle holder as compared to others?

A. The jaws are serrated for a better grip
B. Has a built-in scissor
C. Does not have a ratcheting device
D. The tips are magnetized

Explanation B
Olsen-Hegar needle holders are popular among veterinarians who are performing surgery without assistants, because Olsen-Hegar holders have a built-in suture scissor. One major disadvantage is that one may inadvertently cut the suture when tying a knot. All standard needle holders will have a ratcheting device built into them.


14. Clipping an abdomen for a ventral midline laparotomy is one of the more common procedures done as a surgical nurse working with dogs and cats. Which of the following statements is most accurate?

A. The hair should be clipped from the xiphoid to the base of the pubis in all males
B. The abdomen should be clipped widely with at least 2 cm margins cranial to the xiphoid and 2 cm caudal to the pubis
C. As long as 0.5 cm margins of clipped areas are present around the incision, the surgeon should have no trouble
D. The abdomen should be clipped from the manubrium to the pubis with 2 cm margins cranial to the manubrium and 2 cm caudal to the pubis
E. Only enough hair should be clipped to perform the procedure

Explanation B
The abdomen should be clipped widely with at least 2 cm margins cranial to the xiphoid and 2 cm caudal to the pubis. The manubrium is the most cranial bone of the sternum and would imply clipping the chest, which is not necessary for a laparotomy. Occasionally surgical complications necessitate the lengthening of an incision; in effect, it is important to clip widely to allow the surgeon the flexibility to extend the incision if necessary.

15. A 12 kg Springer Spaniel has been presented to your hospital for pyometra surgery. The veterinarian would like you to give 20 mls of Unasyn over 20 minutes on a syringe pump before the procedure. How many milliliters per hour will you set the pump to run for?

A. 60
B. 3
C. 20
D. 1

Explanation A
20 mls multiplied by 60 (minutes in 1 hour)= 1200 divided by 20 minutes= 60 mls/hr.




16. Asepsis implies which of the following?

A. There are only symbiotic bacteria present
B. There are less than 1000 colonies of bacteria present
C. There is no living organism present
D. There are less than 100 colonies of bacteria present

Explanation C
Asepsis means absolutely no living organisms present. The concept of aseptic technique is very important, and technicians should be very aware of sterility in the operating room. This includes walkiwithinng within the room, passing instruments, prepping the patient, and working the operating room. Adhering to strict aseptic principles decreases the likelihood a patient will develop a post-operative infection.

17. The broad ligament attaches which structure to the body?

A. Bladder
B. Spleen
C. Uterus
D. Intestines

Explanation C
The broad ligament is attaches the uterus to the pelvis.


18. Asepsis implies which of the following?

A. There are less than 1000 colonies of
bacteria present
B. There are only symbiotic bacteria present
C. There are less than 100 colonies of bacteria present
D. There is no living organism present

Explanation D
Asepsis means absolutely no living organisms present. The concept of aseptic technique is very important, and technicians should be very aware of sterility in the operating room. This includes walking within the room, passing instruments, prepping the patient, and working within the operating room. Adhering to strict aseptic principles decreases the likelihood a patient will develop a post-operative infection.
19. In regards to the musculoskeletal system, what is the function of an abductor muscle?

A. Moves a limb away from the median plane
B. Will not allow a limb to move away from the median plane
C. Moves a limb toward median plane
D. Prevents rotational movement of a limb

Explanation A
Abduction is movement away from the median plane.

Adduction is movement toward the median plane.

20. A dog sustains a humeral fracture. Which nerve would most likely be damaged?

A. Ulnar nerve
B. Sciatic nerve
C. Suprascapular nerve
D. Radial nerve

Explanation D
The radial nerve innervates the extensor and supinator muscles located in the forelimb and provides distal sensation. This is the most commonly injured nerve in a forelimb fracture. The sciatic nerve runs along the hind limbs and can be immediately ruled out. The suprascapular nerve is higher up the forelimb and less likely to be injured. The ulnar nerve runs along the medial aspect of the humerus and is thought to be more protected than the radial nerve which courses along the lateral aspect of the humerus.


21. You are scrubbing in to assist in a surgery. The scrub should occur in which order?

A. Fingertips, hands, wrists, forearms
B. Forearms, wrists, hands, fingers
C. Between fingers, wrists, forearms, fingertips
D. Elbows, forearms, hands, fingers

Explanation A
The scrub should start at the fingertips and work up towards the forearms. The scrub should not go back in the reverse direction. The elbows are not typically included in the scrub at all.



22. Chronic exposure to which hormone leads to a pyometra?

A. Estrogen
B. Progesterone
C. Luteinizing hormone
D. Testosterone

Explanation B
Pyometra is often related to increased progesterone levels and their effect on the lining of the uterus.
Prolonged exposure to estrogen can cause bone marrow suppression.

23. An incision made from xyphoid to pubis would be found where?

A. Over the dorsal hip region
B. Ventral cervical region
C. Ventral chest over the sternum
D. Ventral midline

Explanation D
The xyphoid is the lowest part of the sternum. The pubis is one of the bones that makes up the hip. An incision from xyphoid to pubis implies a ventral midline incision as is customarily performed during abdominal exploratories.

24. This instrument is commonly used in surgery for grasping tissues. vWhat is the name of this instrument? (see image)


A. Allis tissue forceps
B. Kelly forceps
C. Brown-Adson forceps
D. Debakey forceps

Explanation C
The Brown-Adson tissue forceps are thumb forceps used for grasping tissue without causing excessive trauma. Note the multiple tiny teeth on each tip. Debakey thumb forceps are even less traumatic in that they don't have tiny teeth at the tip. Allis tissue forceps as well as Kelly forceps are different primarily in that they have a "scissor-type" handle. These can be very traumatic to delicate structures.


25. A dog has torn his cranial cruciate ligament and is having surgery. What area should you clip and aseptically prep?

A. Stifle
B. Abdomen
C. Shoulder
D. Hip
E. Elbow

Explanation C
The correct answer is stifle. An extracapsular repair involves placing a synthetic suture material like heavy gauge fishing line spanning in a similar orientation as the cranial cruciate ligament, except the material is outside the joint. This is a very common surgery performed in small breed dogs with ruptured cranial cruciate ligaments.


26. Which of the following is accurate about a cryptorchid dog?

A. Has both male and female sexual organs
B. Is prone to prostate infections
C. Has one or both testicles retained and not in the scrotum
D. Has an additional testicle
E. Has one testicle larger than the other

Explanation C
A cryptorchid dog has one or both testicles retained. They are usually retained in the abdomen or in the inguinal region.



27. Which animal might receive a perineal urethrostomy?
A. A dog with a pus-filled uterus
B. A dog that has a puppy stuck in the birth canal
C. A male cat with a urethral obstruction
D. A female dog with a large bladder stone

Explanation C
Perineal urethrostomies are performed in male cats with a urethral blockage. The procedure is performed when a cat has had multiple episodes of obstruction or when the obstruction cannot be relieved manually.

The procedure entails making a new opening in the urethra in the perineal area and removing the penis.

28. A 10 kg Miniature Schnauzer is to receive 22mg/kg cefazolin intravenously following a laceration repair. If the concentration of the cefazolin is 50mg/ml, how many milliliters should be administered?

A. 2.2
B. 3.2
C. 6.0
D. 4.4
E. 1.5

Explanation D
The answer is 4.4 mL. 10kg x 22mg/kg = 220mg cefazolin. 220mg/ 50mg/ml = 4.4 mL to be administered.




29. What is the best method for handling tissues during abdominal surgery when they must be placed outside of the peritoneal cavity?

A. Tissues and organs should never be exteriorized from the abdomen
B. Tissues and organs outside the abdomen should be wrapped in a dry gauze or sponge
C. Tissues and organs outside the abdomen should be covered with saline-moistened sponges
D. Tissues and organs outside the abdomen should be covered in an antibiotic-impregnated solution and sponges

Explanation C
Tissues and organs should always be handled with exceptional care. To avoid desiccation, all tissues/organs should be intermittently moistened with sterile saline or wrapped in saline-impregnated gauze or lap sponges. Antibiotic-impregnated solutions are not necessary, can be irritating, and may select for resistant organisms. Allowing the tissues/organs to dry will cause damage to their surfaces and result in subsequent inflammation.





30. 72 hours have passed since performing and exploratory laparotomy. It is important to evaluate the incision on a daily basis to help detect any complications early. Which of the following would you not expect to find on a 3-day-old incision?

A. Mild serosanguinous discharge
B. Moderate pain
C. Moderate swelling
D. Moderate redness

Explanation A
An incision will demonstrate all the classic signs of inflammation (redness, swelling, pain, and heat). Occasionally, there may be mild serosanguinous discharge from an incision, but this usually resolves in 24-48 hours. Persistence of discharge is worrisome as this may perpetuate bacterial colonization and subsequent incisional failure.


31. Which of the following suture/needle combination is most commonly used in veterinary medicine?

A. Swaged, curved needle
B. Swaged, straight needle
C. Eyed, straight needle
D. Eyed, curved needle

Explanation A
A swaged needle is one that has the suture connected to the needle. It is essentially "eye-less". Curved needles are preferentially used to suture all anatomic structures such as fascia, subcutaneous tissue, dermis, and skin. Eyed needles have a hole at the end through which suture is fed. These types of needles are more traumatic to the tissues and not as commonly used.



32. Which of the following could be used for hemostasis at the site of a liver punch biopsy?

A. Silver nitrate
B. Bone wax
C. Styptic powder
D. Gelfoam

Explanation D
Gelfoam is a sterile compressed sponge that is intended to aid in hemostasis; it allows for absorption of blood and formation of a clot at the bleeding site. It has a very useful application in liver biopsies.

Bone wax controls bleeding from bone and functions as a mechanical plug that is pressed into the bleeding bone surface.

Silver nitrate applicators are used to stop small superficial bleeders such as a snipped skin tag or a bleeding toenail. These are not sterile.

Styptic powder is used to stop bleeding toenails and would never be used on tissues.




33. In what position is colic surgery most commonly performed?

A. Dorsal recumbency
B. Ventral recumbency
C. Standing
D. Lateral recumbency

Explanation A
The correct answer is dorsal recumbency (horse is laying on his/her back). Dorsal recumbency usually provides the best access to the horse's organs when performing colic surgery.

Placing a horse in dorsal recumbency requires a skilled team which is able to support all of the horse's needs. Padding will be extremely important to prevent any damage to muscle groups. A standing flank approach may be performed for select causes of colic but is not as common of a surgical position as dorsal. The patient is given enough sedation to be able to stand; also, a local anesthetic block along the skin and abdominal musculature is typically administered to prevent the horse from feeling pain.



34. When performing a median sternotomy as seen in the image below, the surgeon will use the retractor seen in the image. What is its name?


A. Balfour retractor
B. Army-Navy retractor
C. Gelpis retractor
D. Finochietto retractor

Explanation D
A Finochietto retractor is specifically designed for rib retraction. Balfour retractors are designed for retraction of the abdominal wall. Gelpis retractors are used to increase visibility in small areas such as the knee joint. Army-Navy retractors are very versatile and can be used to retract in many situations.


35. When placing a bandage on the limb, what is the main purpose for leaving the tips of the toes exposed?


A. Prevent swelling
B. Prevent odor
C. Monitor for swelling
D. Prevent soiling
E. Allow for toe nail trims

Explanation C
Leaving the toes exposed does not prevent soiling of the bandage, odor, or swelling. It is to monitor the toes for swelling in case the bandage is too tight. The two middle toes should be together. If swelling occurs, the toes will begin to spread apart.

36. Bandages are commonly placed on the legs of animals after surgical procedures to help prevent swelling and protect the incision. They can also be used to help stabilize fractures or protect wounds. Which of the following is NOT a sign of a potential bandage complication when monitoring the bandage of a forelimb bandage?

A. Swelling of the neck
B. Swelling of the toes
C. Slipping of the bandage
D. Soiling of the bandage

Explanation A
Swelling of the neck would definitely be alarming but would not be associated with a bandage complication. Bandage complications are usually seen as a result of slippage, wetting, or soiling, which result in bandage sores. Additionally, slippage or improper placement can result in constriction and subsequent problems with circulation. If circulation is interrupted, a tourniquet effect may occur; this can be a very serious complication resulting in loss of the limb if gone unchecked.



37. Which describes the proper order of intestinal segments?

A. Duodenum, jejunum, ileum, colon
B. Ileum, duodenum, jejunum, colon
C. Jejunum, duodenum, ileum, colon Your A
D. Jejunum, ileum, duodenum, colon

Explanation A
The proper order of the GI tract is: esophagus, stomach, duodenum, jejunum, ileum, cecum, colon.

The duodenum, jejunum, and ileum make up the small intestine. The cecum is the pouch that connects the small intestine to the colon (the large intestine).


38. Which of these therapies would prevent weight-bearing of a limb?

A. Schroeder-Thomas splint
B. Mason-Meta splint
C. Ehmer sling
D. Fiberglass cast

Explanation C
Two common examples of slings which prevent weight-bearing are:
1) Ehmer sling- used for coxofemoral luxations (dislocated hips) to hold hip in place
2) Velpeau Sling- used for shoulder luxation or after shoulder surgery

Splints provide rigid support and do not prevent weight bearing on the limb. They do not go around the entire limb.

Casts provide support and go all the way around the limb.

39. A dog is being referred to the neurologist for a cervical disk compression that is causing forelimb paresis. Where will the surgical incision likely be made?

A. Inside the mouth
B. The dorsal neck region
C. Between the shoulder blades
D. The ventral side of the neck

Explanation D
A cervical disk surgery typically requires an incision made on the underside of the neck. This surgery is referred to as a "ventral slot".




40. A thoracotomy procedure would involve an incision made into the:

A. Forelimb
B. Chest
C. Skull
D. Tympanic membrane
E. Abdomen

Explanation B
A thoracotomy is opening of the chest. Thora = thorax (chest), -otomy (opening into)
A 3-year old female spayed DSH cat presents for evaluation of a fistulous swelling of the ventrum. Physical exam is unremarkable, except for an area of matted hair over an erythematous 1 cm swelling on the ventrum that exudes a small amount of purulent material which you shave and examine. The cat has no history of fighting; what parasite can cause a lesion like this?



Demodex cati
Notoedres cati
Microsporum canis
Cuterebra Your Answer
Ctenocephalides felis
Explanation
The lesion described is what is seen with Cuterebra infestations. Cuterebra is a botfly. The adults deposit eggs in the environment that animals may acquire as they pass through contaminated areas. The heat from the host causes eggs to hatch, and the larvae typically enter the body through the mouth during grooming or through open wounds. The larvae migrate to subcutaneous locations on the body and develop. They require a breathing pore in the skin and eventually will exit the skin. Lesions in dogs and cats are most commonly seen around the head, neck, and trunk. Suspect lesions should be explored, enlarged, and probed with forceps. The lesion should not be squeezed because rupturing the larva can cause anaphylaxis. It is preferable to remove the larva in one piece as residual pieces may cause recurrent infection or abscesses.

Ctenocephalides felis is the cat flea, which can cause irritation but not the fistulated swelling described here. Demodex cati and Notoedres cati are mites and microsporum canis is a dermatophyte. These can all cause pruritus, dermatitis, and crusting but should not cause the fistulated swelling described here.

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