For the Surgery Geeks - Test your knowledge with some tough questions.

1. The gastric mucosa is biologically highly active and this is represented by weight and blood supply. The gastric mucosa accounts for ----- of the stomach's weight and receives ----- of the gastric blood supply.

• A. 35% and 60%
• B. 35% and 80%
• C. 50% and 50%
• D. 80% and 50%
• E. 50% and 80%

2. What anatomical abnormalities make up brachiocephalic syndrome?

• A. Stenotic nares, elongated soft palate, everted laryngeal ventricles (saccules), laryngeal paralysis, hypoplastic trachea
• B. Stenotic nares, elongated soft palate, everted laryngeal ventricles (saccules), laryngeal collapse, hypoplastic trachea
• C. Stenotic nares, elongated soft palate, everted laryngeal ventricles (saccules), laryngeal collapse, hyperplastic trachea
• D. Stenotic nares, stenotic choanae, elongated soft palate, everted laryngeal ventricles (saccules), laryngeal collapse, hypoplastic trachea.
• E. Stenotic nares, elongated soft palate, everted laryngeal ventricles (saccules), laryngeal paralysis, hypoplastic trachea, reduced pulmonary compliance.

3. The rima glottidis is formed by the corniculate processes of the arytenoid cartilages and the vocal folds.

• True
• False

4. Dehiscence of an enterotomy is most common between day ---- and day --- because why?

• A. 1 and 2 because a strong fibrin seal has not developed and the closure is reliant totally on the sutures.
• B. 1 and 2 because oedema of the intestinal wall causes the wound to be weak and omentum has not has time to form a water tight seal.
• C. 2 and 3 because the patient is eating again and the combination of movement and increased intestinal contents increases the risk of leakage.
• D. 3 and 4, a combination of vascular compromise at the wound edges and high level of intestinal bacteria increases the risk of leakage.
• E. 3 and 5 , this is at the end of the lag phase of healing where fibrinolysis has occurred but collagen deposition is still minimal.

5. Diagnostic findings of uroperitoneum include

• A. Radiology - Loss of detail to the abdomen. Abdominocentesis with fluid showing the same creatinine and urea levels as those in peripheral blood. Gradually the urea and creatinine increases as urine is leaked out.
• B. Radiology - Loss of detail in the retroperitoneal space due to leakage of urine through damaged/inflamed peritoneum. Abdominocentesis with fluid showing the same creatinine and urea levels as those in peripheral blood.
• C. Radiology - Loss of detail to the abdomen. Abdominocentesis with fluid showing the same creatinine and urea levels as those in peripheral blood initially and then urea reduces and creatinine stays high in the abdominal fluid compared with blood.
• D. Radiology - Loss of detail to the abdomen. Abdominocentesis with fluid showing the same creatinine and urea levels as those in peripheral blood initially and then creatinine reduces and urea stays high in the abdominal fluid compared with blood.
• E. Radiology - A standing fluid line in the abdomen with gas pattern in the small intestine due to ileus. Abdominocentesis with fluid showing the same creatinine and urea levels as those in peripheral blood initially and then both urea and creatinine reduces in the abdominal fluid compared with blood.

6. Rupture of the contralateral cranial cruciate ligament (CCL), if the stifle has no radiographic sign of degenerative joint disease, occurs in -------% of dogs within 1 year following surgical treatment of the initial injured CCL.

• A. 25%
• B. 50%
• C. 37%
• D. 33%
• E. 60%

7. Biological osteosynthesis is the term given to what process or surgical technique?

• A. The process of fracture treatment where the proximal and distal joints are correctly spatially aligned and the bone shaft is stabilised using AO principles of minimal handling and anatomical reconstruction.
• B. The natural process of bone healing that occurs in nature when there is no intervention.
• C. The process of fracture treatment where the fracture fragments are reduced, stabilised and compressed with surgical implants.
• D. The process of fracture treatment where the proximal and distal joints are correctly spatially aligned and the bone shaft is stabilised using a buttress implant construct without anatomical reconstruction of the bone column.
• E. The process of bone healing that occurs when there is a fracture gap and this is filled with cancellous bone graft.

8. The concept of "strain" is important in fracture healing. Why?

• A. Strain is defined as the material or gap change in length divided by the original length ( ?L/L), therefore large gaps have greater strain and bone is only produced by osteoblasts in areas of low strain.
• B. Bone is viscoelastic and therefore can form in areas of high strain so small gaps are the best.
• C. Strain is measured by a force-deformation curve where a material deforms when loaded. The best implants are those with a steep force-deformation curve because they are strongest.
• D. Strain is defined as the material or gap change in length divided by the original length ( ?L/L), therefore small gaps have greater strain and bone is only produced by osteoblasts in areas of low strain.
• E. Strain is actually a term related to ligament injury and has nothing to do with bone healing.

9. This is the medial side of a hindlimb with the paw at the bottom. What is the procedure that has been performed here?



10. This liver mass, removed from a dog, was diagnosed as a massive hepatocellular carcinoma (HCC) Which of the following statement is true?.

• A. Prognosis for patients with massive HCC is poor with frequent metastasis and median survival time of 6 months.
• B. Prognosis for patients with massive HCC is good with rare metastatic disease and median survival time of 4 years.
• C. Prognosis for patients with massive HCC is good but metastatic disease is common and median survival time of 1 year.
• D. Massive hepatocellular carcinoma is rare in dogs with most HCC presenting with diffuse or nodular morphology.
• E. Patients with massive hepatic haemangiosarcoma tend to have a better prognosis than carcinoma patients due to better response to chemotherapy.

Answers.

1) E
2) B
3) T
4) E
5) C
6) C
7) D
8) D
9) Reverse saphenous conduit flap.
10) B