ACVSPh2SACB ACVS Phase II Small Animal Case-based Practice Exam

I. Introduction to the ACVS Phase II Small Animal Practical Exam • Exam Overview: o Explanation of the structure and format of the Phase II Small Animal Practical Exam. o Emphasis on practical, hands-on skills required to demonstrate competency in veterinary surgery and clinical decision-making. o Understanding the real-world application of knowledge and the high level of clinical judgment necessary for success. • Objective of the Exam: o Assessing the candidate’s ability to perform and manage a variety of small animal surgical procedures and treatments. o Evaluating technical proficiency, clinical decision-making, and patient management across different surgical cases. o Emphasis on safety, precision, and optimal care for the small animal patient. II. Preoperative Patient Evaluation • Initial Patient Assessment: o Detailed physical examination to assess the patient’s overall health and identify any abnormalities or contraindications for surgery. o Collection of patient history, including presenting complaint, previous medical conditions, and current medications. o Laboratory diagnostics (blood work, urinalysis, etc.) and imaging studies (radiographs, ultrasound) to assess the surgical area and determine the patient's suitability for surgery. • Anesthetic Risk Assessment: o Evaluation of anesthetic risk using tools such as the ASA (American Society of Anesthesiologists) classification system. o Determining the need for preoperative stabilization (e.g., fluid therapy, correction of electrolyte imbalances, or management of comorbidities). o Consideration of specific risk factors for small animal patients (e.g., brachycephalic breeds, geriatric or pediatric patients). • Surgical Planning: o Creating a comprehensive surgical plan, including the selection of the appropriate procedure, the necessary equipment, and the surgical approach. o Determining whether additional steps (such as preoperative imaging or specialized consultations) are needed. • Client Communication: o Explaining the procedure to the client, discussing risks, expected outcomes, and alternatives. o Ensuring informed consent is obtained prior to surgery. III. Surgical Techniques and Procedures • Pre-Surgical Preparation: o Preparing the surgical environment, ensuring a sterile field, and maintaining aseptic technique. o Choosing the appropriate surgical instruments for the procedure. o Preparing the patient for surgery, including clipping the surgical site, antiseptic scrubbing, and draping. • Common Surgical Procedures: o Spaying (Ovariohysterectomy):  Techniques for spaying in both canine and feline patients, including abdominal approach and careful dissection of tissues.  Considerations for laparoscopy versus traditional open surgery.  Post-operative care, including monitoring for complications like hemorrhage or infection. o Castration (Orchiectomy):  Steps for performing a castration in male dogs and cats, including incision placement, ligature use, and tissue handling.  Understanding complications such as hemorrhage and proper closure techniques. o Soft Tissue Surgery:  Techniques for excising tumors, abscesses, or foreign bodies.  Safe handling of tissues, ensuring appropriate margins for tumor removal.  Closure techniques for different types of soft tissue surgeries (e.g., interrupted versus continuous suturing). o Orthopedic Procedures:  Fracture Repair:  Techniques for managing fractures in small animals, including open reduction, internal fixation (ORIF), and external fixation.  Proper alignment and stabilization of bone fractures using plates, screws, or pins.  Considerations for post-operative care, including pain management and rehabilitation.  Cruciate Ligament Repair:  Steps for repairing ruptured cranial cruciate ligaments, including tibial plateau leveling osteotomy (TPLO) and lateral suture techniques.  Post-operative management and rehabilitation. o Ocular Surgery:  Techniques for managing common ocular issues in small animals, such as enucleation, conjunctival resection, or cataract removal.  Management of ocular trauma or infections and understanding surgical interventions to preserve vision. o Gastrointestinal Surgery:  Gastric Dilatation and Volvulus (GDV) Surgery:  Performing a gastropexy to prevent recurrence of GDV, and managing the post-operative patient for complications.  Bowel Resection and Anastomosis:  Resection of necrotic or diseased portions of the intestine with subsequent anastomosis (reconnection) of the bowel.  Considerations for managing intestinal continuity, blood flow, and infection control. o Urological Surgery:  Cystotomy for Bladder Stones:  Techniques for performing a cystotomy to remove bladder stones in dogs and cats.  Considerations for patient recovery and preventing recurrence of urinary tract issues.  Nephrectomy or Ureteral Surgery:  Surgical approaches for managing renal disease, including nephrectomy or ureteral reimplantation. IV. Anesthesia and Pain Management • Anesthesia Techniques: o Induction and maintenance of general anesthesia in small animals, including the choice of anesthetic agents and monitoring techniques. o Management of specific anesthesia risks for small animals, such as the use of inhalants, analgesics, and sedatives. • Monitoring During Surgery: o Use of monitoring equipment such as ECG, pulse oximetry, capnography, and blood pressure monitoring during surgery. o Recognition of abnormal parameters and the steps required to correct them. • Pain Management: o Understanding the role of multimodal analgesia in small animal surgery, including opioids, NSAIDs, local anesthetics, and adjunct medications. o Assessing post-operative pain and making adjustments to the pain management protocol based on the patient's needs. • Postoperative Care: o Monitoring and managing the animal’s recovery post-surgery, including controlling pain, managing fluid therapy, and ensuring proper nutrition. o Recognizing and managing common post-surgical complications such as infection, hemorrhage, and dehiscence. V. Postoperative Management and Complications • Wound Management: o Proper techniques for wound closure, including the choice of sutures, tension, and layer closure for optimal healing. o Monitoring for signs of infection, swelling, or dehiscence and managing these issues promptly. • Infection Control: o Preventing surgical site infections through proper sterile technique and appropriate antimicrobial use. o Early detection and management of infections, including drainage, wound care, and the use of systemic antibiotics. • Rehabilitation and Recovery: o Developing rehabilitation plans for patients undergoing orthopedic or soft tissue surgery. o Recommendations for physical therapy, exercise restrictions, and gradual reintroduction to normal activity. • Complications Management: o Identification and management of complications such as blood loss, hypovolemia, sepsis, or adverse reactions to anesthesia. o Emergency management techniques, including blood transfusions, fluid resuscitation, and pharmacological interventions. VI. Client Communication and Education • Client Education: o Explaining the surgical process, potential risks, and expected outcomes to the client before, during, and after surgery. o Providing clear post-operative instructions, including wound care, activity restrictions, and medication administration. o Discussing long-term care and potential follow-up visits to ensure the animal’s recovery. • Ethical Considerations: o Addressing ethical dilemmas, such as deciding between surgical intervention and conservative management, or discussing end-of-life decisions for patients with poor prognoses. o Ensuring informed consent and understanding client expectations for outcomes. VII. Case Scenarios and Practice • Real-World Surgical Scenarios: o Practice cases involving common surgical conditions seen in small animal practice, such as fractures, tumors, or soft tissue injuries. o Detailed analysis and step-by-step breakdown of case management, from preoperative evaluation to post-operative recovery. • Interactive Problem Solving: o Engaging candidates in interactive scenarios where they will be required to make decisions based on evolving patient data. o Emphasis on clinical reasoning, adaptability, and effective decision-making in a clinical setting.