European College of Veterinary Surgeons
Certifying Examination
Large Animal Case-based Examination
MOCK EXAM EQUINE SOFT TISSUE
100 POINTS TOTAL
Total time: 30 minutes
March, 15
Page 1
3 Minutes
You are presented with a 3 year old Arab colt for castration. At the
time of your preliminary clinical examination you can only palpate
the left testicle.
1. Give 3 reasons why the right testicle may not be palpable.
1. Cryptorchid
[1 pt_____]
2. Previous hemi –castration
[1 pt_____]
3. Congenital absence
[1 pt_____]
Question Maximum [3 pts_____]
2. What 4 further diagnostic tests would you perform before surgery?
1. Sedate and palpate the inguinal region
[2 pts_____]
2. Check for castration scars
[2 pts_____]
3. Rectal examination
[2 pts_____]
4. Ultrasound
[2 pts_____]
Question Maximum [8 pts_____]
Total:
March, 15
[11 pts_____]
Page 2
2.5 Minutes
As a result of further examination you suspect that the right testicle
is abdominally retained.
Is it more common for the left or right testicle to be abdominally retained and
why?
Left more common
Testicle is larger when it descends
Question Maximum [2 pts_____]
List 6 different surgical approaches that can be used for cryptorchidectomy.
1. Inguinal
[1 pt_____]
2. Parainguinal
[1 pt_____]
3. Suprapubic paramedian
[1 pt_____]
4. Flank
[1 pt_____]
5. Laparoscopic (recumbent)
[1 pt_____]
6. Laparoscopic (standing)
[1 pt_____]
Question Maximum [6 pts_____]
Total:
March, 15
[8 pts_____]
Page 3
3 Minutes
You elect to anaesthetise the horse and use an inguinal approach to
perform the cryptorchid castration.
1. Which 4 structures border the deep inguinal ring?
1. Caudal edge of internal abdominal oblique muscle
[2 pts_____].
2. Rectus abdominus muscle
[2 pts_____]
3. Prepubic tendon
[2 pts_____]
4. Inguinal ligament
[2 pts_____]
Question Maximum [8 pts_____]
2. Fill in the steps when performing an inguinal cryptorchid castration
1. Make a 10-15cm skin incision over the superficial inguinal ring
2. Bluntly dissect the inguinal fascia to expose the superficial ring
3. Locate rudimentary common vaginal tunic
[2 pts_____]
4. Incise vaginal tunic to expose a portion of the epididymis
[2 pts_____]
5. Locate tail of epididymis. Proper ligament of the testis connects tail of
epididymis to caudal pole of testicle.
[2 pts_____]
6. Testis is pulled through vaginal ring and exteriorised for removal.
Question Maximum [6 pts_____]
Total:
March, 15
[14 pts_____]
Page 4
3.5 Minutes
At surgery the left testicle is removed using a closed technique. On
the right side an inguinal approach was made, the vaginal process
incised and the epididymis located. However traction on the proper
ligament fails to exteriorise the testicle.
1. List 3 techniques that you might use to facilitate finding the retained testicle.
1. Enlarge the vaginal ring
[2 pts_____]
2. Perform parainguinal approach
[2 pts_____]
3. Use laparoscopy (recumbent, standing)
[2 pts_____]
Question Maximum [6 pts_____]
2. At this time the anaesthetist tells you that the mean arterial pressure (MAP) is
55mmHg.
Interpret this finding
Hypotension
[1 pt_____]
3. List three methods for correction of the MAP in this horse.
1. Increase fluid administration rate
[2 pts_____]
2. Decrease anaesthetic depth
[2 pts_____]
3. Administer inotropic or vasoactive drugs/calcium
[2 pts_____]
4. Stop intermittent positive pressure ventilation
[2 pts_____]
Question Maximum [6 pts_____]
Total:
March, 15
[13 pts_____]
Page 5
5 Minutes
In view of the anaesthetist’s concerns, you elect to terminate the surgery and
recover the horse, and to perform a standing laparoscopic procedure the
following day.
Describe where you would make your scope portal.
Right side (1), slightly dorsal to crus of internal abdominal oblique muscle (1) and
midway between last rib and tuber coxae (1)
[3 pts_____]
What technique is being used in the picture to facilitate removal?
Retrieval bag
[1 pt_____]
What do you observe about the retained testicle?
Enlargement
[2 pts_____]
What are the two most likely causes of this?
Sertoli cell tumor
[1 pt_____]
Teratoma
[1 pt_____]
What 3 other techniques might be used to facilitate removal of the testicle?
1. Macerate testicle
[1 pt_____]
2. Enlarge incision
[1 pt_____]
3. Try to aspirate contents
[1 pt_____]
Question Maximum [3 pts_____]
Total:
March, 15
[11 pts_____]
Page 6
3 Minutes
The slide shows the laparoscopic appearance of the caudal aspect of the right
side of the abdomen following removal of the enlarged testicle.
What are the labelled structures?
A. Mesorchium
[1 pt_____]
B. Bladder
[1 pt_____]
C. Lateral ligament of the bladder
[1 pt_____]
D. Body wall
[1 pt_____]
Question Maximum [4 pts_____]
What technique has been used to free the testicle?
(Ligasure) electrocautery
[2 pts_____]
The horse is given intramuscular penicillin and intravenous gentamicin for 5
days post operatively and flunixin meglumine is provided for analgesia.
What is the mode of action of gentamicin?
Bactericidal by interference with ribosomal protein synthesis
[2 pts_____]
What is its spectrum of activity?
Good activity against gram negatives but poor activity against gram positives &
anaerobes
[2 pts_____]
What is the mode of action of penicillin?
Bactericidal by interference with cell wall development
[2 pts_____]
What is its spectrum of activity?
Good activity against gram positives & anaerobes
Low activity against gram negatives
[2 pts_____]
Total:
March, 15
[14 pts_____]
Page 7
2 Minutes
Initially the horse made good progress. However, 4 days post operatively he
develops signs of severe oedema and discharge from the flank wound. The next
day the horse is dull and pyrexic (temperature 39.3oC) and begins to show signs
of colic.
What further diagnostic techniques would you perform?
1. Rectal examination
[1 pt_____]
2. Abdominocentesis
[1 pt_____]
3. Swab wound for culture and sensitivity
[1 pt_____]
4. CBC & inflammatory profile
[1 pt_____]
5. Ultrasonography(local/abdominal)
[1 pt_____]
Question Maximum [5 pts_____]
Total:
March, 15
[5 pts_____]
Page 8
2 Minutes
You do an abdominocentesis and a blood cell count. The results are presented in
this slide.
How would you interpret these findings?
Septic peritonitis
[2 pts_____]
The horse shows signs of increased discomfort over the next few hours. What
would you do next?
Debride/drain wound
Flank laparotomy
[2 pts_____]
Total:
March, 15
[4 pts_____]
Page 9
2 Minutes
You elect to debride the abscess and to do an exploratory laparotomy via a right
flank laparotomy. At surgery you find a large abscess in the body wall and
intestine adhered to the abscess. The adhesions are broken down and the affected
portion of intestine is exteriorised.
What portion of intestine is involved?
Pelvic flexure of large colon
[1 pt_____]
What procedure would you perform next?
Partial resection and end-to-end anastomosis of the large colon
Total:
March, 15
[2 pts_____]
[3 pts_____]
Page 10
2 Minutes
You elect to perform a partial resection of the large colon and an end-to-end
anastomosis.
How many taenial bands are present on the following parts of the large colon?
1. Right ventral colon
4
[1 pt_____]
2. Left ventral colon
4
[1 pt_____]
3. Pelvic flexure
1
[1 pt_____]
4. Left dorsal colon
1
[1 pt_____]
5. Right dorsal colon
3
[1 pt_____]
Question Maximum [5 pts_____]
Draw lines on the diagram below to show how you would transect the right
ventral and dorsal colon when performing a resection of the large colon and an
end-to-end anastomosis.
[3 pts_____]
Total:
March, 15
[8 pts_____]
Page 11
2 Minutes
The slide shows two staplers that can be used to perform a large
colon resection.
1. Fill in the following details for each stapler:
Stapler 1
Name the instrument
TA90
[1 pt_____]
What size(s) of staples would you use with this stapler?
4.8mm
[1 pt_____]
Describe the staple pattern.
Double row of staggered staples
[1 pt_____]
How long is the row of staples that is placed?
91.5 mm
[1 pt_____]
Maximum thickness of tissue in which instrument will properly close
2 mm
[1 pt_____]
Question maximum [5 pts_____]
Stapler 2
Name the instrument
GIA80
[1 pt_____]
What size staples does this stapler use?
4.8mm
[1 pt_____]
Describe the staple pattern.
Two double rows of staggered staple & cut between [1 pt_____]
How long is the row of staples that is placed?
80mm
[1 pt_____]
Question maximum [4 pts_____]
Total:
March, 15
[9 pts_____]