RCVS Statutory Membership Examination Regional Veterinary Surgery: practice questions

RCVS Statutory Membership Examination (SME) · UK · Royal College of Veterinary Surgeons

Original practice questions written to the published syllabus · not past papers

10worked here, free

30written to this exam in this subject

13syllabus units

What this subject covers

Surgery region by region, head to tail, in large and small animals, including rumenotomy, abomasal displacement, caesarean section and ovariohysterectomy.

In the exams: SAVC spay DOPS (bitch ovariohysterectomy); AVE Surgery OSCE (canine OHE on a model); NEB ovariohysterectomy requirement; ICAR AICE-JRF core group 07

Dehorning
Surgery of the eye
Surgery of the ear
Surgery of the oral cavity
Thoracic surgery
Rumenotomy
Correction of left and right abomasal displacement
Laparotomy and enterotomy
Caesarean section
Urolithiasis
Castration
Surgery of the tail
Ovariohysterectomy
Cystotomy and gastropexy

Where the 30 questions fall

How our questions for RCVS Statutory Membership Examination spread across the units of Regional Veterinary Surgery. Difficulty: 7 easy, 18 medium, 5 hard.

Surgery of the ear	4
Ovariohysterectomy	4
Caesarean section	3
Surgery of the tail	3
Cystotomy and gastropexy	3
Thoracic surgery	2
Correction of left and right abomasal displacement	2
Laparotomy and enterotomy	2
Urolithiasis	2
Castration	2
Dehorning	1
Surgery of the eye	1
Surgery of the oral cavity	1

10 practice questions, worked

Choose an answer, then open the working. Each explanation says why the right answer is right and why the others are not.

1 · Surgery of the ear · easy

A dog has a fluctuant swelling of the concave surface of the pinna. Which statement guides treatment best?

It always resolves without treatment within a week, so the owner is reassured and no further visit is needed
It usually reflects head shaking from an underlying problem such as otitis, which must be treated too
It is usually a bacterial abscess, so it is lanced and the dog is given a long antimicrobial course
It is usually a benign cartilage tumour, so the pinna is amputated through healthy tissue margins

Answer and working

B. It usually reflects head shaking from an underlying problem such as otitis, which must be treated too

An aural haematoma forms after head shaking or scratching, usually from otitis externa, ear mites, allergy or a foreign body. Draining or suturing it without treating the cause leads to recurrence. It is blood, not pus or a tumour, and left alone it fibroses and leaves a crumpled ear.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

2 · Thoracic surgery · easy

Why must ventilation be controlled once the pleura is opened during thoracotomy?

The phrenic nerve is always cut during the approach to the thoracic cavity
The diaphragm becomes paralysed by contact with room air in the open chest
The anaesthetic agent is absorbed faster through the pleura and causes apnoea
Opening the pleural space removes negative pressure, so the lungs collapse

Answer and working

D. Opening the pleural space removes negative pressure, so the lungs collapse

Lung inflation depends on negative intrapleural pressure; when the pleura is opened the lungs collapse, so positive-pressure ventilation is needed until the chest is closed and air evacuated. The phrenic nerve is preserved and the diaphragm does not stop because of air contact.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

3 · Correction of left and right abomasal displacement · medium

In the Utrecht (left flank) abomasopexy, how is the abomasum fixed in its normal position?

The omentum near the pylorus is sutured to the left flank incision at the transversus
A toggle is placed blindly through the left flank into the gas-filled abomasum
A suture in the greater curvature is passed out through the ventral wall right of midline
The abomasum is sutured to the rumen wall so that both organs move back together

Answer and working

C. A suture in the greater curvature is passed out through the ventral wall right of midline

Through the left flank the surgeon places a suture in the greater curvature of the abomasum and passes its ends through the ventral abdominal wall, right of the midline, where they are tied, fixing the organ in place. Omentopexy is a right flank method; suturing to the rumen is not used; toggles are placed through the ventral wall with the cow on her back.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

4 · Laparotomy and enterotomy · easy

Where should an enterotomy be made to remove a small-intestinal foreign body in a dog?

On the antimesenteric border, in healthy tissue just aboral to the object
On the mesenteric border, directly over the object, to reach it more quickly
Through the stomach, pulling the object back by forceps along the gut
On the antimesenteric border, in the discoloured bowel over the object

Answer and working

A. On the antimesenteric border, in healthy tissue just aboral to the object

The antimesenteric border avoids the mesenteric vessels, and the incision is made in healthy bowel just aboral (distal) to the foreign body, where the wall heals reliably. Incising over the object places the wound in compromised tissue; incising the mesenteric border risks the blood supply.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

5 · Caesarean section · medium

In anaesthesia for caesarean section in a bitch, which choice best protects the puppies?

Give a long-acting alpha-2 agonist to keep the bitch calm during the whole surgery
Prepare and clip before induction, use short-acting agents, avoid alpha-2 agonists
Induce first and then clip and scrub slowly, so the bitch is fully stable before cut
Use deep inhalant anaesthesia for an hour before incision to ensure good relaxation

Answer and working

B. Prepare and clip before induction, use short-acting agents, avoid alpha-2 agonists

Every minute of anaesthesia before delivery exposes the puppies to drugs, so the bitch is clipped and prepared before induction, short-acting induction agents and inhalants are used with local infiltration, and alpha-2 agonists, linked with poorer neonatal survival, are usually avoided.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

6 · Urolithiasis · medium

A blocked male cat has a heart rate of 120 per minute, weak pulses and serum potassium of 8.5 mmol/L. What should happen first?

Withhold fluids, because they will distend the bladder until it bursts
Perform perineal urethrostomy immediately to remove the cause of block
Induce general anaesthesia at once and pass a catheter forcefully
Stabilise: treat hyperkalaemia and give fluids before relieving the block

Answer and working

D. Stabilise: treat hyperkalaemia and give fluids before relieving the block

Hyperkalaemia causes bradycardia and dangerous arrhythmias; it is treated first (fluids, cardioprotection and measures that drive potassium into cells) and the patient stabilised before sedation or anaesthesia for catheterisation. Perineal urethrostomy is for recurrent obstruction, not the first step.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

7 · Castration · easy

In equine castration, how is an emasculator placed on the spermatic cord?

Across the scrotal skin and the cord together, closing on both layers
Upside down, so that the crushing jaw lies next to the testis below
'Nut to nut', with the crushing jaw proximal and the cutting edge distal
Wing nut toward the body, so the cutting edge sits closest to the horse

Answer and working

C. 'Nut to nut', with the crushing jaw proximal and the cutting edge distal

The wing nut faces the testis ('nut to nut'), putting the crushing jaw proximally on the stump and the cutting edge distally, so the stump left in the horse is crushed for haemostasis. Reversing it leaves a cut, uncrushed stump that bleeds.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

8 · Surgery of the tail · medium

A dog with a perineal hernia cannot urinate and the swelling is firm and growing. What has most likely happened and what is done first?

Prostatic abscess; drain it and delay the repair by three months
Rectal sacculation; give an enema and repair the hernia at once
Strangulated fat; ignore the urine retention and repair at once
Retroflexed bladder; decompress it and stabilise before repair

Answer and working

D. Retroflexed bladder; decompress it and stabilise before repair

Retroflexion of the bladder into a perineal hernia obstructs urination and is an emergency; the bladder is decompressed by catheter or cystocentesis and the dog stabilised, including correcting azotaemia and hyperkalaemia, before definitive repair.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

9 · Ovariohysterectomy · easy

In a routine bitch ovariohysterectomy, where is the ventral midline skin incision usually made?

In the cranial third of the caudal abdomen, just caudal to the umbilicus
On the right flank, a hand's width behind the last rib, in most bitches
In the cranial abdomen, from the xiphoid to the umbilicus, in all bitches
In the caudal third of the abdomen, just cranial to the pubis in a bitch

Answer and working

A. In the cranial third of the caudal abdomen, just caudal to the umbilicus

The bitch's ovaries lie well cranially, so the incision begins just caudal to the umbilicus in the cranial third of the caudal abdomen; in the queen it is in the middle third. A caudal incision makes the ovarian pedicles hard to reach; the flank approach is used mainly in cats.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

10 · Cystotomy and gastropexy · medium

A dog has bladder stones identified as calcium oxalate on analysis of a voided fragment. Which statement guides management?

They form only with urease-producing infection, so antibiotics cure them
They cannot be dissolved by diet, so they are removed physically
They dissolve within weeks on a calculolytic diet and antimicrobials
They are radiolucent and can be seen only with a contrast cystogram

Answer and working

B. They cannot be dissolved by diet, so they are removed physically

Calcium oxalate uroliths are not dissolved by diet; they are removed by cystotomy or minimally invasive methods, then recurrence is reduced by diet and water intake. Infection-induced struvite can be dissolved with diet and antimicrobials; calcium oxalate is radio-opaque.

Further reading: Fubini & Ducharme, Farm Animal Surgery; Fossum, Small Animal Surgery; Weaver et al., Bovine Surgery and Lameness

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