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Module 15 > Approach to Coughing Horse > Flashcards

Approach to Coughing Horse Flashcards

1
Q

what are the clnical signs of respiratory disease (7)

A
  1. cough
  2. nasal discharge +/- lymph node enlargement
  3. alterations in rate, pattern or effort of respiration
  4. respiratory noise
  5. altered airflow at nostrils
  6. poor performance
  7. weight loss
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2
Q

what is the diagnositc approach to coughing (6)

A
  1. detailed history provides vital information
  2. routine exam
  3. provisional diagnosis
  4. therapeutic trial
  5. further investigations if required
  6. prognosis
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3
Q

what are some questions to ask the owner if a horse has a cough (7)

A
  1. duration, frequency
  2. character
  3. nasal discharge at any stage
  4. cough related to feeding, stabling, exercise?
  5. eating and drinking normally
  6. dewormed recently
  7. in contact with donkeys
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4
Q

what are some questions to ask the owner if the horse has nasal discharge (8)

A
  1. duration
  2. quantity increasing or decreasing
  3. unilateral or bilateral
  4. clear, mucoid purulent or bloody
  5. malodorous
  6. related to feeding or head posture
  7. any change in facial contours
  8. associated cough
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5
Q

what are questions to ask the owner of a horse with dyspnea (6)

A
  1. normal at rest
  2. if only at exercise, what speed does it occur
  3. nasal discharge or cough
  4. if apparent at rest is it related to housing
  5. seasonal
  6. worsened by feeding
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6
Q

what history questions can be asked if a horse has respiratory signs (5)

A

1, duration: infection vs. allergic

  1. health of individual: prev episodes, medication/vaccination, deworming
  2. recent travel: competitions, long distances
  3. health of cohorts
  4. environment and seasonality: changes in environment, severe equine astham (SEA), summer pasture associated
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7
Q

what are breed dispositions to coughing (4)

A
  1. idiopathic tachypnea of clydesdale foals
  2. laryngeal disease less common in ponies
  3. mini horse/pony: tracheal collapse
  4. mild-moderate equine asthma: thoroughbred and standardbred
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8
Q

what can be clinically observed in the coughing horses environment (4)

A
  1. mucopus on the floor (coughed from mouth or nasal discharge)
  2. bedding/forage (including adjacent stables)
  3. location of forage and bedding storage/muck heap
  4. ventilation
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9
Q

what should be observed of the horse before you start clinical exam

A
  1. breathing at rest: rate, pattern, depth
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10
Q

what are rapid deep breaths associated with

A

respiratory distress

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11
Q

what can rapid deep dyspnea be caused by (4)

A
  1. hypoxemia due to cardiorespiratory compromise
  2. severe anemia
  3. hypovolemia
  4. endotoxemia
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12
Q

what can rapid shallow breathing be indicative of

A

pain

particularly pleural pain

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13
Q

what can slow deep breathing be indicative of

A

increased effort

uderlying pathology such as equine asthma (ROA, heaves)

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14
Q

how do you tell if there is increased breathing effort or distress

A

nostril flare and/or thorax including abdomen

noise inspiratory/expiratory or both, URT or LRT

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15
Q

what are the signs of URT obstruction during clinical exam

A
  1. predominately inspiratory
  2. often associated with noise (stertor/stridor)
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16
Q

what can cause upper airway obstructions (6)

A
  1. severe trauma
  2. swelling
  3. edema of head
  4. nasal passages
  5. pharyngeal obstruction
  6. laryngeal dysfunction
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17
Q

what can cause pharyngeal obstruction

A

severe strangles

streptococcus equi

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18
Q

what can cause laryngeal dysfunction

A

laryngeal swelling/edema

bilateral laryngeal paralysis (trauma, hepatic encephalopathy, primary neurological, idiopathic)

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19
Q

what areas can be examined in the head and neck for cause of cough (7)

A
  1. nasal discharge (colour, volume, uni or bilateral, odour and character, epistaxis)
  2. uniform air movement at nostrils
  3. lymph nodes (submandibular, retropharyngeal region)
  4. swellings/asymmetry of head
  5. eyes: conjunctiva, epiphora, nasolacrimal tract
  6. tracheal palpation & sensitivity (positive tracheal pinch response)
  7. URT noise (usually inspiratory)
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20
Q

how should you evaluate swellings/asymmetry of the head

A

particular attention to sinus surface anatomy

percussion over sinuses –> hollow/resonance

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21
Q

what can cause epistaxis at rest (3)

A
  1. guttural pouch mycosis
  2. ethmoidal hematoma
  3. nasal polyp
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22
Q

what can cause epistaxis after exercise

A

exercise induced pulmonary hemorrhage

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23
Q

what can cause epistaxis after trauma (2)

A
  1. sinus hemorrhage
  2. ethmoidal: post nasogastric intubation
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24
Q

how is thoracic auscultation done (5)

A

systemic exam

  1. palpation of thorax: pain pleuritis? rib fracture in foals
  2. lung fields on both sides
  3. trachea
  4. assess the audibility and distribution of breath sounds (normal)
  5. are adventitious sounds (abnormal) audible? wheezes, crackles, friction ribs
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25
Q

what are normal breath sounds

A

soft, blowing, low pitch

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26
Q

what can be heard with thoracic auscultation

A

attenuation and reflection of sound waves

inspiration > expiration

loudest over trachea (inspiration = expiration)

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27
Q

what is the rebreathing test

A
  1. exacerbation of lung sounds
  2. depth of respiration increases due to increased CO2
  3. large bag used for 60 seconds
  4. any coughing abnormal
  5. accentuates
28
Q

what are wheezes sounds

A

continuous, musical

associated with flow limitations (obstruction/constriction)

29
Q

when are wheezes hear

A

expiratory: common in ROA

inspiratory

or

inspiratory & expiratory

30
Q

are wheezes mono or polyphonic

A

monophonic

polyphonic

31
Q

what are crackles

A

short, non musical (paper crumpling)

associated with small airways opening or air moving through mucus

32
Q

when are crackles heard

A

expiratory: associated with inflamed airway epithelia
inspiratory: associated with excessive mucus in small airways

inspiratory and expiratory

33
Q

what do pleural friction rubs sound like

A

sandpaper

inspiration/expiration

34
Q

what other sounds can be heard on auscultation

A
  1. expiratory grunt if in pain
  2. GIT sounds
  3. muscle tremors
  4. thumps (hypocalcemia): phrenic nerve runs over heart and contracts with a heart beat
35
Q

describe the differential diagnosis for bronchovesicular sounds, pleural friction rubs, absence of sounds

A
36
Q

what is thoracic percussion

A

detect alterations in density of intrathoracic structures

37
Q

what are ancillary diagnostic tests (6)

A
  1. infectious disease sampling: nasopharyngeal swab, serology
  2. endoscopy
  3. lower resp tract sampling: tracheal wash, bronchoalveolar lavage
  4. ultrasonography
  5. thoracocentesis
  6. radiology
38
Q

what are infectious causes of respiratory diseases

A
  1. bacterial resp disease: streptococcus equi (strangles)
  2. viral: equine influenza A, equine herpes virus type 1 & 4, equine viral arteritis, equine adenovirus, equine rhinitis virus A & B
39
Q

what type of bacteria causes strangles

A

Streptococcus equi

40
Q

is streptococcus equi gram - or +

A

gram positive

41
Q

what is the acute disease of strangles

A

highly contangious mainly in young, naive horses

42
Q

how do horses become infected with strangles

A

nose or mouth

invade URT lymphoid tissue

43
Q

what are the signs of acute disease of strangles (3)

A
  1. pyrexia
  2. pharyngitis
  3. lymph node abscessation
44
Q

how is acute strangles disease treated

A

with antimicrobials

45
Q

how do horses recover from acute disease strangles

A

most abscesses rupture followed by a full recovery

46
Q

what is the chronic strangles disease

A

carrier state

retropharyngeal nodes can rupture pus into guttural pouch –> fails to clear and become carriers

47
Q

what are the complications of chronic strangles disease

A

guttural pouch empyema

pneumonia

abdominal abscess

purpura hemorrhagica

48
Q

how do you sample for strangles for diagnosis

A

aspiration and culture from abscess lymph nodes

nasopharyngeal swab or lavage

guttural pouch lavage

serology

49
Q

what type of virus is equine influenza A

A

orthomyxoviridae (RNA) with two subtypes

1 = H7N7 equine 1 influenza

2 = H3N8 equine 2 influenza

50
Q

what is the pathogenesis of equine influenza (6)

A
  1. neuroaminidase (NA) glycoproteins break down mucociliary protection giving access to underlying epithelial cells
  2. hemagglutinin (HA) glycoproteins are responsible for viral attachment to host cells
  3. replicate in resp epithelium
  4. cell necrosis and desquamation: irritant receptors exposed and cause excess mucus production and inflammation with massive lymphocyte infiltration and edema which causes cough
  5. impaired ciliated clearance system
  6. normal architecture takes 6 weeks to recover
51
Q

what is the morbidity of equine influenza

A

high

52
Q

what is the mortality of equine influenza

A

low

53
Q

what are the clinical signs of equine influenza (8)

A
  1. extreme pyrexia: 39-41C
  2. upper resp tract signs: serous or mucopurulent nasal discharge
  3. lymphadenopathy
  4. pharyngitis
  5. tracheitis
  6. harsh cough for several weeks
  7. anorexia
  8. depression
54
Q

what is the incubation period for equine influenza

A

3-5 days

55
Q

how long does uncomplicated equine influenza last

A

2-10 days

56
Q

how long are horses infected after clinical signs with equine influenza

A

3-6 days

57
Q

how is equine influenza diagnosed

A
  1. history and clinical signs
  2. viral detection (PCR, ELISA)
  3. serology
58
Q

how is equine influenza treated

A
  1. prompt isolation of affected and all contacts
  2. symptomatic: hydration & NSAIDs (pyrexia)
  3. minimize stress and prolonged rest
  4. antibiotics if suspect secondary bacterial infection
  5. vaccination
59
Q

what is the vaccination schedule of equine influenza

A
  1. first vaccine: influenza + tetanus at 1 month
  2. second: influenza + tetanus at 6 months
  3. third: influenza at 1 year
  4. yearly boosters of influenza and every 2-3 years tetanus
60
Q

what equine herpes virus causes resp disease

A

1 & 4

61
Q

how long does immunity to equine herpes virus last

A

short

prone to repeat infections

62
Q

how is a latent infection of equine herpes virus established

A

lymph nodes and ganglia

63
Q

what are the clinical signs to EHV 1 & 4

A

similar to EI (less severe)

less marked cough

64
Q

what does the severity of clinical signs of EHV depend on

A

age

immune status

strain

dose

65
Q

what is endoscopy used for

A

visualize normal/anatomical abnormalities

66
Q

what can be seen on endoscopy of URT (7)

A
  1. nasal passage
  2. ethmoid turbinates
  3. sinus drainage angle
  4. pharynx and larynx
  5. guttural pouches
  6. trachea and carina
  7. proximal bronchi
67
Q

how does endoscopy help assess trachea secretions

A

secretions accumulate due to impaired mucociliary clearance mechansim

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Module 15 (27 decks)

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