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CMS - term 1 > Cardiorespiratory > Flashcards

Cardiorespiratory Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

small animal common breed issues

A

brachycephalics - BOAS
small dogs - tracheal collapse
large dogs - laryngeal paralysis

ask about familial issues

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2
Q

age related common URT issues

A

young - congenital or infectious
old - neoplasia

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3
Q

URT exam small animal

A

nares - discharge, stenosis, air flow (unilateral and bilateral)

facial asymmetry, pain - severe infection or neoplasia

ocular - retropulsion (decreased in dental disease and neoplasia), discharge, palpebral swelling (vitamin a deficiency in reptiles)

ears - otitis secondary to dental, polyps

laryngeal and tracheal palpation - foreign body, trauma, kennel cough

auscultation - stridor (laryngeal), stertor (nasal)

oral cavity - dental, choana, soft palate

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4
Q

primary nasal and nasopharyngeal signs

A

nasal discharge
sneezing
stertor (snoring)
distortion of facial anatomy
neuro signs (rare)

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5
Q

primary laryngeal signs

A

stridor
decreased heat tolerance
voice change (esp birds)
cough
respiratory distress

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6
Q

primary tracheal signs

A

cough
respiratory distress - in severe cases

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7
Q

specific disease testing - nasopharyngeal

A

PCR swabs

cats - chlamydia felis, calicivirus, herpesvirus, m felis, b bronchiseptica

dogs - adenovirus, parainfluenza, herpes, distemper, b bronchiseptica, mycoplasma spp

small mammals - b bronchiseptica (guineas and rabbits), p multocida and chalmydia (rabbits)

tortoise - herpesvirus, mycoplasma spp, picornavirus (useful to differentiate vial from bacterial)

snakes - adenovirus, reovirus, arenavirus, paramyxovirus, ferlavirus, nidovirus

birds - chlaydia psittaci

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8
Q

nasal flush

A

head towards floor - aspiration
sterile saline
cytology and culture
can flush out foreign body - therapeutic

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9
Q

nasal swab

A

better sensitivity if deep swab - needs deep sedation or GA
not as useful as flush

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10
Q

radiograph - nasal and nasopharynx

A

mostly just useful for dental disease

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11
Q

CT - nasal and nasopharynx

A

cross sectional - avoids superimposition of structures
space occupying lesions
surgical planning
if can’t get endoscope through
needs GA

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12
Q

rhinoscopy - nasal and nasopharynx

A

preferred
rigid endocscope
deep GA
risk of haemorrhage
masses, fungal plaques, foreign bodie
endocope guided biopsies
samples for culture
targeted treatment or flushes

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13
Q

pharygocopy

A

flexible scope - retroflex behind soft palate for caudal nasopharynx
foreign bodies, polyps and stenosis above soft palate

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14
Q

emergency management of epistaxis

A

reduce BP to slow bleeding - cage rest, sedation
reduce bleeding - ice packs or packing in nose
treatment for hypovolemic shock (rare)
treat underlying disease

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15
Q

common underlying causes - emergency epistaxis

A

coagulopathy
invasive nasal disease
trauma - foreign body, penetrating injury

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16
Q

viral causes - nasal and nasopharynx - small animal

A

kennel cough
cat flu
tortoise - herpes
snakes - all viruses - poor prognosis
ferrets - human strains of influenza

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17
Q

viral - nasal and nasopharynx - treatments

A

NSAIDs
Nebulisation
systemic mucolytics
fluid therapy
supportive feeding

feline herpes virus - ocular topical antiviral preparations, famciclovir, omega interferon systemic

chelonian herpes - aciclovir (expensive)

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18
Q

bacterial causes - nasal and nasopharynx - small animals

A

primary rarer than secondary to immunocompromise or infection

b bronchiseptica
p multocida - rabbits
mycoplasma - birds, chelonia, rats
chlamydia - birds and cats

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19
Q

bacterial - nasal and nasopharynx - treatment

A

systemic antibiotics
systemic mucolytics
NSAIDs
supportive care - nebulisation, assisted feeding, fluid
prevention - vaccination and reduced stressors

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20
Q

primary conditions - bacterial nasal and nasopharynx

A

viral or fungal infection
dental disease
foreign body
neoplasia - necrosis, inflammation, obstruction
trauma - foreign bodies, penetrating injuries
hypovitaminosis A - damage to epithelium –> immunocompromise

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21
Q

fungal disease - small animals - nasal and nasopharynx

A

aspergillosis

dogs - disseminated - immunocompetant
birds - usually immunocompromised

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21
Q

foreign body - nasal and nasopharynx

A

cats - grass blade behind soft palate
dog - grass seeds, stones
small mammals and chelonia - hay

removal
treatment of secondary infection
NSAIDs for pain

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21
Q

fungal treatment - small animal - nasal and nasopharynx

A

topical - irrigation post debulking, nebulisation with anti fungal agents (amphotericin B, azoles, terbinafine)

systemic -
azoles - don’t use itraconazole in african grey parrots
amphoterin B
terbinafine

supportive care - treat secondary infection, liver support, GI support

monitor - bloods for liver and WBCs

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21
Q

trauma - nasal and nasopharyngeal

A

internal - stick injuries
external - bite wounds

remove stick if present
analgesia
treat secondary infections

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21
Q

nasopharyngeal polyps - small animal

A

common in cats
benign - in cats from the lining of the middle ear (hypoplasia)

remove via traction
surgery - incision through midline of soft palate

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22
Q

neoplasia - nasal and nasopharyngeal

A

adenocarcinoma - most common
other epithelial also quite common

radiotherapy
surgery in some cases for reduction
sometimes chemo

10-18 month median survival

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23
Q

specific disease testing - layrngeal disease

A

rare without concurrent signs
kennel cough - usually other signs but can be only laryngeal

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24
Q

radiograph - laryngeal disease

A

masses or obstruction
not that useful
best without ETT

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25
Q

CT - laryngeal disease

A

better sensitivity than radiograph
can access airway lumen

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26
Q

MRI - laryngeal disease

A

soft tissue lesions
airway narrowing

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27
Q

laryngoscopy - laryngeal disease

A

most useful

assessing normal function - arytenoid abduction
thickening
masses
everted laryngeal saccules - BOAS
extraluminal masses - compress airways
laryngeal collapse

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28
Q

treatment - laryngitis

A

inflammation - eg kennel cough, irritation, trauma

NSAID - mild cases
steroids - more severe
treat underlying condition

severe cases - oedema and obstruction - steroids, oxygen, sedation or GA, intubation, tracheostomy

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29
Q

treatment - foreign body - laryngeal

A

less common than nasal or tracheal

remove
treat irritation and secondary infection
tracheostomy if obstructed

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30
Q

treatment - trauma - laryngeal

A

treatment of cartilage fractures - surgery - fibrotic tissue may form in healing, ongoing stenosis

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31
Q

emergency treatment - laryngeal

A

Often present as emergencies

oxygen
sedation
intubation/tracheostomy
antibiotics
steroids - for oedema
surgery - soft tissue repair, remoev foreign bodies, repair cartilage fractures, manage secondary laryngeal paralysis

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32
Q

treatment - laryngeal paralysis

A

common in large dogs - roaring sound
failure of arytenoid and vocal fold movement in inspiration
muscle or nerve damage or generalised neuropathy in cats
cyanosis and collapse in severe cases

anti inflammatories
surgery - laryngoplasty (tie back)

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33
Q

treatment - neoplasia - laryngeal

A

advance imaging to assess
benign - surgery
malignant - surgery, radiotherapy, chemo

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34
Q

specific disease testing - tracheal

A

rarely indicated
kennel cough

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35
Q

radiograph and CT - tracheal

A

tracheal collapse
foreign bodies
stenosis
rule out cardio and pulmonary disease

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36
Q

fluroscopy - tracheal

A

dynamic disease - eg trahceal collapse
can be done conscious
see what happens in breathing or coughing
negative pressure to see if tracheal collapse
assess where to put a stent

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37
Q

tracheobroncosopy - trachea

A

endoscopy
evaulate dynamic disease
masses
foreign bodies
cytology of biopsy samples
pass tube via ETT

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38
Q

tracheal wash

A

saline pushed in then reaspirated
GA
blind or by endoscope

conscious or sedated - LA under skin and catheter pushed through neck into trachea

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39
Q

treatment - tracheitis

A

infection, irritation, trauma

NSAIDs - mild
steroids - severe
treat underlying infection
small foreign body - irritation without obstruction - remove

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40
Q

treatment - tracheal obstruction

A

remove obstruction - may need surgery if big but often complications in tracheal surgery
NSAIDs
treatment of secondary infection
tracheostomy

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41
Q

treatment - tracheal trauma

A

assess any cervical bite for airway damage
can be iatrogenic damage from ETT (cats most common)

penetrating injury - surgical repair, cuff ETT distal to site
minor injury - debridment and primary closure
major injury - resection and anastomosis (stenosis common sequelae)
supportive care - analgesia, antibiotics, airway maintenance until healing (swelling obstruction after surgery)

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42
Q

treatment - tracheal stenosis

A

narrowing of trachea - iatrogenic, traumatic, or neoplasic

oxygen
anxiolytics
dilation - balloon catheter or bougie - can cause fibrosis
stent
low dose rpeds after surgery to prevent stricutre

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43
Q

treatment - tracheal collapse

A

toy breeds predisposed
collapse of cartilage rings

emergency management - cool dark environment (stress), oxygen, sedation, cough suppression, steroids

ongoing -
BCS control
exercise restriction
harness
avoid smoke or heavy perfume
treat concurrent respiratory disease
sedatives in stressful circumstances

conservative management -
steroids
antitussives
antisecretory
bronchodilators
antibiotics

surgical management - extraluminal ring prosthesis, stent

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44
Q

BOAS components

A

all or some of -

stenotic nares and nasal passages
overlong soft palate
laryngeal saccule eversion
tracheal hypoplasia

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45
Q

BOAS emergency management

A

oxygen
sedation
short acting steroids
intubation or tracheostomy
cool dark environment
active cooling if hyperthermic

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46
Q

BOAS management

A

weight management
avoid walking if hot
anti-inflammatories
manage GI signs

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47
Q

BOAS surgery

A

indicated if acute distress or where signs persist with management
correction of stenotic nares
resection of aberant turbinates
soft palate resection
layrngeal sacculectomy
laryngeal tie back

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48
Q

BOAS prevention

A

breed for respiratory function
kennel club respiratory function scheme

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49
Q

Cario Physical Exam

A

heart rate
rhythm
murmur
gallop
femoral pulses
respiratory exam

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50
Q

diagnostic tests - cardio - blood pressure

A

all patients with cardiac disease
can have hyper or hypo tension
hypotension - usually reduced CO - DCM and arrythmia
Hypertension - cats, chronic hypertension can cause hypertrophy, MMVS in dogs,can worsen mitral regurgitation
Doppler
oscillometric
invasive

consider ACE inhibitors

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51
Q

diagnostic tests - cardio - hematology and biochem

A

screening of general health
presence of systemic conditions

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52
Q

diagnostic tests - cardio - NT-proBNP

A

differentiating cardiac from respiratory
stretching of cardiac chambers

cats -
>100 - increased stretch, further investigation
>270 - respiratory signs secondary to cardiac failure

dogs -
900-1800 - increased stretch
>1500 - increased risk of heart failure in next 12 months
>1800 - likely clinical signs of heart disease

breed differences -
doberman - >735 - increased risk of DCM
labrador - can be normal <2000

SNAP test - good for emergency to differentiate cardiac and respiratory in dyspnoeic patients

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53
Q

diagnostic tests - cardiac - troponin

A

releases in repsonse to cardiac injury - cardiac injury or necrosis indicator
extremely high in myocarditis and sustained ventricular arrhythmia

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54
Q

diagnostic tests - cardiac - ECG

A

establish nature of an arrythmia
NB arrythmias not necessarily cardiac in origin - can be systemic disease

dobermans and boxers - often arrythmia before murmur (non-clinical stage)

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55
Q

diagnostic tests - cardiac - thoracic ultrasound

A

emergency assessment of dyspnoeic patients
differentiate cardiac and respiratory
looking for left atrial enlargement - bascially always cardiac origin
also look for pleural or pericardial effusion

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56
Q

diagnostic tests - cardiac - echo

A

specific diagnosis
assess function
murmur investigation
advised if MMVD murmur 3/6 or higher
screening for at risk breeds
measurements to assess slight dilations, thickenings, valvular prolapse
colour doppler setting to see regurgitation

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57
Q

diagnostic tests - cardiac - radiography

A

best test for congestive heart failure
staging cardiomegaly
use when concurrent disease to see if respiratory failure
stabilise first
sedation - riskier in heart patients but can be done safely - butorphanol and alfax/propofol

size of heart
shape of heart
venous congestion
trahceal collapse
lung patterns

vertebral heart score - long axis and perpendicular axis - serial measurement to monitor progression
vertebal left atrial score - central ventral aspect of carina to caudal aspect of left atrium - differentiate stages of heart disease
measure vertebrae from T4

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58
Q

Preclinical management of cardiac disease

A

delay progression of disease
arrythmias - preclinical in large breeds
antithrombotics - clodidogrel or aspirin - prevent thromboembolism in cats (most significant preclinical risk)
investigate at risk animals

MMVD - investigate form 3/6 murmur
dobermans - screen from 3-4 yo
cats - screen if gallop, murmur or arrhythmia

pimbobendan - improved muscle contraction and vasodilation, improved cardiac output, delayed onset of clinical disease, improved outcoems in MMVD and DCM

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59
Q

clinical management of cardiac disease

A

manage congestion, cardiac output and RAAS
ideally owners can monitor increased resting respiratory rate/effort at home for early warning

pimobendan - control cardiac output
clodidogrel - antithromboembolitic
ACE inhibitors - loop of henles diuretics - fureosemide, torasemide
thiazides - act on DCT - hydrochlorthiazide
spironolactone - aldosterone agonist

ACEI, thiazides and sprionolactone work on different parts of RAAS - can use in combination

benazepril + spironolactone = cardalis - controls 2 arms of RAAS

risk of RAAS suppresion:
decrease blood pressure
decrease GFR
hyperkalemia
kidney injury in azotemic patients

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60
Q

deleterious effects of RAAS

A

electrolyte derangements
myocardial hypertrophy
fibrosis
formation of reactive oxygen species
inflammatory cytokines

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61
Q

surgical options for cardiac disease

A

mitral valve repair - gold standard
transcatheter edge to edge repair - safer alternative to valve repair when contraindications for surgery, cheaper and more available
transeptal puncture - palliative surgery, used to decompress left atrium and reduce pressure - in cases of advanced refractory heart failure

not many places that do them and expensive
but actual fix
should be offered as an option

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62
Q

MMVD staging

A

A - at risk
B1 - degenerative mitral valve changes present, normal left atrium and ventricle measurements
B2 - degenerative mitral valve changes, left atrium and ventricle dilation
C - past or present congestive heart failure
D - CHF refractory to standard therapy

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63
Q

DCM staging

A

B - B2 - differentiate between whether electrical disturbances are present

arrythmias more common early in disease than in MMVD

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64
Q

example treatment for different cardiac disease staging

A

B2 -
pimobendan
may be candidate for repair under bypass or transcatheter edge to edge repair

C-
diuretic, pimobendan, benazepril, spironolactone
may be candidate for valve repair under bypass or trans catheter edge to edge

D -
diuretic, hydrochlorothiazide, pimobendan, benazepril, spironolactone
may be candidate for valve repair under bypass, may benefit from transseptal puncture (temporary palliative)

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65
Q

ECG clip positioning

A

red - right fore
yellow - left fore
green - left hind

66
Q

normal cardiac conduction

A

impulse starts at SAN
spreads through atria
to AVN
down bundles of His
through purkinje fibres
to ventricles
ventricular contraction

67
Q

PQRS wave

A

P - atrial contraction
PR - conduction to ventricles
QRS - ventricular contraction

68
Q

supraventricular tachycardia - atrial fibrillation

A

irregular, chaotic, fast rhythm (>140bpm, large breeds)
variable pulse quality, pulse deficits
irregular narrow waves, tachycardia, not consistent P waves preceding QRS complexes
atria not properly contributing to ventricular filling
often precedes CHF
rate or rhythm control to treat - usually rate

69
Q

atrial fibrillation treatment

A

rate control -
diltiazem - slows conduction through SAN/AVN
digoxin - negative chronotropy

digoxin toxicity - GI and non specific signs, can also cause myocardial toxicity, stop for 24-48 hours then start again at lower dose

frequent monitoring
ideally 24 hour holter ECG

70
Q

supraventricular tachycardia - atrial flutter

A

manage similar to atrial fibrillation - diltiazen +/- digoxin
no true P wave, around one QRS for 4-5 flutter rates
saw tooth base line pattern
normal QRS

71
Q

ventricular arrythmias - ventricular premature complexes (VPCs)

A

short R-R interval
no P
wide weird looking QRS
caused by ectopic beat originating somewhere other than AVN
not continuous - just occasional weird complexes
cardiac or secondary to extracardiac cause - abdominal, neoplasia, toxicity, trauma
in cats nearly always from primary cardiac disease

72
Q

ventricular arrythmias - accelerated idioventricular rhythm (AIVR)

A

4 or more consecutive VPCs
not and emergency usually
common following abdominal surgery

73
Q

ventricular arrythmias - ventricular tachycardias

A

4 or more VPCs also with fast rate (>160-180bpm)
if sustained and signs of poor cardiac output - emergency
lidocaine bolus

74
Q

bradycardias - sinus node dysfunction (SND)/ sick sinus syndrome (SSS)

A

Affecting entire cardiac conduction system
fibrofatty replacement of nodal tissue
can have sinus tachycardia, AV block, or tachycardia (brady-tachy syndrome)
middle aged to older small breeds

SND - asymptomatic form
SSS - symptomatic, collapse

not consistent so needs long ECG recording
atropine response test - indicates whether will respond to anticholinergics

management -
anticholinergics
pacemaker

75
Q

bradycardias - AV block

A

1st degree - long PR - usually not clinically relevant
2nd degree - usually non conductive P waves
- type 1 - wenkebach - phyiological - long PR before block
- type 2 - mobitz - pathological - PR consistent before block
3rd degree - complete interruption of AV conduction - non conducted P waves

76
Q

bradycardias - general signs

A

non specific - lethargy, anorexia
collapse
heart failure

77
Q

indications - thoracocentesis

A

accumulated air or fluid in pleural space

–> increased pressure on lungs, dyspnoea

78
Q

causes of pneumothorax

A

trauma - RTA, penetrating thoracic wound
lung rupture following IPPC
ruptured pulmonary mass
pneumonia

79
Q

causes of pleural effusion

A

true transudate effusion - hypoproteinemia
modified transudates - right sided CHF, obstruction to lymphatic drainage, lung lobe torsion, neoplasia, diaphragmatic hernia
exudates - active inflammation, sepsis (pyothorax)
chyle (lymphatic fluid) - CHF, neoplasia, trauma, lymphangiectasia, congenital lesions, venous thrombosis
blood - neoplasia, trauma, coagulopathy, lung lobe torsion

80
Q

thoracocentesis - procedure

A

using needle and threww way tap

needle into intercostal space (Avoid intercostal artery on caudal rib border) - maintain slight suction
stop when pop, fluid flowing, or touch lung
attach tap without allowing air flow into cavity
dorsal needle placement if air being removed, ventral if fluid

81
Q

indications - pericardiocentesis

A

pericardial effusion

82
Q

causes of pericardial effusion

A

cardiac or pericardial neoplasms
right sided heart failure
hypoproteinemia
trauma
infection

pericardial effusion –> increased pressure in pericardial sac –> compromised cardiac function

83
Q

signs of pericardial effusion

A

acute - sudden collapse, dyspnoea, rapid deterioration, death
chronic - insidious onset exercise intolerance, signs of right sided hart failure (Ascites), often mistaken for weight gain

84
Q

indications - chest drain

A

need for repeated thoracocentesis - higher risk of trauma to lungs to keep doing it over and over

85
Q

pericardiocentesis - procedure

A

ultrasound to find fluid space around the heart
use ultrasound to guide needle placement
aspirate without going into heart

86
Q

chest drain - procedure

A

incision at an intercostal space
artery forceps to make a tunnel
push the drain through to space three ribs away from incision
penetrate through intercostal muscle
aspirate to remove air/fluid
finger trap suture

87
Q

calf pneumonia - investigation

A

post mortem of dead calves
clinical exam of symptomatic and in contact calves
assessment of environmental factors

88
Q

calf pneumonia - environmental factors

A

vaccination
ventilation
mixed aged groups
new calves brought in
cleanliness
stocking density
ambient temperature
failure of passive transfer
group housing - poorer rate of disease detection

89
Q

calf pneumonia - calf factors

A

respiratory defenses
failure of passive transfer
stress

90
Q

calf pneumonia - viral causes

A

BRSV
PI3
adenovirus
coronavirus
rhinovirus
BVD

91
Q

calf pneumonia - bacterial causes

A

pasteurella multocida
manheima hemolytica
haemophilus somni

secondary to sepsis -
acinomyes pyogenes
salmonella
e coli

also - mycoplasma spp. - mycoplasma bovis most common

92
Q

calf pneumonia - lung lesions

A

viral - consolidated cranioventral lung field, interstitial pneumonia

bacterial - purulent bronchopneumonia, necrosis

93
Q

calf pneumonia - further tests

A

bacterial - deep nasopharyngeal swab and culture
viral - BAL and flourescent antibody test (FAT)
auscultation - wheezes and crackles
fecal worm egg count - for lungworm

94
Q

calf pneumonia - treatment

A

NSAIDs
steroids - in severe dyspnoea
vaccination - can be done when already ill
antibiotics - for secondary bacterial infection
management - ventilation
supportive therapy - fluids

95
Q

calf pneumonia - prevention

A

quarantine of new calves (shipping fever)
purchase from known vendors
reduced cumulative stressors - not doing everything horrible at same time as weaning, gradual weaning
minimising mixed groups
vaccination of dry cows
colostrum management
management of parturition
post weaning management

96
Q

equine asthma

A

non-septic lower airway inflammation

mild to moderate - formerly inflammatory airway disease - no signs at rest
severe - formerly recurrent airway obstruction - signs at rest

97
Q

mild equine asthma - IAD

A

common in young performance horses
no signs at rest
increased tracheal mucous on endoscopy
can be caused by viruses, bacteria, parasites, environmental irritant, allergies
mild increase in BAL neutrophils, eosinophils and/or mast cells without indicators of infection

98
Q

severe equine asthma - RAO

A

Allergen induced hypersensitivity
usually older than 7
frequent coughing, exercise intolerance, increase respiratory effort at rest
no signs of infection
usually associated with stable allergens and poor ventilation, or environmental pollens
increased tracheal mucous on endoscopy
moderate to severe increase in neutrophils on BAL or TW
diagnosis based on clinical signs of respiratory cytology

99
Q

severe equine asthma - clinical signs

A

sub-clinical - exercise intolerance

mild - sporadic coughing, serous/mucoid nasal discharge

severe - persistent cough, increased expiratory effort (abdominal heave), mild tachypnoea, wheezing, severe exercise intolerance, weight loss

acute exacerbation - marked tachypnoea, severe expiratory dyspnoea, nostril flaring, paroxysmal coughing

100
Q

equine asthma - pathophysiology

A

neutrophilic inflammation
mucous hypersecretion
bronchoconstriction/bronchospasm

thickening, inflammation and mucous –> increased expiratory effort –> small airways collapse during expiration

101
Q

equine asthma - treatment

A

removal of environmental irritants - reduce time at pasture, reduce dust/spore exposure, improve ventilation, turn horse out before mucking out, avoid/soak hay

control airway inflammation
reverse bronchoconstriction

chronic cases can lead to irreversible change

102
Q

equine asthma - medical treatment

A

rapidexon - dexamethasone
equipred - prednisolone
ventipulmin - mucolytic - open respiratory passages
ipratropium bromide - relaxes airway muscles (inhalant)
brown inhaler - declomateasone dipropionate - steroid inhaler, prevention
orange inhaler - flixotide - prevention of inflammation
aservo equihaler - Ciclesonide - special horse inhaler
ventolin - regular blue inhaler

buscopan - antispasm
atropine - in acute attacks
sputolosin - added to feed, loosens mucous

103
Q

equine bradydyssrhythmias

A

mostly physiological (normal) - high vagal tone

AV block
sinus arrythmia
sinus bradycardia
sinoatrial block
sinoatrial arrest

abolished with increased sympathetic tone

104
Q

equine tachydysrhythmias

A

pathological

supraventricular or ventricular

premature depolarisations
tachycardia
fibrillation

causes can be inflammatory, degenerative, metabolic, toxicity

105
Q

equine - second degree AV block

A

most common physiological dysrhythmia

long pauses and variation in length of diastole - can occur in normal horses

not normal if present during exercise - should be abolished by increased vagal tone

advanced - conduction block at AVN, exercise intolerance or collapse. usually associated with inflammatory or degenerative changes at AVN

106
Q

equine - 3rd degree AV block

A

complete AV dissociation
severe exercise intolerance and frequent collapse

107
Q

equine - 3rd degree AC block treatment

A

anti dysrhythmic medication - caution, monitor with ECG holter
anti-inflammatories - dexmethasone
pace maker placement

108
Q

equine - premature depolarisations

A

Supraventricular - originate in atria - normal QRS

Ventricular - originate in ventricles - abnormal QRS (isolated occurence can be normal)

109
Q

equine - atrial fibrillation

A

predisposed due to high resting vagal tone and large atrial mass
common in thoroughbreds

110
Q

equine - signs of atrial fibrillation

A

reduced performance
prolonged recovery after exercise
normal resting HR
low grade cough
irregularly, regular rhythm with absence of S4 on auscultation

sustained - persistent at rest and during exercise
paroxysmal - sudden and transient AF that spontaenously goes back to normal rhythm

111
Q

equine - paroxysmal atrial fibrillation

A

usually during strenuous exercise
reverts within 24-48 hours post exercise

112
Q

equine - secondary atrial fibrillation

A

occurs as consequence of underlying structural cardiac disease

eg mitral valve insufficiency (enlarged left atrium) or primary mycocardial disease

signs - more profound exercise intolerance, resting tachycardia, loud cardiac murmurs

113
Q

equine - atrial fibrillation cardioversion

A

treatment - conversion to normal sinus rhythm

success depends on -
duration of AF - prolonged AF leads to structural and electrical remodelling
presence of underlying disease - horses with existing cardiac disease are poor candidates

done with continuous ECG monitoring (hospital setting)

medical - quinidine - prolongs effective refractory period
electrocardioversion - electrodes placed across atria

114
Q

equine - atrial fibrillation - management

A

regular exercising ECG recordings
moderate exercise levels by maximal HR achievable
severe cases should be retired

115
Q

equine - valvular regurgitation

A

physiological - some degree normal in fit athletic thoroughbreds

pathological -
congenital - valvular dysplasia
degenerative - endocardiosis
inflammatory/infectious - endocarditis
idiopathic

116
Q

equine - valvular regurgitation - diagnostics

A

examination - gistory, signs, murmur characteristics

echocardiography - valves, regurgitation jet (dopple, size, direction and velocity), cardiac structure

electrocardiography - concurrent dysrhythmias

117
Q

equine - valvular regurgitation -aortic

A

most common
middle age
usually degenerative

severity assessed by loudness of murmur, quality or arterial pulse and monitoring progression

good prognosis if no structural change

118
Q

equine - valvular regurgitation - mitral

A

second most common
higher prevalence in thoroughbreds

most likely form of regurgitation to lead to CHF
pulmonary hypertension
risk factor for AF

119
Q

Equine - ventricular septal defect

A

most common congenital cardiac defect
common in welsh moutain ponies

hole in membranous portion of srptum
blood flows left to right
loud and course pansystolic murmur on right side (4th intercostal space)
often murmur also audible on left side

prognosis depends on size and position of defect
poor prognosis - large defects as measured on ECG, evidence of right ventricular overload

120
Q

Equine - dysrhythmia and murmur summary

A

2nd degre AV block common and normal at rest
AF most common dysrhythmia and affects performance
dysrhythmias should be thoroughly assessed in active horses

aortic and mitral regurgitation common
often exist in normal horses and can function. athigh athletic ability
loud or progressive murmurs or those associated with clinical signs should be investigated

121
Q

equine - guttural pouch anatomy

A

large air filled space - 300-500ml
entrance through ostia
stylohyoid bone through centre
medial compartment - internal carotid artery and occipital condyle
lateral compartment - maxillary artery, external carotid artery and facial nerve

122
Q

equine - guttural pouch empyema

A

common
strangles - strep equi equi

dullness
pyrexia
bilateral or unilateral nasal discharge
sometimes neuropathy

diagnosed with endoscopy, radiography, culture/PCR to identify bacteria

treatment -
acute - liquid pus - drain by encouraging floor feeding or drain with foley catheter
chronic - chondroids (soild pebbles) - lavage, endoscopic basket or surgical removal

123
Q

equine - guttural pouch mycosis

A

aspergillus or candida
attaches to neurovascular structures - internal carotid

signs -
epistaxis
death - due to bleeding
dysphagia
facial paralysis

diagnosis - clincial signs and endoscopy

treatment - topical antifungals or surgery (referral - vessel ligation, balloon catheter)

124
Q

equine - guttural pouch tympany

A

uncommon
foals - fillies and arabs
unilateral or bilateral distension of pouches
otherwise healthy seeming
snoring noise when suckling

secondary to inflammation from infection or persistant coughing

diagnosis - endoscopy, radiography

treatment - foley catheter into pouch for termporary relief, surgery

care for facial nerve

125
Q

equine - temperohyoid osteoarthropathy

A

uncommon
fusion of temperohyoid joint - due to arthritis or middle ear infection
exacerbated by movement of tongue when swallowing, vocalising, head and neck movements, oral and dental exam

fused joint –> fracture –> nerve damage

signs -
vestibular disease
head tilt
facial paralysis
head shaking
pain on palpation at base of ear

diagnosis - endoscopy, radiography, CT

treatment - NSAIDs, antibiotics, surgery

treatment depending on underlying cause

126
Q

equine - recurrent laryngeal neuropathy (RLN)

A

common cause of poor performance
degeneration of recurrent laryngeal nerves
large breed horses
paralysis of left intrinsic laryngeal muscles - prevents arytenoid movement

signs -
inspiratory road, exercise intolerance
best to hear noise in canter when all legs of ground (wood sawing sound)

treatment -
prosethtic laryngoplasty - suture to tighten - treatment of choice in performance horses or severe cases
Hobdays - effective at reducing noise
removal of aretynoid cartilage
neuromuscular pedicle graft
tracheostomy - can race with it in
laryngeal pacemaker

post surgical complications - aspiration pneumonia, coughing during feeding, implant failure

127
Q

equine - dorsal displacement of the soft palate (DDSP)

A

most common nasopharyngeal disorder if both respiratory noise and poor performance

signs -
choking/gurgling/’swallowing tongue” at exercise
respiratory noise
drop in exercise tolerance
can be silent

diagnosis -
resting endoscopy

treatment -
eliinate pre disposing factors and concurrent disease
get the horse fitter
allow time
change tack - nose bands or tongue ties to stop caudal movement of tongues
tracheostomy

128
Q

equine - epiglottic entrapment

A

loose epiglottic mucosal tissue traped over dorsal surface of epiglottis

signs -
respiratory noise
exercise intolerance
some incidental asymptomatic cases found at endoscopy

diagnosis -
resting endoscopy
exercising endoscopy (may only entrap under exercise)

treatment -
surgery

129
Q

equine - sub-epiglottic cysts

A

uncommon
inflammatory, traumatic or congenital

signs -
foals - nasal discharge of milk, repsiratory noise (congenital)
poor performance
coughing
dysphagia
nasal discharge

diagnosis -
endoscopy - oral, may be missed on nasal endoscopy

treatment -
excision via lryngotomy
laser excision
formalin injection

130
Q

equine - arytenoid chondropathy

A

inflammatory/infectious/dystrophic change
one or both arytenoids
young thoroughbreds

signs -
acute - respiratory distress, inspiratory noise
chronic - poor performance, inspiratory noise

diagnosis -
endoscopy

treatment -
NSAIDs
antibiotics
steroids
tracheostomy
arytenoidectomy
debridement

131
Q

equine - 4th-brancial arch defects

A

congenital

signs -
right sided laryngeal dysfunction
rostral displacement of palatopharyngeal arch
abnormalities of cartilages and associated msucles
aerophagia –> bloating
poor performance
dysphagia
aspiration pneumonia
burping
respiratory obstruction

diagnosis -
endoscopy
radiography

treatment - none, maybe tracheostomy

poor prognosis for performance

132
Q

equine - characteristics of infectious URT disease

A

nasal discharge
pyrexia
cough
depression
anorexia
lymphadenopathy
limb oedema
ocular discharge
abortion/acute onset neurological disease (EHV 1)

133
Q

equine influenza

A

young horses, big groups
subclinical shedding
primary aerosol and direct contact spread
virus attaches to mucosal cells and penetrates URT cells

signs -
coughing - dry, harsh, frequent - main thing
pyrexia
nasal discharge
dullness
inappetance
muscle soreness

complications - secondary bacterial infection

treatment (symptomatic) -
NSAIDs
good air hygiene
rest
antibiotics for secondary infection
antivirals - not often used

134
Q

Equine Herpesvirus 1 and 4

A

latency - in t lymphocytes and trigeminal nerve ganglion

1 - respiratory, abortion, and neuro
4 - respiratory only

1 -
likes endothelial cells - vasculitis and thromboischemia
effects nervous system - ischemic nerve cell death - ataxia, bladdder ditension, urinary incontinence, penile protrusion, flaccid tail and anus
placental disease - abortion, still birth, weak foals

signs (both) -
usually mild in adults
rhinopneumonia
biphasic pyrexia
nasal discharge
swelling lmph nodes
oedema and hyperemia of mm
coughing - less harsh than influenza

complications - secondary bacterial infection

treatment -
symptomatic
antibiotics for secondary infection

135
Q

equine - other URT viruses

A

picornavirus - rhinitis
gammaherpesviruses - multimodal pulmonary fibrosis
adenovirus - usually only if immunodeficient
hendra virus and african horse sickness - systemic but can manifest as respiratory disease

136
Q

strangles

A

strep equi equi (bacterial)
chronic carrier
abscesses - pathognomonic
inhaled or ingested, attaches to tonsil crypts

signs -
local rhinitis
pharyngitis
translocation to local lymph nodes
abscess formation - can drain into guttural pouch causing guttural pouch empyema
pain
mucopurulent nasal discharge
pyrexia
inappetance
swelling - respiratory distress, cough, dysphagia

complications - dyspnoea, carrier state, metastatic strangles (abscesses at other sites), pupura haemorrhagica (hypersensitivity reaction - need steroids, antibiotics, analgesia and nursing)

treatment -
NSAIDs
hot pack abscesses
lance abscesses
tracheostomy - if respiratory distress
antibiotics - only if very sick and compromised - can lengthen disease and prevent development of immunity

137
Q

equine - respiratory biosecurity

A

isolation and barrier nursing of clinical cases
separate equipment and feed and water buckets
PPE
foot baths
clean and siinfect between handling horses
identify in contact animals and keep in separate groups
avoid crowding

138
Q

equine - respirtory - confirmation of freedom from disease

A

EIV - signs resolved, repeat negative PCR on nasopharyngeal swab
EHV - signs resolved (endemic in UK, never confirmed free)
strep equi - signs resolved, 3 negative swabs, negative bilateral guttural pouch samples

139
Q

farm animal pneumonia

A

respiratory disease complex
viruses followed by bacteria
husbandry and environmental
welfare and economic impact
young animals
stress
main cause of mortality in young cattle
usually LRT

140
Q

weaning - causes of stress

A

leave mother
change in diet
market/transport
change of housing

141
Q

bovine respiratory disease complex - signs

A

dullness
lethargy
pyrexia
inappetance
tachypnoea
dyspnoea
coughing - not in shipping fever
nasal and ocular discharge

142
Q

bovine respiratory disease complex - mycoplasma bovis

A

increasing diagnoses as cause

mastitis
eye infection
joint infection
repro infection
meningitis

associated with manheimia hemolytica

biofilm
no cell wall - limited treatment options

143
Q

bovine respiratory disease complex - manheimia hemolytica

A

normal respiratory tract flora

severe inflammation
bronchopenumonia
concurrent infections

shipping fever

signs similar to histophilus somni

144
Q

bovine respiratory disease complex - IBR

A

herpes - latency
old as well as young

lots of nasal discharge
high morbidity
sudden spread
erosions on nasal septum
pyrexia
depression
halitosis

ddx - manhemia hemolytica, malignant cattharal fever, bluetongue

can vaccinate while sick

145
Q

cattle lungworm

A

coughing
vaccination available

picked up off pasture

146
Q

fog fever

A

atypical interstitial pneumonia
intoxication from lush grass after winter

147
Q

ovine respiratory complex - bacteria

A

manheimia hemolytica
pasteurella multocida
bibersteinia trehalosi
mycoplasma ovipneumoniae

148
Q

ovine respiratory complex - viruses

A

PI3
ovine pulmonary adenocarcinoma (jaagsietke)
maedi-visna

149
Q

ovine lungworm

A

milder then cattle
chronic cough

150
Q

ovine respiratory complex - manheimia hemolytica

A

most important sheep respiratory pathogen
2 forms - septicemic and systemic

septicemic - sudden death in young lambs
systemic - acute onset depression, lethargy, inappetance

vaccines - combined with clostridial diseases

151
Q

ovine respiratory complex - biberstenia trehalosi

A

recently weaned lambs
sudden death
treatment - oxytetracycline

vaccines - combined with clostridial diseases

152
Q

ovine respiratory complex - PI3

A

young and growing lambs
usually mild or non-clinical

153
Q

ovine respiratory complex - mycoplasma

A

enzootic pneumonia
mild to severe
coughing
reduced weight gain
isn’t usually fatal, but bad for production

154
Q

ovine respiratory complex - Jaagsietke

A

contagious tumour - lungs
respiratory transmission
retrovirus
iceberg disease
lungs produce lots of fluid and are heavy
secondary bacterial infections

weight loss
fluid out of nose when wheelbarrowed
laboured breathing
nasal discharge

155
Q

ovine respiratory complex - maedi visna

A

interstitial pneumonia
transmission. incolostrum, or air borne
very contagious
no vaccine
no cure

causes caprine arthritis encephalitis (CAE)

156
Q

porcine respiratory disease complex

A

mycoplasma hyopneumonia - enzootic pneumonia
streptococcus suis

barking cough
gradual spread - aerosol

vaccination available

ELISA
lung scoring at slaughter

157
Q

farm animal pneumonia - prevention

A

colostrum management
nutrition
vaccination
ventilation and air quality
minimise stress
early identification and isolation
quarantine of new animals

158
Q

equine - infectious pleuropneumonia

A

viral - equine influenza
bacterial - rodococcus equi equi

contamination of LRT with URT bacteria
inhibition of normal clearance mechanisms

159
Q

equine - transit fever

A

pleuropneumonia

stress during travel
head held up for long
aspiration

160
Q

aims in anaesthesia - patients with cardiac disease

A

maintain CO levels
avoid hypo-hypertension
avoid excessive tachy/bradycardia
avoid increases in myocardial workload
avoid myocardial depression and arythmogenesis
maintain oxygenation (NB IPPV can be detrimental - can impair output through lungs)
maintain good fluid balance and avoid overinfusion

161
Q

mitral regurgitation - anaesthesia

A

common in older patients
can lead to pulmonar congestion or oedema

pre oxygemate
keep HR steady
avoid ionotropic drugs
aim for small decrease in afterload - avoid ketamine and alpha-2 (increase afterload)
avoid arrythmias - can use and anti-arryhthmic drug
maintain preload
IPPV for pulmonary congestion/oedema - may help push fluid back into circulation

162
Q

cardiomyopathy - anaesthesia

A

CO is HR dependent
common in dobermans
occurs in DCM, and HCM

avoid big HR changes
dobutamine infusion - maintains BP
avoid ketamine. inhyperthyroid cats - want to ensure adequate preload and avoid sympathetic stimulation

163
Q

ventricular dysrhythmias/cardiac contusions - anaesthesia

A

anaesthetise sooner rather than later - golden 12 hours before contusions appear
ensure other parameters within good limits
ensure good analgesia - opioids
avoid sympathetic stimulation

if arryhtmia is significant and not responding to treatment - recover

164
Q

pacemakers - anaesthesia

A

mostly in patients with 3rd degree AV block

pre treat - atropine, glycopyrrolate, isoproterenol
pre-oxygenate
don’t use anything that lowers HR - pethidine preffered
place external pacing leads prior to induction (riskiest part so good to have them in place)

165
Q

patent ductus arteriosus - anaesthesia

A

if reverses to R-L then poor candidates for anaesthesia - global hypoxia
systemic hypertension and increased pulomary circulation pressure can cause shunt reversal - IPPV and inhaled anaesthetic agents

prevent hypothermia. -often young patients
avoid worsening of shunt - hypoxia, high CO2 pain
maintain HR - pethidine as opioid of choice
pre oxygenate
analgesia

166
Q

branham reflex

A

sudden bradycardia may occur reflexively after patent ductus arteriosus ligated

167
Q

effect of anaesthesia on gas exchange

A

hypoventilation - detrimental as many resp conditions already have underlying hypoventilation
avoid drugs causing bronchospasm
dead space
IPPV - can compress pulmonary capillaries
ventilation/perfusion mismatch exacerbated
shunts –> hypoxemia
increased shunt fraction

168
Q

airway challenges - anaesthesia

A

jaw fractures
TMJ pathology
jaw pathology
eosinophilic myositis

IPPV where necessary
careful with airwat pressures
ET tube
pulse ox in recovery

CMS - term 1 (15 decks)

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