Cardiorespiratory disease Flashcards by Thomas Conway

Scenario: A 5-year-old Thoroughbred racehorse presents with a history of poor performance and an abnormal respiratory noise during exercise. Resting endoscopy is unremarkable.

Lead-in: Which of the following diagnostic tests would be most helpful in identifying the cause of this horse’s respiratory noise?

Options:

a) Rebreathing endoscopy
b) High-speed treadmill endoscopy
c) Radiography of the head and neck
d) Ultrasonography of the larynx
e) Computed tomography (CT) of the head

Answer: b) High-speed treadmill endoscopy

Explanation: High-speed treadmill endoscopy allows for dynamic visualization of the upper airway during exercise, which is essential for diagnosing dynamic functional abnormalities that may not be evident at rest.

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Scenario: A 10-year-old Warmblood gelding presents with a history of inspiratory noise during exercise. Resting endoscopy reveals left laryngeal hemiplegia (LLH) grade III.

Lead-in: Which of the following surgical treatments would be most appropriate for this horse?

Options:

a) Staphylectomy
b) Myectomy (sternothyroid and sternohyoid)
c) Laryngoplasty (“tie-back”)
d) Arytenoidectomy
e) Ventriculocordectomy

Answer: c) Laryngoplasty (“tie-back”)

Explanation: Laryngoplasty is the most common and effective surgical treatment for LLH. It involves placing a suture to permanently hold the arytenoid cartilage in an abducted position, improving airflow.

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Scenario: A 7-year-old Thoroughbred mare presents with a history of intermittent respiratory noise and exercise intolerance. Resting endoscopy reveals dorsal displacement of the soft palate (DDSP).

Lead-in: Which of the following surgical treatments would be most appropriate for this mare?

Options:

a) Staphylectomy
b) Myectomy (sternothyroid and sternohyoid)
c) Tie-forward surgery
d) Arytenoidectomy
e) Tie-back surgery

Answer: c) Tie-forward surgery

Explanation: Tie-forward surgery is currently the most popular and successful surgical treatment for DDSP. It involves placing a prosthesis to mimic the action of the thyrohyoid muscle, stabilizing the larynx and preventing the soft palate from displacing.

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Scenario: A 3-year-old Standardbred filly presents with a history of respiratory noise and exercise intolerance. Endoscopy reveals an epiglottic entrapment.

Lead-in: Which of the following treatment options would be most appropriate for this filly?

Options:

a) Conservative management with rest and anti-inflammatories
b) Laryngoplasty
c) Ventriculocordectomy
d) Arytenoidectomy
e) Laser division of the entrapping membrane

Answer: e) Laser division of the entrapping membrane

Explanation: Laser division of the entrapping membrane is the most effective treatment for epiglottic entrapment. It can be performed standing under sedation and has a good success rate.

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Scenario: A 12-year-old Warmblood gelding presents with a history of unilateral nasal discharge and facial swelling. Endoscopy reveals a mass in the nasal passage. Radiographs show a tooth root abscess involving the right maxillary sinus.

Lead-in: Which of the following treatment options would be most appropriate for this gelding?

Options:

a) Systemic antibiotics
b) Nasal lavage
c) Sinus trephination and drainage
d) Tooth repulsion via sinusotomy
e) Radiation therapy

Answer: d) Tooth repulsion via sinusotomy

Explanation: Tooth root abscesses are a common cause of sinusitis in horses. Repulsion of the affected tooth via sinusotomy is the most effective treatment for this condition.

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Scenario: A 6-year-old Thoroughbred mare presents with a history of respiratory noise and exercise intolerance. Endoscopy reveals arytenoid chondritis of the left arytenoid cartilage.

Lead-in: Which of the following treatment options would be most appropriate for the initial management of this mare?

Options:

a) Systemic and topical anti-inflammatories
b) Laryngoplasty
c) Arytenoidectomy
d) Ventriculocordectomy
e) Permanent tracheostomy

Answer: a) Systemic and topical anti-inflammatories

Explanation: Medical management with systemic and topical anti-inflammatories is the initial treatment of choice for arytenoid chondritis. This often results in significant improvement, especially in acute cases.

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Scenario: A 4-year-old Standardbred gelding presents with a history of respiratory noise during exercise. Endoscopy reveals a subepiglottic cyst.

Lead-in: Which of the following treatment options would be most appropriate for this gelding?

Options:

a) Conservative management with rest and anti-inflammatories
b) Laryngoplasty
c) Ventriculocordectomy
d) Surgical removal of the cyst
e) Laser ablation of the cyst

Answer: d) Surgical removal of the cyst

Explanation: Surgical removal of the cyst is the most effective treatment for subepiglottic cysts. This can be done through a laryngotomy or orally using a snare wire.

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Scenario: A 10-year-old Warmblood mare presents with a history of respiratory noise and exercise intolerance. Endoscopy reveals a medial deviation of the aryepiglottic folds (MDAF).

Lead-in: Which of the following treatment options would be most appropriate for this mare?

Options:

a) Conservative management with rest and anti-inflammatories
b) Laryngoplasty
c) Ventriculocordectomy
d) Arytenoidectomy
e) Laser surgery to remove excess tissue

Answer: e) Laser surgery to remove excess tissue

Explanation: Laser surgery to remove the excess tissue causing the medial deviation is the most effective treatment for MDAF.

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Scenario: A 3-year-old filly is presented with a suspected case of Strangles. You perform an endoscopic examination of the guttural pouches.

Lead-in: Which of the following endoscopic findings would be most consistent with a diagnosis of Strangles?

Options:

a) Bilateral accumulation of mucopurulent exudate in the guttural pouches
b) Presence of a diphtheritic membrane on the pharynx
c) Erythema and swelling of the epiglottis
d) Dorsal displacement of the soft palate
e) Left laryngeal hemiplegia

Answer: a) Bilateral accumulation of mucopurulent exudate in the guttural pouches

Explanation: Strangles, caused by Streptococcus equi, often leads to the formation of abscesses in the retropharyngeal lymph nodes, which can rupture into the guttural pouches, resulting in the accumulation of purulent material

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Scenario: A 7-year-old gelding is diagnosed with pleuropneumonia. Thoracic ultrasound reveals a large amount of pleural fluid.

Lead-in: Which of the following treatment options would be most appropriate for managing this horse’s pleural effusion?

Options:

a) Systemic antibiotics alone
b) Thoracocentesis and chest drainage
c) Surgical removal of the affected lung lobe
d) Corticosteroids and anti-inflammatories
e) Observation and monitoring

Answer: b) Thoracocentesis and chest drainage

Explanation: Thoracocentesis allows for the removal of pleural fluid, which can improve respiratory function and facilitate resolution of the infection. Systemic antibiotics are also necessary to treat the underlying infection, but drainage of the pleural fluid is essential for managing this horse’s condition.

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Scenario: A 10-year-old mare presents with a history of unilateral nasal discharge. Endoscopy reveals a mass in the nasal passage. Biopsy of the mass confirms a diagnosis of ethmoid hematoma.

Lead-in: Which of the following treatment options would be most appropriate for this mare?

Options:

a) Systemic antibiotics
b) Surgical removal of the mass
c) Radiation therapy
d) Intratumoral injection of formalin
e) No treatment necessary

Answer: d) Intratumoral injection of formalin

Explanation: Intratumoral injection of formalin is the most common and effective treatment for ethmoid hematoma. It causes necrosis and shrinkage of the mass, resolving the clinical signs.

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Scenario: A 6-month-old foal presents with a history of respiratory distress and coughing. Thoracic radiographs reveal an interstitial pneumonia.

Lead-in: Which of the following is the most likely cause of this foal’s pneumonia?

Options:

a) Rhodococcus equi infection
b) EHV-1 infection
c) Meconium aspiration syndrome
d) Parascaris equorum migration
e) Milk aspiration

Answer: a) Rhodococcus equi infection

Explanation: Rhodococcus equi is a common cause of pneumonia in foals, typically between 1 and 6 months of age. It often causes an insidious onset of respiratory disease with characteristic radiographic findings.

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Scenario: A 2-year-old colt presents with a history of coughing and nasal discharge. Endoscopy reveals a subepiglottic cyst.

Lead-in: Which of the following treatment options would be most appropriate for this colt?

Options:

a) Conservative management with rest and anti-inflammatories
b) Laryngoplasty
c) Ventriculocordectomy
d) Arytenoidectomy
e) Surgical removal of the cyst

Answer: e) Surgical removal of the cyst

Explanation: Surgical removal of the cyst is the most effective treatment for subepiglottic cysts. This can be done through a laryngotomy or orally using a snare wire.

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Scenario: A 10-year-old mare presents with a history of respiratory noise during exercise. Endoscopy reveals arytenoid chondritis of the left arytenoid cartilage.

Lead-in: Which of the following treatment options would be most appropriate for the initial management of this mare?

Options:

a) Systemic and topical anti-inflammatories
b) Laryngoplasty
c) Arytenoidectomy
d) Ventriculocordectomy
e) Permanent tracheostomy

Answer: a) Systemic and topical anti-inflammatories

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Scenario: A 5-year-old gelding presents with a history of respiratory noise and exercise intolerance. Endoscopy reveals a rostral displacement of the palatopharyngeal arch.

Lead-in: Which of the following surgical treatments would be most appropriate for this gelding?

Options:

a) Staphylectomy
b) Myectomy (sternothyroid and sternohyoid)
c) Tie-forward surgery
d) Arytenoidectomy
e) Ventriculocordectomy

Answer: b) Myectomy (sternothyroid and sternohyoid)

Explanation: Myectomy of the sternothyroid and sternohyoid muscles can reduce caudal traction on the larynx, helping to resolve the rostral displacement of the palatopharyngeal arch.

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Scenario: A 7-year-old mare presents with a history of respiratory noise during exercise. Endoscopy reveals a persistent dorsal displacement of the soft palate (DDSP).

Lead-in: Which of the following surgical treatments would be most appropriate for this mare?

Options:

a) Staphylectomy
b) Myectomy (sternothyroid and sternohyoid)
c) Tie-forward surgery
d) Arytenoidectomy
e) Ventriculocordectomy

Answer: a) Staphylectomy

Explanation: Staphylectomy is a surgical procedure that involves removing a portion of the soft palate. This can be helpful in cases of DDSP where the soft palate is excessively long or flaccid.

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Scenario: A 12-year-old gelding presents with a history of unilateral nasal discharge and facial swelling. Endoscopy reveals a mass in the nasal passage. Biopsy of the mass confirms a diagnosis of ethmoid hematoma.

Lead-in: Which of the following treatment options would be LEAST appropriate for this gelding?

Options:

a) Systemic antibiotics
b) Surgical removal of the mass
c) Radiation therapy
d) Intratumoral injection of formalin
e) No treatment necessary

Answer: b) Surgical removal of the mass

Explanation: Surgical removal of an ethmoid hematoma is generally not recommended due to the high risk of complications, including bleeding and recurrence. The other options are more appropriate treatment modalities for this condition.

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Scenario: A 6-month-old foal presents with a history of respiratory distress and coughing. Thoracic radiographs reveal an interstitial pneumonia.

Lead-in: Which of the following diagnostic tests would be most helpful in confirming the most likely cause of this foal’s pneumonia?

Options:

a) Transtracheal wash with cytology and PCR
b) Nasal swab for viral isolation
c) Blood culture for bacterial infection
d) Faecal egg count for parasite burden
e) Ultrasound examination of the thorax

Answer: a) Transtracheal wash with cytology and PCR

Explanation: A transtracheal wash (TTW) allows for the collection of samples from the lower airways, which can then be analyzed for cytology and the presence of infectious agents using PCR. This is the most helpful diagnostic test for confirming the cause of pneumonia in foals, including Rhodococcus equi infection, which is a common cause in this age group

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Scenario: A 1-day-old foal is presented with respiratory distress. The foal was born following a dystocia and has evidence of meconium staining on its coat. Auscultation of the lungs reveals diffuse crackles and wheezes.

Lead-in: Which of the following treatment options would be the most appropriate initial therapy for this foal?

Options:

a) Intravenous antibiotics and anti-inflammatories
b) Oxygen supplementation and bronchodilator therapy
c) Thoracocentesis and chest drainage
d) Mechanical ventilation and surfactant administration
e) Corticosteroids and nebulization

Answer: b) Oxygen supplementation and bronchodilator therapy

Explanation: The clinical signs and history suggest meconium aspiration syndrome (MAS). The initial treatment for MAS should focus on improving oxygenation and reducing airway obstruction. Oxygen supplementation can be provided via nasal insufflation or a mask. Bronchodilators, such as albuterol, can help to open up the airways and improve ventilation. While antibiotics and anti-inflammatories may be necessary in some cases, they are not the most appropriate initial therapy. Thoracocentesis and chest drainage are not indicated for MAS. Mechanical ventilation and surfactant administration may be required in severe cases, but they are not the first-line treatment. Corticosteroids are not routinely used in the treatment of MAS

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Scenario: A 3-week-old foal presents with a mild cough and increased respiratory effort. The foal is bright and alert, but its respiratory rate is elevated. Auscultation of the chest reveals crackles and wheezes.

Lead-in: Which of the following diagnostic tests would be most helpful in identifying the cause of the foal’s respiratory signs?

Options:

a) Transtracheal wash
b) Blood culture
c) Faecal egg count
d) Ultrasound examination of the thorax
e) Radiography of the thorax

Answer: a) Transtracheal wash

Explanation: A transtracheal wash allows for the collection of samples from the lower airways, which can then be analyzed for cytology and the presence of infectious agents. This is the most helpful diagnostic test for confirming the cause of pneumonia in foals, including Rhodococcus equi infection, which is a common cause in this age group.

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Scenario: A 1-month-old foal is diagnosed with Rhodococcus equi pneumonia.

Lead-in: Which of the following antimicrobial choices is the most appropriate for treating this condition?

Options:

a) Erythromycin and rifampin
b) Penicillin and gentamicin
c) Ceftiofur and metronidazole
d) Trimethoprim sulfadiazine and doxycycline
e) Chloramphenicol and enrofloxacin

Answer: a) Erythromycin and rifampin

Explanation: The combination of a macrolide (such as erythromycin) and rifampin is the most effective treatment for Rhodococcus equi pneumonia in foals.

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Scenario: A 2-week-old foal presents with a high fever, lethargy, and cough. Thoracic radiographs reveal an interstitial pneumonia with multiple abscesses.

Lead-in: Which of the following is the most likely cause of this foal’s pneumonia?

Options:

a) Rhodococcus equi infection
b) Viral pneumonia
c) Meconium aspiration syndrome
d) Milk aspiration
e) Parasitic pneumonia

Answer: a) Rhodococcus equi infection

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Scenario: A newborn foal is diagnosed with a congenital abnormality of the upper respiratory tract that is causing severe respiratory distress.

Lead-in: Which of the following is the most likely cause of this foal’s respiratory distress?

Options:

a) Choanal atresia
b) Epiglottic entrapment
c) Dorsal displacement of the soft palate
d) Subepiglottic cyst
e) Laryngeal hemiplegia

Answer: a) Choanal atresia

Explanation: Choanal atresia is a congenital condition where the back of the nasal passage is blocked, preventing airflow. This can cause severe respiratory distress in newborn foals.

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Scenario: A 3-month-old foal presents with a history of coughing and nasal discharge. Endoscopy reveals a subepiglottic cyst.

Lead-in: Which of the following treatment options would be most appropriate for this foal?

Options:

a) Conservative management with rest and anti-inflammatories
b) Laryngoplasty
c) Ventriculocordectomy
d) Arytenoidectomy
e) Surgical removal of the cyst

Answer: e) Surgical removal of the cyst

Explanation: Surgical removal of the cyst is the most effective treatment for subepiglottic cysts. This can be done through a laryngotomy or orally using a snare wire.

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Scenario: A 1-week-old foal presents with a rib fracture and respiratory distress. Lead-in: Which of the following treatment options would be most appropriate for this foal? Options: a) Conservative management with rest and pain relief b) Surgical repair of the rib fracture c) Thoracocentesis d) Mechanical ventilation e) Corticosteroids

Answer: a) Conservative management with rest and pain relief Explanation: Most rib fractures in foals heal well with conservative management, including rest, pain relief, and supportive care. Surgical repair is rarely necessary.

Scenario: A 2-month-old foal presents with a history of fever, lethargy, and cough. Thoracic radiographs reveal an interstitial pneumonia. Lead-in: Which of the following diagnostic tests would be most helpful in confirming the most likely cause of this foal's pneumonia? Options: a) Transtracheal wash with cytology and PCR b) Nasal swab for viral isolation c) Blood culture for bacterial infection d) Faecal egg count for parasite burden e) Ultrasound examination of the thorax

Answer: a) Transtracheal wash with cytology and PCR Explanation: A transtracheal wash (TTW) allows for the collection of samples from the lower airways, which can then be analyzed for cytology and the presence of infectious agents using PCR. This is the most helpful diagnostic test for confirming the cause of pneumonia in foals, including Rhodococcus equi infection, which is a common cause in this age group.

Scenario: A 3-week-old foal presents with a history of coughing and nasal discharge. The foal is pyrexic and has an elevated respiratory rate. Lead-in: Which of the following is the most likely cause of this foal's respiratory signs? Options: a) Bacterial pneumonia b) Viral pneumonia c) Parasitic pneumonia d) Fungal pneumonia e) Allergic respiratory disease

Answer: a) Bacterial pneumonia Explanation: Bacterial pneumonia is a common cause of respiratory disease in foals, particularly those that are stressed or immunocompromised. The presence of fever and nasal discharge further supports this diagnosis.

A 10-year-old Warmblood gelding is diagnosed with grade III left laryngeal hemiplegia. The most appropriate surgical treatment for this condition is .........................

Answer: Laryngoplasty ("tie-back")

A 6-year-old Thoroughbred mare presents with a history of respiratory noise and exercise intolerance. Endoscopy reveals arytenoid chondritis. The most appropriate initial management for this condition is .........................

Answer: Any licenced NSAID: Phenylbutazone Flunixin Ketoprofen Meloxicam Firocoxib Suxibuzone

......................... is a respiratory condition characterized by the presence of a fluid line in the paranasal sinuses on radiographic examination.

Answer: Sinusitis

A foal is diagnosed with Rodococcus equi. You elect to treat this with.......................and.........................

Rifampin AND Azithromycin OR Clarithromycin.

Scenario: A 10-year-old Warmblood gelding with severe equine asthma (SEA) is experiencing an acute exacerbation of respiratory distress. Lead-in: Which of the following treatments would be the most appropriate first-line therapy in this case? Options: a) Intravenous prednisolone (1 mg/kg) b) Inhaled ciclesonide (343 µg/actuation) c) Intravenous dexamethasone (0.04-0.1 mg/kg) d) Nebulized clenbuterol (0.8 µg/kg) e) Oral clenbuterol (0.8 µg/kg)

Answer: c) Intravenous dexamethasone (0.04-0.1 mg/kg) Explanation: Intravenous dexamethasone is the most appropriate first-line therapy for acute exacerbations of severe equine asthma (SEA) due to its rapid onset of action and potent anti-inflammatory effects. Prednisolone is not licenced as an IV preparation.

Scenario: A 5-year-old Thoroughbred mare presents with a history of poor performance and exercise intolerance. A diagnosis of mild to moderate equine asthma (mEA) is made based on clinical signs and bronchoalveolar lavage (BAL) findings. Lead-in: Which of the following cytological profiles would be most consistent with this diagnosis? Options: a) 5% neutrophils, 2% eosinophils, 5% mast cells b) 20% neutrophils, 1% eosinophils, 2% mast cells c) 30% neutrophils, 1% eosinophils, 1% mast cells d) 5% neutrophils, 10% eosinophils, 2% mast cells e) 15% neutrophils, 1% eosinophils, 10% mast cells

Answer: a) 5% neutrophils, 2% eosinophils, 5% mast cells Explanation: Horses with mEA typically have BAL fluid with lower neutrophil percentages than those with severe equine asthma (SEA). The presence of mast cells and eosinophils can also be seen in some cases of mEA.

Scenario: An owner is concerned about the risk of her horse developing equine asthma. She asks for your advice on preventative measures. Lead-in: Which of the following management practices would be LEAST helpful in preventing equine asthma? Options: a) Keeping the horse outdoors as much as possible b) Feeding hay from a hay net c) Soaking hay before feeding d) Using dust-free bedding materials e) Ensuring good ventilation in the stable

Answer: b) Feeding hay from a hay net Explanation: Feeding hay from a hay net increases the horse's exposure to respirable dust and mold spores, which can trigger or worsen equine asthma.

Scenario: A 7-year-old Warmblood gelding with SEA is being treated with inhaled ciclesonide. The owner is concerned about potential side effects of the medication. Lead-in: Which of the following side effects is LEAST likely to occur with inhaled ciclesonide administration? Options: a) Laminitis b) Adrenal gland atrophy c) Immune suppression d) Hyperglycemia e) Delayed wound healing

Answer: d) Hyperglycemia Explanation: Inhaled ciclesonide is a corticosteroid with a high first-pass metabolism in the liver, which reduces the risk of systemic side effects. Hyperglycemia is not a typical side effect of ciclesonide

Scenario: A 12-year-old Thoroughbred mare with SEA is being managed with environmental modifications and inhaled corticosteroids. The owner reports that the mare's clinical signs have improved significantly, but she is still concerned about the long-term prognosis. Lead-in: Which of the following statements about the long-term management of SEA is most accurate? Options: a) Horses with SEA can be cured with appropriate management. b) Horses with SEA will eventually develop irreversible lung damage. c) Horses with SEA require lifelong management to control clinical signs. d) Horses with SEA should not be used for any athletic activities. e) Horses with SEA are at increased risk of developing other respiratory diseases.

Answer: c) Horses with SEA require lifelong management to control clinical signs. Explanation: SEA is a chronic condition that cannot be cured but can be managed effectively with environmental modifications and medication.

Scenario: A 5-year-old Quarter Horse gelding is diagnosed with mEA based on clinical signs and BAL fluid cytology. The owner is reluctant to use corticosteroids due to concerns about potential side effects. Lead-in: Which of the following treatment options would be the most appropriate alternative to corticosteroids in this case? Options: a) Systemic bronchodilators b) Nebulized bronchodilators c) Interferon-alpha d) Cromoglicate e) Omega-3 fatty acid supplementation

Answer: c) Interferon-alpha Explanation: Interferon-alpha has been shown to be effective in the treatment of mEA, particularly in reducing the relapse rate. Bronchodilators are ineffective without steroids.

Scenario: A 10-year-old Warmblood mare with SEA is being treated with oral clenbuterol. The owner reports that the mare's respiratory effort has decreased, but she is concerned about potential side effects of the medication. Lead-in: Which of the following side effects is most commonly associated with clenbuterol administration in horses? Options: a) Tachycardia b) Hypotension c) Laminitis d) Colic e) Hepatotoxicity

Answer: a) Tachycardia Explanation: Clenbuterol is a beta-2 adrenergic agonist that can cause tachycardia as a side effect.

Scenario: A 7-year-old Thoroughbred gelding with SEA is being managed with environmental modifications and inhaled corticosteroids. The owner reports that the gelding's clinical signs have been well controlled for the past year. Lead-in: Which of the following diagnostic tests would be most helpful in monitoring this gelding's response to therapy? Options: a) BAL fluid cytology b) Complete blood count c) Serum biochemistry profile d) Thoracic radiography e) Arterial blood gas analysis

Answer: a) BAL fluid cytology Explanation: BAL fluid cytology allows for the assessment of airway inflammation, which is a key indicator of disease activity in equine asthma.

Scenario: A 12-year-old pony mare with SEA is being treated with oral dexamethasone. The owner is concerned about the potential for the mare to develop laminitis as a side effect of the medication. Lead-in: Which of the following management practices would be most helpful in reducing the risk of laminitis in this mare? Options: a) Restricting the mare's access to pasture b) Increasing the mare's dietary intake of carbohydrates c) Administering prophylactic antibiotics d) Providing the mare with a soft, deep bedding e) Shoeing the mare with corrective shoes

Answer: a) Restricting the mare's access to pasture Explanation: Restricting access to pasture can help to reduce the risk of laminitis in horses receiving corticosteroids, as lush pasture can increase the risk of insulin dysregulation.

......................... is a glucocorticoid medication that is administered via inhalation and has minimal impact on cortisol levels.

Answer: Ciclesonide

In horses with mild to moderate equine asthma, ......................... have been shown to have a positive response to treatment and a decreased relapse rate.

Answer: Interferon Alpha.

......................... is the most effective first-line therapy for acute exacerbations of severe equine asthma.

Answer: Dexamethasone

......................... is a diagnostic test that can be used to monitor a horse's response to therapy for severe equine asthma by assessing airway inflammation.

Answer: BAL (Bronchoalveolar lavage)

Scenario: A 10-year-old Thoroughbred gelding presents with a history of intermittent, mild epistaxis from the left nostril. The episodes occur sporadically and are not associated with exercise. Lead-in: Which of the following diagnostic approaches would be LEAST helpful in identifying the underlying cause of this horse's epistaxis? Options: a) Endoscopy of the upper respiratory tract b) Radiography of the skull and sinuses c) Biopsy of any abnormal tissue identified in the nasal passages d) Bronchoalveolar lavage (BAL) and cytological examination e) Hematology and coagulation profile

Answer: d) Bronchoalveolar lavage (BAL) and cytological examination Explanation: BAL is primarily used to assess the lower airways and is unlikely to be helpful in diagnosing the cause of intermittent, mild epistaxis originating from the nasal passages. The other options are more relevant for investigating potential causes in the nasal cavity or sinuses.

Scenario: A 5-year-old Warmblood mare presents with acute onset, severe epistaxis from both nostrils. The bleeding started after the horse was kicked in the head by another horse in the field. Lead-in: Which of the following is the most likely source of this mare's epistaxis? Options: a) Ethmoid hematoma b) Guttural pouch mycosis c) Pulmonary hemorrhage d) Trauma to the nasal cavity e) Exercise-induced pulmonary hemorrhage (EIPH)

Answer: d) Trauma to the nasal cavity Explanation: Given the history of recent head trauma, the most likely source of epistaxis is damage to the nasal cavity itself. While the other options can cause epistaxis, they are less likely in this scenario.

Scenario: A 12-year-old Quarter Horse gelding presents with a history of recurrent, unilateral epistaxis from the right nostril. Endoscopy reveals a mass in the ethmoid region. Lead-in: Which of the following diagnostic tests would be most helpful in confirming the most likely diagnosis? Options: a) Biopsy of the mass b) Radiography of the skull c) Sinus trephination d) Guttural pouch endoscopy e) Computed tomography (CT) scan

Answer: a) Biopsy of the mass Explanation: A biopsy of the mass is essential to obtain a definitive diagnosis and guide treatment decisions. While the other options may provide additional information, they are not as crucial for confirming the diagnosis.

Scenario: A 7-year-old Thoroughbred mare presents with a history of severe epistaxis following a routine dental procedure. The bleeding is originating from the left nostril. Lead-in: Which of the following is the most likely cause of this mare's epistaxis? Options: a) Iatrogenic trauma to the nasal cavity b) Ethmoid hematoma c) Guttural pouch mycosis d) Pulmonary hemorrhage e) Exercise-induced pulmonary hemorrhage (EIPH)

Answer: a) Iatrogenic trauma to the nasal cavity Explanation: Given the history of a recent dental procedure, iatrogenic trauma to the nasal cavity is the most likely cause of the epistaxis. Dental procedures can sometimes cause damage to the nasal passages, leading to bleeding.

Scenario: An 8-year-old Warmblood gelding presents with a history of epistaxis and dysphagia. Endoscopy reveals blood in the pharynx and larynx. Lead-in: Which of the following diagnostic tests would be most helpful in identifying the source of this horse's bleeding? Options: a) Radiography of the skull b) Sinus trephination c) Guttural pouch endoscopy d) Computed tomography (CT) scan e) Ultrasonography of the neck

Answer: d) Computed tomography (CT) scan Explanation: A CT scan can provide detailed images of the bones and soft tissues of the head and neck, allowing for precise localization of the bleeding source in cases where endoscopy is inconclusive.

......................... is a common cause of epistaxis in horses, often presenting with intermittent, mild bleeding from one nostril.

Answer: Ethmoid hematoma

Scenario: A 6-year-old Thoroughbred racehorse presents with a history of exercise intolerance and poor performance. Auscultation reveals a grade III/VI holosystolic murmur with a point of maximal intensity (PMI) over the mitral valve. Lead-in: Which of the following diagnostic tests would be most helpful in confirming the suspected diagnosis and assessing the severity of the underlying condition? Options: a) Echocardiography b) Electrocardiography (ECG) c) Thoracic radiography d) Arterial blood gas analysis e) Cardiac troponin I measurement

Answer: a) Echocardiography Explanation: Echocardiography is the gold standard for diagnosing and assessing the severity of valvular heart disease, such as mitral regurgitation, which is suspected in this case based on the clinical findings.

Scenario: A 10-year-old Warmblood gelding presents with a history of mild epistaxis and exercise intolerance. Auscultation reveals a grade II/VI holodiastolic murmur with a PMI over the aortic valve. Lead-in: Which of the following is the most likely cause of this gelding's clinical signs? Options: a) Aortic regurgitation b) Mitral regurgitation c) Tricuspid regurgitation d) Ventricular septal defect e) Atrial septal defect

Answer: a) Aortic regurgitation Explanation: Aortic regurgitation is a common cause of holodiastolic murmurs in horses and can lead to exercise intolerance and, in some cases, epistaxis due to increased back pressure in the pulmonary circulation.

Scenario: A 12-year-old Quarter Horse mare presents with a history of poor performance and exercise intolerance. Auscultation reveals an irregularly irregular rhythm and a grade III/VI holosystolic murmur with a PMI over the mitral valve. Lead-in: Which of the following is the most likely cause of this mare's irregular rhythm? Options: a) Second-degree atrioventricular block b) Ventricular premature c) Atrial fibrillation depolarizations d) Sinus tachycardia e) Supraventricular tachycardia

Answer: c) Atrial fibrillation Explanation: Atrial fibrillation is the most common cardiac dysrhythmia in horses and often presents with an irregularly irregular rhythm and poor performance.

Scenario: A 7-year-old Thoroughbred gelding presents with a history of sudden death during exercise. Necropsy reveals a ruptured aorta. Lead-in: Which of the following is the most likely underlying cause of this gelding's aortic rupture? Options: a) Congenital heart defect b) Bacterial endocarditis c) Myocarditis d) Trauma e) a) Aortic aneurysm

Answer: e) Aortic aneurysm Explanation: Aortic aneurysms are a common cause of sudden death in horses, as they can weaken the vessel wall and lead to rupture, especially during strenuous exercise.

Scenario: A 5-year-old Warmblood mare presents with a history of exercise intolerance and poor performance. Auscultation reveals a grade II/VI holosystolic murmur with a PMI over the pulmonic valve. Lead-in: Which of the following is the most likely cause of this mare's murmur? Options: a) Physiological murmur b) Pulmonic regurgitation c) Aortic regurgitation d) Mitral regurgitation e) Tricuspid regurgitation

Answer: a) Physiological murmur Explanation: Physiological murmurs are common in horses, particularly young, athletic animals, and often have a PMI over the pulmonic valve. They are not associated with any underlying pathology and are usually benign.

Scenario: A 10-year-old Quarter Horse gelding presents with a history of collapsing episodes during exercise. Auscultation reveals a grade IV/VI holosystolic murmur with a PMI over the mitral valve and an irregularly irregular rhythm. Lead-in: Which of the following is the most likely cause of this gelding's collapsing episodes? Options: a) Aortic regurgitation and ventricular b) Mitral regurgitation and atrial fibrillation premature depolarizations c) Tricuspid regurgitation and second-degree atrioventricular block d) Ventricular septal defect and sinus tachycardia e) Atrial septal defect and supraventricular tachycardia

Answer: b) Mitral regurgitation and atrial fibrillation Explanation: Mitral regurgitation can lead to left atrial enlargement and dysfunction, which can predispose the horse to atrial fibrillation. The combination of mitral regurgitation and atrial fibrillation can cause significant exercise intolerance and collapsing episodes.

Scenario: A 12-year-old Thoroughbred gelding presents with a history of fever, lethargy, and anorexia. Auscultation reveals a grade IV/VI holosystolic murmur with a PMI over the mitral valve and an irregularly irregular rhythm. Lead-in: Which of the following is the most likely cause of this gelding's clinical signs? Options: a) Bacterial endocarditis b) Myocarditis c) Pericarditis d) Aortic aneurysm e) Congenital heart defect

Answer: a) Bacterial endocarditis Explanation: Bacterial endocarditis is an infection of the heart valves that can cause fever, lethargy, anorexia, and a new or worsening heart murmur. The irregular rhythm suggests possible concurrent atrial fibrillation, which can be a complication of endocarditis. Pyrexia is the big clue!

Scenario: A 7-year-old Warmblood mare presents with a history of exercise intolerance and poor performance. Auscultation reveals a grade III/VI holodiastolic murmur with a PMI over the aortic valve. Lead-in: Which of the following treatment options would be most appropriate for this mare? Options: a) No treatment is necessary at this time b) Oral quinidine sulfate c) Intravenous lidocaine d) Pericardiocentesis e) Surgical valve replacement

Answer: a) No treatment is necessary at this time Explanation: Mild to moderate aortic regurgitation is often well-tolerated in horses and does not require treatment. The mare should be monitored regularly for any signs of worsening heart function or exercise intolerance.

Scenario: A 3-year-old Standardbred filly presents with a history of poor performance and exercise intolerance. Auscultation reveals a grade III/VI continuous murmur with a PMI on the right side but audible on both sides of the chest. Lead-in: Which of the following is the most likely cause of this filly's murmur? Options: a) Ventricular septal defect b) Aorto-pulmonary fistula c) Patent ductus arteriosus d) Aorto-cardiac fistula e) Atrial septal defect

Aorto-cardiac fistula Explanation: Aorto-cardiac fistulas are a rare but serious congenital defect that creates an abnormal connection between the aorta and a cardiac chamber, typically the right atrium or ventricle. This results in a continuous murmur that is often louder on the right side of the chest.

Scenario: A 12-year-old Thoroughbred gelding presents with a history of exercise intolerance and poor performance. Auscultation reveals an irregularly irregular rhythm and a grade III/VI holosystolic murmur with a PMI over the mitral valve. Lead-in: Which of the following treatment options would be most appropriate for this gelding? Options: a) Quinidine sulfate PO b) Intravenous lidocaine c) Pericardiocentesis d) Surgical valve replacement e) No treatment is necessary at this time

Answer: a) Quinidine sulfate PO Explanation: Quinidine sulfate is an antiarrhythmic drug that can be used to convert atrial fibrillation to a normal sinus rhythm.

Scenario: A 7-year-old Warmblood mare presents with a history of fever, lethargy, and anorexia. Auscultation reveals a grade IV/VI holosystolic murmur with a PMI over the mitral valve and an irregularly irregular rhythm. Lead-in: Which of the following diagnostic tests would be most helpful in confirming the most likely diagnosis? Options: a) Thoracic radiography b) Echocardiography c) Blood culture d) Arterial blood gas analysis e) Cardiac troponin I measurement

Blood culture Explanation: Blood cultures are essential for confirming a diagnosis of bacterial endocarditis, which is suspected in this case based on the clinical signs and auscultation findings.

Scenario: A 7-year-old Warmblood mare presents with a history of fever, lethargy, and anorexia. Auscultation reveals a grade IV/VI holosystolic murmur with a PMI over the mitral valve and an irregularly irregular rhythm. Lead-in: Which of the following treatment options would be most appropriate for this mare? Options: a) Amoxicillin PO. b) Oral quinidine sulphate c) Intravenous lidocaine d) Ampicillin IV e) Surgical valve replacement

Ampicillin IV would be the best initial treatment until culture and sensitivity can be obtained. Explanation: Bacterial endocarditis is suspected in this case, and treatment requires appropriate antibiotic therapy based on culture and sensitivity results.

Scenario: A 10-year-old Quarter Horse gelding presents with a history of collapsing episodes during exercise. Auscultation reveals a grade IV/VI holosystolic murmur with a PMI over the tricuspid valve. Lead-in: Which of the following is a potential complication of this gelding's condition? Options: a) Septic emboli to the lungs b) Myocardial infarction c) Pericardial effusion d) Aortic aneurysm e) Congenital heart defect

Answer: a) Septic emboli to the lungs Explanation: Right-sided endocarditis, which can occur with tricuspid valve infections, can lead to the formation of septic emboli that travel to the lungs, causing pneumonia or abscesses.

......................... is the most common cause of sudden death during exercise in horses, accounting for around 30% of cases.

Answer: Vascular rupture

......................... is the most important clinical sign to evaluate in a horse with pericardial disease.

Answer: Venous distension

You obtain the following ECG from an equid. Based off of this, what is the most appropriate course of action? a) Lidocaine IV. b) DC cardioversion. c) Do nothing. d) Quinidine sulphate conversion. e) Atropine IV.

c) The ECG shows 2nd degree AV block, which is considered normal in horses due to their high vagal tone.

You obtain the following ECG from an equine that frequently collapses during work. What is the most appropriate next step? a) Lidocaine IV.

This ECG is typical with sustained atrial fibrillation. DC cardioversion is the best treatment choice.

You obtain the following ECG from buster. What is the most likely diagnosis? a) Atrial fibrillation. b) Ventricular flutter. c) Atrial flutter. d) Ventricular tachycardia. e) 3rd degree AV block.

d) V, tach.

You obtain this ECG. What is the most appropriate treatment: a) Pimobendane IM b) Frusemide IV c) Magnesium IV d) Potassium IV e) Calcium IV.

This is V tach and from the treatment choices given, only magnesium is a treatment for V tach.

You obtain the following ECG. What is the diagnosis? a) Ventricular tachycardia. b) Atrial flutter. c) Ventricular flutter. d) Tosardes de points e) Ventricular fibrillation

d) Tosardes de points as there is a wandering baseline.