Clinical Examination Flashcards
What further diagnostics can be used to investigate respiratory disease?
Endoscopy
Respiratory function tests
Laboratory and clinical pathology
Imaging
What history factors should you consider during a respiratory case?
Herd or individual problem? Neonate, juvenile or adult? Performance, pleasure or production? Management and environment Disease time course and features Response to treatment Cough specifics
What should you ask when presented with a coughing patient?
Type - soft productive
- harsh, dry, unproductive
- honking
Frequency
- all the time?
- Exercise / excitement
- paroxysmal
- pulling on lead?
What should you observe from a distance in a coughing patient?
General behaviour and demeanour Respiratory rate, effort and pattern Inspiration and expiratory noise Nostril flare Bilateral nostril airflow Noise - Sterter, honking, roaring, whistling
What should you look at during a general clinical examination?
BCS Posture Abdominal effort Hypertrophy of abdominal muscles Mucous membranes Eyes Jugular veins Pectoral oedema
What should you look for in the nares and nasal passages?
Airflow obstruction
Discharges
How can you assess the paranasal sinuses in horses?
FACIAL SYMMETRY
Percussion
What can be assessed in the pharyngeal area in horses?
Gutteral pouches - swelling
Lymph nodes - enlargement, discharge
Larynx
- asymmetry of cricoarytenoideus dorsalis muscle
- movement in response to slap over withers
What can be assessed in the pharyngeal area of other species?
Lymph nodes - size, discharge
What does radiating heart sounds in equines indicate?
Pleural effusion
In what animals would you expect to be able to hear louder sounds on thoracic auscultation?
Foals
Thin animals
How reliable is thoracic auscultation in small animals?
Not very - absence of sounds doesn’t mean absence of disease
What do crackles indicate?
Small airways and alveoli
What do wheezes indicate?
Partial obstruction of larger airways
How can palpation of the apex beat be useful?
Shifting of apex beat is likely to indicate displacement of the heart, probably due to a space occupying lesion
What could cause epistaxis in a 13 year old eventing horse?
Infection Inflammation Trauma Degenerative disease Neoplasia Congenital/developmental Multifactorial
What infection could cause epistaxis in a 13 year old eventing horse?
Nasal aspirgillosis
Sinusitis
Gutteral pouch mycosis
What inflammation could cause epistaxis in a 13 year old eventing horse?
Lower airway disease
What trauma could cause epistaxis in a 13 year old eventing horse?
Nasal/pharyngeal trauma
Nasal/pharyngeal foreign body
What degenerative disease could cause epistaxis in a 13 year old eventing horse?
Mitral insufficiency
What neoplasia could cause epistaxis in a 13 year old eventing horse?
Sinus neoplasia
Ethmoid haematoma
Pulmonary neoplasia
What congenital abnormality could cause epistaxis in a 13 year old eventing horse?
Sinus cyst
What multifactorial disease process could cause epistaxis in a 13 year old eventing horse?
Atrial fibrillation
EIPH
What can you visualise with equine endoscopy?
Nasal passages Guttural pouch Nasopharynx Soft palate Larynx Trachea
When can endoscopy be performed in horses?
At rest - standing restrained and/or sedated
Exercise - treadmill or dynamic endoscopy
What techniques can be aided by endoscopy in horses?
Tracheal aspirate
BAL
Biopsy
Foreign Body retrieval
What can endoscopy be used to visualise in small animals?
Trachea
Mainstem bronchi
Larger divisions of main bronchi
Smaller airways NOT accessible
What are the requirements for endoscopy in small animals?
Able to tolerate GA
Sufficient diameter of trachea (>5mm)
