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Respiratory > Clinical examination and investigation of respiratory disease > Flashcards

Clinical examination and investigation of respiratory disease Flashcards

1
Q

history + signalment

A 
Herd or individual problem 
Neonate, juvenile, or adult 
Performance, pleasure, or production 
Management and environment 
Disease time course and features 
Response to treatment
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2
Q

cough description

A

type (non/productive)

frequency

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3
Q

observe from a distance - what to look for

A

general behaviour and demeanour
Respiratory rate, effort and pattern
inspiratory and expiratory noise

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4
Q

general clinical exam

A 
Body condition 
Posture 
Abdominal effort 
Hypertrophy of abdominal muscles 
Mucous membranes 
Eyes 
Jugular veins 
Pectoral oedema
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5
Q

specific clinical exam

A

Nares and Nasal Passages
airflow obstruction
Discharges

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6
Q

paranasal sinuses - horse

A

Looking for facial symmetry

Percussion

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7
Q

pharyngeal area

A 
Guttural Pouches (Horse) - swelling 
Lymph nodes - enlargement, discharges 
Larynx (Horse) - Asymmetry of cricoarytenoideus dorsalis muscle - Movement in response to slap over withers
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8
Q

Equine Thoracic Auscultation and Percussion

A 
Quiet room 
Just audible in adult horse 
Louder in foals and thin animals 
Absence of noise - consolidation 
Radiating heart sounds with pleural effusion
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9
Q

Ruminant Auscultation and Percussion area

A

6th intercostal space - point of the elbow
9th intercostal space - midway
11th - level with the tuber coxae
diaphragmatic border - straight

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10
Q

Auscultation - Small Animals

A

Not a reliable indicator of respiratory disease
Absence of sounds does not imply absence of disease
Usually significant if respiratory noise increased
Beware of referred noise from the URT
Differentiate crackles and wheezes

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11
Q

Auscultation - Small Animals - Crackles

A

likely to indicate small airways and alveoli

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12
Q

Auscultation - Small Animals - Wheezes

A

partial obstruction of larger airways

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13
Q

Apex Beat (SA) - shifting

A

displacement of the heart - probably due to a space occupying lesion

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14
Q

Endoscopy - Equine

A

At rest – standing restrained animal +/- sedation
Exercise – treadmill or dynamic endoscopy
Techiques - Tracheal aspirate, BAL, Biopsy, FB retrieval

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15
Q

endoscopy - equine - what to see

A 
Nasal passages 
Guttural pouch 
Nasopharynx 
Soft palate 
Larynx 
Trachea
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16
Q

Endoscopy in Small Animals - what is accessible

A

Trachea
Mainstem bronchi
Larger divisions of main bronchi
Smaller airways not accessible

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17
Q

Endoscopy - Small Animals

A

Patient able to tolerate general anaesthesia
Sufficient diameter of trachea to accommodate the endoscope (> 5mm)
Take radiographs before endoscopy
Artefact following washes
Place patient in sternal recumbency
Examine airways in systematic fashion

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18
Q

endoscopy - small animals - most useful cases

A

Diseases of major airways - Bronchitis, Parasitic bronchitis
Dynamic disease of the upper airway - Tracheal + Bronchial collapse, Consider also fluoroscopy

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19
Q

endoscopy - small animals - weaknessess

A

Unable to visualise smaller airways - Asthma

Unable to visualise parenchymal lesions - Solitary lung masses, Diffuse alveolar disease

20
Q

Techniques Possible via endoscope

A

Aspiration of samples - Tracheal wash, Guided bronchoalveolar lavage, Cytology brushes
Biopsy of discrete lesions
Retrieval of foreign bodies

21
Q

viral infection diagnosis

A

Paired serology
Virus isolation from buffy coat
Virus isolation from nasopharyngeal swabs
Viral antigen detection by FAT or ELISA from nasopharyngeal swabs
PCR to identify RNA/DNA of specific viruses

22
Q

how to obtain Samples for Cytology and/or Bacterial Culture

A 
Nasopharyngeal swab 
Guttural pouch lavage (horse) 
Endoscopically guided tracheal aspirate 
Transtracheal aspirate 
Bronchoalveolar lavage 
Pleural fluid 
Lung biopsy
23
Q

Nasopharyngeal Swab

A

bacterial culture of specific organisms that are not normal comensals of the pharynx
e.g. Streptococcus equi equi

24
Q

Guttural Pouch Lavage: Equine

A 
Endoscope within GP 
Plastic tubing via biopsy port 
Aspirate mucopurulent discharge 
Lavage both pouches and re-aspirate fluid 
GP has commensal organisms 
Streptococcus equi - Culture, PCR
25
Q

Endoscopically-Guided Tracheal Aspirate: Equine

A

Position endoscope at thoracic inlet
Advance catheter and insert 30 mls sterile (buffered) saline
Withdraw sample
Post-exercise?

26
Q

Endoscopically-Guided Tracheal Aspirate: Small Animals

A

General anaesthesia
Go via ET tube - Not in cats, pull tube first
Blind wash
Use plastic tube via ET tube

27
Q

Endoscopically-Guided Tracheal Aspirate - advantages

A

easy to perform
non-invasive
sample is representative of the whole lung

28
Q

Endoscopically-Guided Tracheal Aspirate - disadvantages

A

sample is contaminated by pharygneal flora (horse)
sample can be contaminated by equipment
wide range in normal cell populations
cells poorly preserved

29
Q

Transtracheal Aspirate (Horse) - method

A

Surgically prepare site in lower third of the
trachea
Local anaesthetic
Insert guide catheter (10 gauge, 3 inch) or needle between tracheal rings
Insert sample catheter (16-14 gauge, 30 cm)
Insert 25 - 30 mls sterile saline
Withdraw sample
Remove sample catheter
Remove guide catheter last to avoid contamination of subcutaneous tissues

30
Q

Transtracheal Aspirate - advantages

A

no pharyngeal contamination
no specialised equipment
useful in young foals where standard endoscopes are too large

31
Q

Transtracheal Aspirate - disadvantages

A

horse may cough catheter into pharynx and contaminate sample
invasive - cellulitis + subcutaneous emphysema

32
Q

Trans-tracheal wash - Small Animals - Indications

A

Collection of tracheal secretions where endoscopy not available - Anaesthesia contra-indicated
Direct access to airway in conscious patient

33
Q

Bronchoalveolar Lavage (Horse)

A 
(Insert guide catheter into trachea) 
Advance BAL tube into bronchus until it will not advance further 
(Inflate balloon) 
Insert 120 - 200 mls sterile saline 
Withdraw sample
34
Q

Bronchoalveolar Lavage (Horse) - advantages

A

sample obtained from the area of tract that is most likely to be affected by e.g. EIPH, COPD
narrow range of cell populations aids interpretation
equipment cheap and accessible therefore used in all large animal species

35
Q

Bronchoalveolar Lavage (Horse) - disadvantages

A

site may not be appropriate in animals with localised pulmonary abscesses or pneumonias

36
Q

Thoracocentesis: Equine

A

Select site in seventh or eight intercostal space, above lateral thoracic vein
surgical preparation and local anaesthesia
stab incision
blunt teat cannula or drain closed from atmosphere

37
Q

Thoracocentesis: Small Animal

A

Cranial or caudal to heart
Site determined by radiography or ultrasound guidance
If fluid evenly distributed then rib-spaces 8 or 9 on either side
Use local anaesthesia (not in cat)
Closed system
catheter/needle, fluid extension set, Three way tap, large volume syringe

38
Q

lung aspiration - indications

A

Where a discrete intrapulmonary abnormality exists or where there is diffuse disease that cannot be accessed in any other way an aspirate of the lung may be appropriate

39
Q

lung aspiration

A

Use ultrasound or fluoroscopic guidance

Incr morbidity + mortality of unguided aspirates means these are saved for the most seriously ill patients

40
Q

lung biopsy - advantages

A

not frequently performed
used for identification of specific forms of pathology
e.g. interstitial pneumonia, neoplasia

41
Q

lung biopsy - disadvantages

A

very invasive - Thoracotomy/thoracoscopy
painful
complications include - uncontrollable haemorrhage, pneumothorax

42
Q

faecal exam - small animals

A

Parasite larvae - Angiostrongylus vasorum

43
Q

Thoracic Radiography

A

pulmonary
pleural cavity
mediastinum

44
Q

Computed Tomography (CT) - small animals

A

Useful for pleural, mediastinal + parenchymal
structures.
High image quality of detailed sectional anatomical structure.
Cheaper and quicker and better detail of lung tissue than MRI
Does not require gating for respiration like MRI.
Radiation exposure unlikely to be an issue in our patients.

45
Q

Thoracic Ultrasonography

A

Sound does not penetrate normal aerated lung
Sound will penetrate non-aerated (diseased) lung
Lesions that do not extend to the surface of the lung are not visible
Extremely useful for characterising pleural effusion
Can be used to obtain samples - pleurocentesis, lung biopsy etc.

46
Q

pulomary function tests - equine

A 
Track exercise tests 
Treadmill exercise tests 
Oesophageal manometry 
Flow-volume loops 
Oxygen uptake 
Blood gas analysis

Respiratory (21 decks)

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