Clinical examination and investigation of respiratory disease Flashcards

Question

Endoscopically-Guided Tracheal Aspirate: Equine

Answer 1

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

Answer 2

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

Answer 3

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

Answer 4

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

Answer 5

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

Answer 6

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

Answer 7

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

Answer 8

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

Answer 9

``` (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 ```

Answer 10

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

Answer 11

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

Answer 12

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

Answer 13

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

Answer 14

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

Answer 15

Use ultrasound or fluoroscopic guidance | Incr morbidity + mortality of unguided aspirates means these are saved for the most seriously ill patients

Answer 16

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

Answer 17

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

Answer 18

Parasite larvae - Angiostrongylus vasorum

Answer 19

pulmonary pleural cavity mediastinum

Answer 20

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.

Answer 21

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.

Answer 22

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