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RUSVM LAM1 > Cough/ Nasal discharge > Flashcards

Cough/ Nasal discharge Flashcards

1
Q

What is the physiology of cough?

A

Cough reflex removes secretions from the tracheobronchial tree promise to the level of the segmental bronchi

Mucociliary escalator => Continuous waves of ciliary motion that start at the level of the bronchioles

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2
Q

What is the neural pathway initiating cough?

A

Involuntary reflex - involve sensory receptor through tracheobronchial tree —> predominantly vagal nerve

Voluntary

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3
Q

T/F: irritants can trigger both bronchoconstriction and cough and bronchoconstriction is a constant component of cough

A

True

Both work through separate reflexes though

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4
Q

What can stimulate a cough?

A

Bronchoconstriction

Excessive mucous production

Deposition of inhaled particles

Release of inflammatory mediator (infectious disease)

Exposure to hot or cold air

Intramural or extramural pressure (tumor, fibrosis, pleural effusion)

Sloughing of airway epithelium (eg smoke inhalation)

Enhanced epithelial permeability

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5
Q

The mucociliary mechanism is made up of a pseudostratified columnar epithelium, how long does this take to regenerate when damaged? How does this relate to resolution of clinical signs?

A

7weeks
If clinical signs do not resolve right away it could be because of the time it takes to regenerate
ESP with viral conditions —> kills epithelium

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6
Q

What cells secrete surfactant like substances that aids in maintaining patency of airway?

A

Clara cells

Metabolize airbone toxins

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7
Q

What do premature foals lack that can cause them to suffer from pleuropneumonia ?

A

Clara cells

Lack of surfactant keeps the airway open

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8
Q

Decreased mucociliary clearance can be caused by?

A 
Decreased cell number 
Mucous plug 
Dehydration 
Irritant gases 
Dust 
Cold weather 
Anesthetic
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9
Q

What will you do as part of your PE on a coughing animal?

A

Auscultation HR

Increase HR, RR, RE and fever

Nasal discharge

  • mucopurulent
  • anaerobic bacteria: associated with foul smell

Palpate the thoracic wall

  • pleura friction rubs
  • fractured ribs

Rebreathing exam

  • inhalation of expired CO2
  • Eupnea and hyperpnea
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10
Q

When listening to lung sounds, increased lung sounds with crackles and wheezes indicate?

A

Pneumonia

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11
Q

On auscultation of the lungs, a ventral dull sounds may indicate??

A

Pleuropneumonia

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12
Q

What is the DDX for cough with fever?

A

Infectious

Secondary to non-infectious condition

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13
Q

What is the DDX for coughing with no fever?

A 
RAO 
Larynx or pharyngeal abnormality 
Parasitic 
EIPH 
Foreign body 
Neoplasia 
Trauma
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14
Q

What is the peracute clinical manifestation of pleuropneumonia?

A 
Fever
Depression
Anorexia
Pleuodynia : smiler signs to colic (abducted elbow, laminitic, weight losss) 
Cough may not be present 
Lung sounds may be normla 
Hyperpnea 
Weight loss (catabolic, decreased appetite)
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15
Q

What are the viral respiratory diseases that can cause a pneumonia?

A 
Equine influenza 
Equine herpes 1 and 4 
Equine viralarteritits 
Equine adenovirus 
Equine rhinovirus 
Hendra virus
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16
Q

A young horse with high fever, cough, and lameness. You ruled out laminitis with hoof testers..

What is your DDX

A

Both
Equine influenza and equine herpes virus cause respiratory problems and a polysynovitis

EHV can also have conjunctivitis, lymphadenopathy, edema, and vasculitis

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17
Q

What systems do EHV1 and EHV4 affect?

A

EHV1: respiratory and neurologic

EHV4: respiratory and reproductive

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18
Q

What virus causes respiratory disease, abortions and foal pneumonia but most infections are Subclinical

A

Equine viral arteritis

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19
Q

Who is most likely to be infected with equine adenovirus

A

Immunopcompromised foals (SCID)

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20
Q

It is late winter-early spring, and a young horse presents with nasal discharge, laryngitis, and mild bronchitis..

What would be you top ddx?

A

Equine rhinovirus

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21
Q

What viral disease causes febrile illness, facial swelling, head pressing, and recumbency and can also be zoonotic

A

Hendra virus

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22
Q

What are the aerobic bacteria that can cause a pneumonia?

A 
Strep zooepidemicus 
Staph aureus 
Actinobacillus equuli 
Pasturella 
E. Coli 
Klebsiella pneumoniae 
Pseudomonas 
Rhodococcus equi
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23
Q

What are the anaerobic bacteria that can cause pneumonia ?

A

Bacteroides fragilis

-common in horses with physiologic stress, including transportation, exercise, and viral infection

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24
Q

Parasitic infection of horses lungs?

A

Dictylocaulus arnfildi (lung worm )

Parascaric equorum (roundworm) — migrate through lung during PPP

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25
Q

In what environment are you more likely to see a primary fungal pneumonia?

A

Dry and dusty

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26
Q

Stress is a major contributor for bacterial pneumonia/pleuropneumonia.. what are some stressors in a horse?

A

Transportation — head elevated can compromise mucociliary clearance/ dehydration can decrease secretions

Exercise —increase in peripheral neutrophil function and oxidative burst of alveolar macrophages

Anesthesia — cuff pressure to high (tracheal necrosis, dorsal recumbency cause atelectasis , anesthetics cause depression of resp defense mechanisms

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27
Q

What can be the EDX of aspiration in a horse?

A

Stomach tube - with mineral oil

Choke

Laryngeal hemiplegia

Dysphagia 
— neonatal encephalopathy 
— botulism 
— guttural pouch disease 
— strangles
28
Q

Severe bronchoconstriction
Pseudomonas cast
Carboxyhmeoglobin >10%

What is the EDX?

A

Smoke inhalation

29
Q

What is the most common primary lung tumor in horse?

A

Glandular cell

DDX:
Pulmonary chondrosarcoma

30
Q

What virus is associated equine multinodular pulmonary fibrosis

A

EHV5

31
Q

How does equine multinodular pulmonary fibroisis?

A

Exercise intolerance

Acute respiratory distress

32
Q

What type of pattern is present on rads that would be consistent with equine multinodular pulmonary fibroisis?

A

Diffuse bronchointerstitial pattern with multiple coalescing circular nodules throughout the lung field

33
Q

Horse presents ..

Thin, dull attitude, poor hair coat 
Tachypnea 
Increased RE and RR 
Abnormal lung sounds 
Occasional dry cough 
Increased WBC 
Increased firbrinogen

What is your ddx?

A

Infectious pneumonia

Viral
Bacterial
Fungal
Parasitic

34
Q

Horse presents ..

Thin, dull attitude, poor hair coat 
Tachypnea 
Increased RE and RR 
Abnormal lung sounds 
Occasional dry cough 
Increased WBC 
Increased firbrinogen

What diagnostic tests can you do?

A

Rads

US

35
Q

Horse presents ..

Thin, dull attitude, poor hair coat 
Tachypnea 
Increased RE and RR 
Abnormal lung sounds 
Occasional dry cough 
Increased WBC 
Increased firbrinogen

Rads- diffused bronchointerstitial pattern with multiple coalescing circular nodules
US- multiple circular hypoechoic masses

DX?

A

Equine multinodular pulmonary fibroisis

36
Q

Proposed treatments of EMPF?

A

Corticosteroids
NSAIDS

Antiviarals — meh, questionable if it works (depends on budget)
Bronchodilators - meh

Oxygen supplementation usually not beneficial because gas exchange cannot occur

Antifibrotic agents
Immune modulators

37
Q

What can be the cause of foal pneumonia in an animal less than 1month and what are the infectious organisms involved?

A

In utero or perinatal infection
Aspiration - meconium, reflex, from nasogastric tube

Surfactant inactivation

Adenovirus (SCIDS)
EVA, EHV1, EHV4
—> can lead to secondary bacterial infection

38
Q

What can be the cause of foal pneumonia in an animal that is 1-6months and what are the infectious organisms involved?

A 
Strep equi zooepidemicus 
Rhodococcus equi (chronic —> abscess formation)

Respiratory viruses are often the primary agents (EVA, EHV)

39
Q

T/F: hyperfribinogenemia and neutropenia reflect an acute process

A

True

40
Q

What does a neutrophilia anemia indicate in a case of pneumonia? What is it is a left shift neutropenia??

A

Chronic

Left shift= very bad prognosis

41
Q

Horse presents with
Symmetric airflow from lungs
Expiratory
Abnormal lung sounds

There is cough but and mucopurulent discharge (bilateral)
Temp is normal
Abnormal lung sounds

What would be your DDX?
What would be your next step diagnostically?

A

Non- infectious lower airway disease

No fever— infectious causes are unlikely

DDX: 
Equine asthma (inflammatory airway obstruction or Recurrent airway obstruction)

Smoke inhalation

Neoplasia (granular cell tumor or pulmonary chondrosarcoma)
Equine multinodular pulmonary fibrosis (associated with EHV5)

Diagnostics:
Endoscopy—> should see pseudomembranous cast with smoke inhalation
BAL
Rads and US for neoplasia or EMPF

42
Q

Adult horse presents with..

Intermittent cough
Serous/mucous bilateral nasal discharge
Symmetrical nasal flow
Abnormal lung sounds : crackles and wheezes
Temp: high

What is your DDX
What further diagnostics will you do?

A

Infectious lower airway disease

DDX: 
Pneumonia/ pleuropneumonia 
—> Bacterial 
—> fungal 
—> parasitic 
—> viral (equine viral arteritis, most other resp viruses affect young horses)

CBC— infectious would have neutrophilia and hyperfibrinogenemia (left shift => bad prognosis)
Transtracheal wash — culture

43
Q

Young horse in a breeding facility..

Has bilateral serous/mucoid discharge
Symmetrical nasal air flow
Cough
Abnormal lung sounds

What is your top DDX and what further diagnostics would you do ?

A

Infectious lower respiratory tract disease

Foal pneumonia
— rhodococcus
—streptococcus equi zooepidemicus

CBC - neutrophilia and hyperfibrinogenemia ( much higher in cases of rhodococcus )
Ultrasounds — pleural abnormalities
Rads — lung consolidation
TTW — culture and cytology (neutorphils)

44
Q

Following a race…

An older horse presents with bilateral epistaxis

What would be your differentials??
What would you do next diagnostically?

A

Exercise induced pulmonary hemorrhage

Trauma
Ethmoid hematoma
Guttural pouch myositis

Pulmonary abscess rupture
Coagulopathy

Endoscopy
EIPH —> +/- blood in trachea
Ethmoid hematoma —> mass in nasal cavity
Guttural pouch myosis —> visualize plaque in pouch
Trauma ( usually by history)

45
Q

Horse presents with
Symmetric airflow from lungs
Expiratory
Abnormal lung sounds

There is cough but and mucopurulent discharge (bilateral)
Temp is normal
Abnormal lung sounds

Endoscopy shows some tracheobronchial mucus
BAL shows.. 
neutrophils >10%
masts > 5%
Eos >5%

What is your dx?

A

Inflammatory airway disease

=> clinical signs are not severe enough and neutrophils not high enough for recurrent obstructive airway disease (25%)

46
Q

Horse presents with
Symmetric airflow from lungs
Expiratory
Abnormal lung sounds

There is regular and frequent cough but and mucopurulent discharge (bilateral)
Temp is normal
Abnormal lung sounds and increase respiratory effort
Inappetence and weight loss

Endoscopy shows some tracheobronchial mucus
BAL shows..
neutrophils >25%

What is your dx?

A

Recurrent airway obstruction

47
Q

What is the treatment for inflammatory airway disease?

A

Environmental
Decrease airborne dust, bedding, and feed

Anti-inflammatories

48
Q

What is the treatment for recurrent airway obstruction??

A

Environmental
Reduced dust, bedding
Increase ventilation

Anti-inflammatories

  • > corticosteroid (prednisolone or dexamethasone)
  • > triamcinolone acetonide and isoflupredone
  • > fluticasone propionate
  • > dedomethasone

Bronchodilators
-> anticholinergic (atropine - careful can cause ileus)

  • > phosphodiesterase inhibitors
  • > B2-agonists (clenbuterol - increase intracellular cAMP and cause smooth muscle relaxation, also some anti-inflammatory properties)
49
Q

What are the aerobic bacteria that ca cause a pneumonia?

A 
Strep zooepidemicus 
Staph aureus 
Actinobacillus equi 
E.coli 
Klebsiella 
Pseudomonas 
Rhodococcus equi
50
Q

What anaerobic bacteria cause a pneumonia?

A

Bactericides fragillis

51
Q

What are the lung worms that can cause a pneumonia?

A

Dictylocaulus arnfeldi

Parascaris equorum

52
Q

What are the theories for cause of EIPH?

A

Capillary rupture theory - stress failure of vessel wall where pulmonary capillary vessels increase and rupture

Lower airway inflammatory theory
Previous dz has damaged airway causing weak areas of fibrosis

Concussive lung injury theory
Impact of hoof on ground transmitted to lung causing shearing in caudodorsal lung

53
Q

How would you grade this EIPH?

Flecks of blood or a short narrow line

A

Grade 1

54
Q

How would you grade this EIPH??????????

Multiple distinct streams covering >1/3 of trachea?

A

Grade 3

55
Q

How would you grade this EIPH?

Multiple coalescing streams covering >90% of trachea

A

Grade 4

56
Q

What is the treatment for EIPH?

A

Furosemide

Controversial because it causes loss of weight and better racing times

Nasal strip (flair)

57
Q

Young horse presents for

Unilateral serous nasal discharge
Temp high
No abnormal lung sounds

What are your top DDX
What diagnostics would you do next?

A

Infectious upper respiratory disease

Viral
Infectious sinusitis

Culture and sensitivity
PCR

58
Q

What are the possible clinical presentations of strangles?

A 
Pneumonia 
Pleuropneumonia 
Guttural pouch empyema 
Weight loss 
Colic of other causes
59
Q

You have a horse that presents with

High fever and depression
Purulent-yellow-green discharge
Respiratory distress

Swelling of the submandibular and retropharygenal lymph nodes

Top DDX?

A

Strangles

Infectious cause = streptococcus equi var equi causes the high fever

Swelling of the retropharyngeal lymph nodes can lead to respiratory distress

60
Q

What is the aseptic vasculitis associated with strangles in mature horses called?

A

Purpura hemorrhagica

61
Q

What respiratory diseases are associated with purpura hemorrhagica ??

How do you treat this?

A

Influenza
Strangles

Purpura hemorrhagica is treated with corticosteroids

62
Q

What is bastard strangles???

A

Systemic manifestation of strangles

Mets to lymphnodes throughout body —> lungs, mesentery, liver, spleen, kidney, and brain

Ocular
Endocarditis
Suppurative necrotic bronchopneumonia

63
Q

What is the treatment for bastard strangles?

A

No complications — best to let dz run its course
Accelerate maturation of abscesses and provide drainage

Long term antimicrobial therapy (complicated disease)

Biosecurity

  • isolate
  • monitor for feverr
  • quarantine until no postive results

Vaccination

64
Q

What specific tests can you do to diagnose bastard strangles?

A

Anti-strep antibody titer
SeM specific ELISA

Serum amyloid A (can help distinguish which animals to give antibiotics — if high)

65
Q

What immune-mediated complications can arise from strangles?

A

Purpura hemorrhagica
Myositis
Glomerulonephritis
Myocarditis

66
Q

What are the EDX for foal pneumonia?

A

Strep zooepidemicus

Actinobacillus equi

67
Q

How do you treat foal pneumonia?

A

Depends on degree of pneumonia

  • gram pos
  • gram neg

Bronchodilators
Fluid therapy
Anti inflammatory
Nebulization

RUSVM LAM1 (17 decks)

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