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Cough/ Nasal discharge Flashcards

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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
In what environment are you more likely to see a primary fungal pneumonia?
Dry and dusty
26
Stress is a major contributor for bacterial pneumonia/pleuropneumonia.. what are some stressors in a horse?
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
27
What can be the EDX of aspiration in a horse?
Stomach tube - with mineral oil Choke Laryngeal hemiplegia ``` Dysphagia — neonatal encephalopathy — botulism — guttural pouch disease — strangles ```
28
Severe bronchoconstriction Pseudomonas cast Carboxyhmeoglobin >10% What is the EDX?
Smoke inhalation
29
What is the most common primary lung tumor in horse?
Glandular cell DDX: Pulmonary chondrosarcoma
30
What virus is associated equine multinodular pulmonary fibrosis
EHV5
31
How does equine multinodular pulmonary fibroisis?
Exercise intolerance Acute respiratory distress
32
What type of pattern is present on rads that would be consistent with equine multinodular pulmonary fibroisis?
Diffuse bronchointerstitial pattern with multiple coalescing circular nodules throughout the lung field
33
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?
Infectious pneumonia Viral Bacterial Fungal Parasitic
34
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?
Rads | US
35
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?
Equine multinodular pulmonary fibroisis
36
Proposed treatments of EMPF?
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
What can be the cause of foal pneumonia in an animal less than 1month and what are the infectious organisms involved?
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
What can be the cause of foal pneumonia in an animal that is 1-6months and what are the infectious organisms involved?
``` Strep equi zooepidemicus Rhodococcus equi (chronic —> abscess formation) ``` Respiratory viruses are often the primary agents (EVA, EHV)
39
T/F: hyperfribinogenemia and neutropenia reflect an acute process
True
40
What does a neutrophilia anemia indicate in a case of pneumonia? What is it is a left shift neutropenia??
Chronic Left shift= very bad prognosis
41
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?
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
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?
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
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 ?
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
Following a race... An older horse presents with bilateral epistaxis What would be your differentials?? What would you do next diagnostically?
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
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?
Inflammatory airway disease => clinical signs are not severe enough and neutrophils not high enough for recurrent obstructive airway disease (25%)
46
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?
Recurrent airway obstruction
47
What is the treatment for inflammatory airway disease?
Environmental Decrease airborne dust, bedding, and feed Anti-inflammatories
48
What is the treatment for recurrent airway obstruction??
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
What are the aerobic bacteria that ca cause a pneumonia?
``` Strep zooepidemicus Staph aureus Actinobacillus equi E.coli Klebsiella Pseudomonas Rhodococcus equi ```
50
What anaerobic bacteria cause a pneumonia?
Bactericides fragillis
51
What are the lung worms that can cause a pneumonia?
Dictylocaulus arnfeldi | Parascaris equorum
52
What are the theories for cause of EIPH?
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
How would you grade this EIPH? Flecks of blood or a short narrow line
Grade 1
54
How would you grade this EIPH?????????? Multiple distinct streams covering >1/3 of trachea?
Grade 3
55
How would you grade this EIPH? Multiple coalescing streams covering >90% of trachea
Grade 4
56
What is the treatment for EIPH?
Furosemide Controversial because it causes loss of weight and better racing times Nasal strip (flair)
57
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?
Infectious upper respiratory disease Viral Infectious sinusitis Culture and sensitivity PCR
58
What are the possible clinical presentations of strangles?
``` Pneumonia Pleuropneumonia Guttural pouch empyema Weight loss Colic of other causes ```
59
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?
Strangles Infectious cause = streptococcus equi var equi causes the high fever Swelling of the retropharyngeal lymph nodes can lead to respiratory distress
60
What is the aseptic vasculitis associated with strangles in mature horses called?
Purpura hemorrhagica
61
What respiratory diseases are associated with purpura hemorrhagica ?? How do you treat this?
Influenza Strangles Purpura hemorrhagica is treated with corticosteroids
62
What is bastard strangles???
Systemic manifestation of strangles Mets to lymphnodes throughout body —> lungs, mesentery, liver, spleen, kidney, and brain Ocular Endocarditis Suppurative necrotic bronchopneumonia
63
What is the treatment for bastard strangles?
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
What specific tests can you do to diagnose bastard strangles?
Anti-strep antibody titer SeM specific ELISA Serum amyloid A (can help distinguish which animals to give antibiotics — if high)
65
What immune-mediated complications can arise from strangles?
Purpura hemorrhagica Myositis Glomerulonephritis Myocarditis
66
What are the EDX for foal pneumonia?
Strep zooepidemicus | Actinobacillus equi
67
How do you treat foal pneumonia?
Depends on degree of pneumonia - gram pos - gram neg Bronchodilators Fluid therapy Anti inflammatory Nebulization

RUSVM LAM1 (17 decks)

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