E2: Respiratory System Evaluation

Question 1

Normal pulmonary artery pressure at rest is 25-30 mmHg. How high can it get with exercise?

Answer 1

Up to 125 mmHg

Question 2

What is a normal respiratory rate in horses? What is the normal respiration pattern?

Answer 2

8-12 bpm

Biphasic respiration

Question 3

What type of disease does it indicate if the head and neck are extended and the horse is making an inspiratory noise?

Answer 3

Upper airway obstruction

Question 4

What can a plaque of edema on the pectorals indicate?

Answer 4

Pleural effusion

Question 5

What are your DDx if upon ausculation you note diminished lung borders?

Answer 5

Pulmonary consolidation

Pleural effusion

Diaphragmatic hernia

Question 6

What are your DDx if upon ausculation you note absent or radiating cardiac sounds?

Answer 6

Pleural effusion

Consolidation

Question 7

What imaging modality is best for evaluating the lung parenchyma (i.e. pulmonary disease)? Which is best for thoracic disease?

Answer 7

Radiography

Ultrasound

Question 8

What increases the rate and depth of respiration by causing CO2 rebreathing in order to elicit and/or accentuate abnormal lung sounds during an examination?

Answer 8

Rebreathing

Question 9

Which is the correct progressive order of respiratory structures from rostral to distal?

a) Pharynx
b) Nares
c) Larynx
d) Trachea
e) Ethmoid
f) Guttural pouch
g) Nasopharynx
h) Nasal passage

Answer 9

b-h-e-g-f-c-d

Nares
Nasal passage
Ethmoid
Nasopharynx
Guttural pouch
Larynx
Trachea

Question 10

While performing an upper airway endoscopy in a horse, in order access the esophagus, the scope needs to be passed in which direction with respect to the larynx?

Answer 10

Dorsally

Question 11

In evaluating the guttural pouch, as seen on upper airway endoscopy in the horse, which would be the axially positioned compartment? What separates the two compartments?

Answer 11

Medial compartment

Stylohyoid bone

Question 12

Complete this correct statement: During upper airway endoscopy as the scope travels past the end of the nasal septum, towards the caudal portion of the naso-pharynx, you will observe:

A. the opening to the oro-pharynx thus leading you to the esophagus.

B. the arytenoids which will then be followed by observation of the guttural pouch opening.

C. the dorsal pharyngeal recess which is located in the same vicinity as the openings of the guttural pouch.

D. the ethmoids which are located ventrally several centimeters caudal to the septum as you advance near the larynx.

Answer 12

C

During upper airway endoscopy as the scope travels past the end of the nasal septum, towards the caudal portion of the naso-pharynx, you will observe the dorsal pharyngeal recess which is located in the same vicinity as the openings of the guttural pouch.

Question 13

As seen on upper airway endoscopy, in which of the following compartments of the guttural pouch do you visualize the internal carotid artery? In which one will you be able to visualize the external carotid artery?

Answer 13

Medial

Lateral

Question 14

What length of endoscope would you use to evaluate the guttural pouch of an adult horse? Which would you use to evalute the bladder of a 4-year-old gelding?

Answer 14

1m

3m

Question 15

T/F: The epiglottis is often temporarily seen below the soft palate after endoscopic evaluation of the esophagus in the normal horse

Answer 15

True

Question 16

T/F: The esophageal opening is found dorsal to the arytenoids in the larynx

Answer 16

True

Question 17

In evaluating the arytenoids, as seen on upper airway endoscopy in the horse, the one positioned on the left side of your screen is the:

Answer 17

Right arytenoid

Question 18

On equine endoscopy, which of the following structure(s) is/are visualized on the walls of pharynx as you approach the larynx, somewhat in the middle part of the nasopharynx?

Answer 18

Openings to the guttural pouch

Question 19

Which lymph nodes will be found under the ventral mucosal covering of the guttural pouch?

Answer 19

Retropharyngeal

Question 20

When is it easiest to visualize the mucosa of the esophagus, as you are entering or as you are coming back out with the endoscope?

Answer 20

Coming back out with the endoscope

Question 21

While performing an upper airway endoscopy in a horse, in order to access the left guttural pouch, where does the scope needs to be passed?

Answer 21

In the left nasal passage

Question 22

T/F: Abnormal thoracic auscultation indicates a LRD, while normal thoracic auscultation indicates URD.

Answer 22

True

Question 23

Which compartment in the guttural pouch is smaller?

Answer 23

Lateral

Question 24

Which mainstem bronchus is larger in the horse?

Answer 24

Right

Question 25

What are these structures in the dorsal potion of which nasal passage?

Answer 25

Ethmoids Left

Question 26

What are the structures indicated by arrows- D, R and L?

Answer 26

D: Dorsal pharyngeal recess R and L: Right and Left cartilagenous flaps covering the **nasopharyngeal openings of the guttural pouch**

Question 27

You know what to do

Answer 27

A: Stylohyoid B: Internal Carotid artery C: External Carotid artery and Maxillary artery D: Medial compartment of the guttural pouch E: Lateral compartment of the guttural pouch

Question 28

What are some diagnostic procedures that might be used with respiratory disease?

Answer 28

1. Transtracheal wash (TTW) 2. Bronchoalveolar lavage (BAL) 3. Thoracentesis 4. Lung aspirate 5. Lung biopsy 6. Fluid cytology 7. Pleuroscopy

Question 29

T/F: Bilateral nasal discharge can be associated with upper or lower respiratory disease.

Answer 29

True

Question 30

What type of respiratory disease, upper or lower, is associated with unilateral nasal discharge?

Answer 30

Upper

Question 31

Where are respiratory sounds heard loudest in a horse? What side are lung sounds the loudest on?

Answer 31

Trachea Right

Question 32

What are 3 types of dagnostic imaging used for the horse respiratory evaluation?

Answer 32

Radiography Ultrasound Nuclear scintigraphy

Question 33

What is nuclear scintigraphy used for in horses?

Answer 33

Ventilation-Perfusion evaluation

Question 34

TTW is typically performed around the junction of \_\_\_\_\_\_\_\_\_\_\_\_\_\_, just above the bifurcation of the \_\_\_\_\_\_\_\_\_\_.

Answer 34

Middle and distal third of the neck Sternothyrohyoideus muscle

Question 35

A 2-yr-old Standardbred gelding presents for a cough and nasal discharge. PE reveals fever, purulent nasal discharge, mild tachypnea and tachycardia, and normal thoracic auscultation. Which of the following best categorizes the disease in this horse? A. Non-infectious URT disease B. Infectious LRT disease C. Infectious URT disease D. Non-infectious LRT disease

Answer 35

C. Infectious URT disease Fever, purulent discharge = infectious Normal auscultation= Upper airway

Question 36

While ____ is a sterile technique, ____ is not and is thus not indicated if a culture is necessary. ______ is for both local and focal multifocal pulmonary, _____ is indicated in diffuse pulmonary disease.

Answer 36

TTW BAL TTW BAL While **_TTW_** is a sterile technique, **_BAL_** is not and is thus not indicated if a culture is necessary. **_TTW_** is for both local and focal multifocal pulmonary, **_BAL_** is indicated in diffuse pulmonary disease.