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Equine BCM Lecture > Equine Upper Airway Dzs > Flashcards

Equine Upper Airway Dzs Flashcards

1
Q

(T/F) Inspiratory noise is always pathologic as it indicates narrowing of the upper airway lumen.

A

(T)

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2
Q

Stridor/stertor (choose) is associated with a low pitched sound.

A

(Stertor is associated with low pitched sounds, stridor is associated with high pitched sounds)

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3
Q

(T/F) Exercising expiratory sounds are normal at a trot, canter, and gallop.

A

(F, not at a trot, yes at a canter/gallop)

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4
Q

What is the primary diagnostic for upper airway cases?

A

(Endoscopy)

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5
Q

Of the following diagnostic techniques, sort them into whether they would be more useful for sinus/nasal passage disease versus larynx/pharynx diseases:

Head radiographs
Dynamic/treadmill endoscopy
Watch during exercise
Head CT/MRI
Dental examination
Ultrasound

A

Head radiographs (Sinus/nasal passage)
Dynamic/treadmill endoscopy (Larynx/pharynx)
Watch during exercise (Larynx/pharynx)
Head CT/MRI (Sinus/nasal passage)
Dental examination (Sinus/nasal passage)
Ultrasound (Larynx/pharynx)

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6
Q

What procedure can be performed to provide an airway in a horse with a life-threatening URT obstruction?

A

(Tracheotomy)

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7
Q

Give causes for the following discharge presentations:

Serous discharge

A

(Viral respiratory infection, allergic rhinitis)

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8
Q

Give causes for the following discharge presentations:

Mucoid to purulent discharge

A

(Primary or secondary bacterial respiratory infection, sinusitis, tooth root abscess)

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9
Q

Give causes for the following discharge presentations:

Fresh hemorrhagic discharge

A

(Guttural pouch mycosis, trauma, lower airway causes such as exercise induced pulmonary hemorrhage)

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10
Q

Give causes for the following discharge presentations:

Old hemorrhagic discharge

A

(Ethmoid hematoma, lower airway causes such as necrotizing pneumonia)

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11
Q

Give causes for the following discharge presentations:

Discharge with feed

A

(Choke, dysphagia d/t pharyngeal obstruction)

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12
Q

Give causes for the following discharge presentations:

Discharge with a fetid odor

A

(Dental or chronic causes)

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13
Q

Is the sinus drainage angle rostral or caudal to the nasal septum termination?

A

(Rostral, so drainage from the sinus drainage angle will be unilateral)

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14
Q

Will discharge from the nostrils be unilateral or bilateral in guttural pouch disease with lots of discharge?

A

(Bilateral; I put the caveat of lots of discharge because it could be unilateral if there is minimal discharge that only drains down one side but something like GP mycosis induced hemorrhage will be bilateral bc the nasopharyngeal ostia are caudal to the termination of the nasal septum)

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15
Q

(T/F) Epidermal inclusion cysts, aka atheroma of false nostril, rarely obstruct the airway and are primarily a cosmetic problem.

A

(T)

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16
Q

Rare enlargement or failure of which muscle allows for alar fold collapse during exercise?

A

(Transversus nasi muscle)

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17
Q

Alar fold collapse is most common in which horse breeds?

A

(Standardbreds and saddlebreds)

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18
Q

Alar fold collapses are associated with noise during inspiration/expiration (choose).

A

(Both, inspiration mainly +/- expiration)

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19
Q

(T/F) Alar fold collapses can cause reduced performance.

A

(T)

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20
Q

What is the purpose of performing a resting and/or dynamic endoscopy in cases of alar fold collapse?

A

(Rule out other causes of noise and exercise intolerance as alar fold collapses can occur in conjunction with other problems)

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21
Q

(T/F) There is evidence that nasal strips reduce peak inspiratory pressure and resistance when a horse is maximally exercising by pulling the dorsal conchal folds laterally and expanding the dorsal meatus.

A

(T)

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22
Q

Why is it optimal to close lacerations and wounds of the nares with a primary closure as opposed to second intention healing?

A

(Scarring can cause secondary stenosis, primary closures minimize scarring)

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23
Q

Paralysis of which cranial nerve leads to a lack of tone in the nostril(s) and may cause flutter or even collapse of the nostril?

A

(Facial nerve/CN VII)

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24
Q

(T/F) Nasal mucosal hemorrhage is rare and all other possible causes of epistaxis should be ruled out first.

A

(T)

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25
When may the collection of blood vessels aka nasal varicosities that bleed in cases of nasal mucosal hemorrhage bleed?
(May bleed during turbulent airflow or randomly)
26
What radiographic projection should be taken in a case of wry nose to determine the degree of deviation?
(A dorsoventral radiograph of the nose)
27
What treatment is pursued in mild cases of wry nose?
(If no dyspnea or problems nursing in a foal, no treatment needed → reduce owner expectation for athleticism and will need to correct asymmetric growth of incisors as needed)
28
What treatment is pursued in severe cases of wry nose?
(Permanent or temporary trach and/or correction via premaxillary/maxillary osteotomy with internal or external fixation)
29
What results from a failure of bucconasal membrane rupture in early gestation?
(Choanal atresia, can be bilateral or unilateral, bilateral cases are fatal without trach)
30
How do the treatments for choanal atresia and choanal stenosis differ?
(Atresia → can relieved the atresia surgically with a laser or long instruments; stenosis → palliative care (can’t really widen the nasal passages))
31
What should you rule out prior to removing a nasal polyp via amputation with an OB wire?
(Rule out an extension of a sinus cyst or involvement of the polyp with the dorsal or ventral nasal conchae → done via radiograph or endoscopy)
32
What is the treatment for fungal rhinitis in horses?
(Surgical debulking AND systemic antifungals (fluconazole or voriconazole)
33
What does the success of treatment of fungal rhinitis in horses depend on?
(Extent of the lesions, causative pathogen, and site of infection)
34
Infections with which fungal organism is common after sinus surgery in horses?
(Aspergillus)
35
(T/F) Nasal septal defects can be congenital or acquired.
(T, congenital makes sense, acquired can be from a conchal mass effect; surgery to resect nasal septum is difficult and associated with blood loss)
36
Which other sinus communicates with the ventral conchal sinus?
(Rostral maxillary sinus)
37
Which other sinuses communicate with the caudal maxillary sinus?
(Frontal and sphenopalatine)
38
What is the most common cause of secondary sinusitis?
(Dental-related sinusitis)
39
What is primary versus secondary sinusitis?
(Primary sinusitis is diagnosed when you cannot find any underlying cause of sinusitis, secondary sinusitis occurs secondarily to a primary disease process)
40
How do the treatments differ for acute versus chronic cases of primary sinusitis?
(Acute → broad spectrum antimicrobials for about a week; chronic (or acute cases that do not respond to broad spectrum abx) → sinus lavage, may need to repeat, and broad spectrum abx)
41
Which of the sinuses of the equine head can be accessed via a conchofrontal sinus trephination?
(Frontal, dorsal conchal, caudal maxillary, and sphenopalatine)
42
Which of the sinuses of the equine head can be accessed via a rostral maxillary sinus trephination?
(Rostral maxillary sinus and ventral conchal sinus)
43
Which of the sinus trephination sites can be utilized for through-through lavage?
(Caudal maxillary site)
44
Sinoscopy is performed via which sinus trephination site?
(Conchofrontal sinus)
45
What further tissue dissection must occur if you want to gain access to the rostral maxillary and ventral conchal sinuses with a conchofrontal bone flap?
(You must fenestrate the maxillary septal bulla to gain access to those two sinuses via a conchofrontal bone flap)
46
What radiographic view is best for finding the circular sinus cyst lesions?
(Oblique radiographs)
47
What occurs secondary to obstruction of sinus drainage which can occur if sinus cysts grow large enough?
(Sinusitis)
48
What might you see on radiographs of a horse with sinus neoplasia?
(Soft tissue or fluid opacity with loss of bone architecture)
49
What are the types of neoplasia that can affect horse sinuses?
(SCC, adenocarcinoma, fibroma, chondroma, hemangiosarcoma, and osteosarcoma)
50
What is the prognosis for sinus neoplasia with treatment?
(Poor → most are euthanized or have palliative care, tx is surgical resection and radiation typically)
51
Suture periostitis is more commonly a young/middle/old (choose) age horse problem.
(Young)
52
What radiographic view is best for observing suture periostitis and what would you look for?
(Oblique rads, will see a gap and periosteal proliferation at the facial sutures)
53
What is the purpose of administering antibiotics to an older horse with suture periostitis secondary to trauma?
(Prevention of secondary sinusitis)
54
Which imaging modality is particularly useful in cases of sinus fractures to look for the extent of damage?
(CT)
55
Is the intermittent epistaxis associated with progressive ethmoid hematomas more commonly unilateral or bilateral?
(Unilateral, bilateral possible if the animal is bilaterally affected but that is less common)
56
What diagnostic technique is best for progressive ethmoid hematomas and what will you expect to see?
(Endoscopy is diagnostic in most cases, will see a dark red to tan-brown encapsulated mass)
57
What is the purpose of performing radiographs in progressive ethmoid hematoma cases?
(To check for sinus involvement)
58
What is the most common first-line treatment for progressive ethmoid hematomas?
(Formalin injection, 25-50mls of 4-10% formalin adm via trans-endoscopic needle, repeated every 3-4 weeks for an average of 5 injections, continue until resolved)
59
Involvement of which sinus in cases of progressive ethmoid hematomas is the most common reason for recurrence?
(Sphenopalatine sinus)
60
Which vessel and cranial nerve are associated with the lateral compartment of the guttural pouch?
(CN7 and external carotid artery)
61
Which vessel and cranial nerves are associated with the medial compartment of the guttural pouch?
(CN 9, 10, 11, and 12, also the sympathetic trunk, and the internal carotid artery)
62
What clinical signs may result from nerve dysfunction associated with the guttural pouches?
(Facial nerve paralysis (eyelid, lip drooping, etc.), dysphagia d/t loss of soft palate function, laryngeal dysfunction, and horner’s syndrome)
63
Of the surgical correction options for guttural pouch tympany, which can be used for bilateral cases?
(Transendoscopic laser creation of a salpingopharyngeal fistula (drains air from both GPs); other surgical correction is a median septum fenestration but this is for unilateral cases (the abnormal air in the affect GP will drain out of the working ostia of the normal GP))
64
What age range is associated with guttural pouch tympany?
(Birth to one year old)
65
What causes guttural pouch tympany?
(The salpingopharyngeal ostium becomes a one-way valve so air can leak into the GP but cannot escape, what causes that to occur your guess is as good as mine)
66
What clinical signs can be seen in cases of GP empyema, which can occur as an extension of URT infections or when the retropharyngeal lnn bursts into the GP?
(Intermittent unilateral nasal discharge, lymph node enlargement, parotid swelling/pain, respiratory noise, and dysphagia)
67
What organism should be screened for in cases of GP empyema?
(Strep equi subsp. equi)
68
In a case of arterial hemorrhage secondary to guttural pouch mycosis, you should wait for what to occur prior to transporting the horse for treatment?
(Clotting and the bleeding to stop, don’t just throw them on a trailer while they’re still actively bleeding)
69
Why might you administer acepromazine to a horse with guttural pouch mycosis either before or after a bleeding event?
(Reduces blood pressure and will keep them calm)
70
What should you do prior to sedating a horse for endoscopy in cases of GP mycosis?
(Assess their systemic status, determine if systemically stable)
71
Explain the premise of placing surgical coils/plugs for treatment of GP mycosis.
(You’re stopping blood flow in the affected artery and starving the fungus)
72
Though the prognosis for GP mycosis is good when treated surgically, it is worse if what signs are present?
(Neurologic signs → head tilt, dysphagia, facial nerve paralysis)
73
What does medical treatment entail for temporohyoid osteoarthropathy and will medical tx improve neurological signs if they are present?
(Medical therapy entails antibiotics and anti-inflammatories for at least 3 weeks, no medical tx will not improve neurological signs)
74
What is the goal of surgical treatment of temporohyoid osteoarthropathy?
(Remove stresses on temporohyoid joint by removing part of the hyoid apparatus → ceratohyoidectomy to be specific)
75
Are the constrictor/elevator muscles or the dilator/tensor muscles of the soft palate important for inspiration?
(Dilator/tensor muscles, constrictor/elevator muscles important for swallowing)
76
Which of the cranial nerves innervate the muscles of the pharynx?
(CN 5, 9, and 10)
77
Lymphoid hyperplasia is more commonly a young/middle/old age horse problem.
(Young, 1-3 years of age, can occur in older horses secondary to inflammation)
78
What is the most common cause of upper airway obstruction in racehorses?
(Palatal dysfunction)
79
Dorsal displacement of the soft palate is associated with obstructing the airway during expiration or inspiration?
(Expiration, gurgling or flutter noise on expiration though can be silent)
80
What is caused by dorsal displacement of the soft palate that ultimately leads to reduced performance?
(Hypercarbia)
81
35% of horses have DDSP at rest which should correct itself if you make them swallow, if it does not correct itself, what should you evaluate the epiglottis for?
(Hypoplasia, epiglottic entrapment, and subepiglottic cysts)
82
Why does medical treatment for DDSP involve NSAIDs, corticosteroids, topical anti-inflammatory throat spray, and changing the environment to minimize dust/mold?
(One of the theories behind why horses get DDSP is inflammation causing neuromuscular dysfunction of the soft palate muscles and/or nerves so thought that if you reduce inflammation, it can treat the DDSP)
83
What are the goals of sternothyroideus tenotomy/tenectomy/myectomy and laryngeal tie-forward surgery, both of which are used for correction of DDSP?
(These surgical correction aim to move the position of the larynx forward so as to keep the soft palate below the epiglottis where is belongs)
84
What is the goal of a laser or thermal palatoplasty which is used for correction of DDSP?
(The resultant scarring is meant to stiffen the soft palate to prevent the dorsal billowing that leads to DDSP)
85
In cases of nasopharyngeal cicatrix there are often no clinical signs unless pharyngeal constriction occurs (variable URT noise and poor performance); those signs will be more severe if what laryngeal cartilage is involved?
(Arytenoid cartilages)
86
How do foals with nasopharyngeal dysfunction typically present and what should you do as soon as possible in those cases?
(Respiratory distress and dysphagic, need to perform a tracheotomy asap, also check for FPT)
87
Why is the prognosis poor to grave for cleft palates in horses?
(Repair has a high chance of dehiscence due to tension, grave prognosis if hard palate involved)
88
Laryngeal hemiplegia is associated with an expiratory or inspiratory obstruction?
(Inspiratory)
89
What does your choice of treatment for laryngeal hemiplegia depend on?
(The job of the horse, conservative appropriate for non-athletic horses, surgical for athletic horses)
90
Of the surgical options for laryngeal hemiplegia (prosthetic laryngoplasty and ventriculocordectomy), which primarily prevents noise?
(Ventriculocordectomy, prosthetic laryngoplasty improves exercise intolerance by tying back the arytenoid cartilage)
91
(T/F) Once the cricoarytenoid dorsalis muscle has lost its function, it cannot be regained.
(F, can be re-innervated overtime, usually 12 months)
92
What is the difference between laryngeal hemiplegia and arytenoid chondropathy?
(Laryngeal hemiplegia is loss of innervation to the CAD causing the inability to abduct the arytenoid cartilage, arytenoid chondropathy is deformation of the arytenoid cartilage due to infection)
93
What imaging modality is useful in determining if a horse has laryngeal hemiplegia versus arytenoid chondropathy?
(Ultrasound, will see an abnormally shaped/enlarged arytenoid with arytenoid chondropathy or an atrophied cricoarytenoid lateralis muscle with laryngeal hemiplegia)
94
What structures cover the epiglottis in cases of an entrapped epiglottis?
(Aryepiglottic folds and subepiglottic mucosa)
95
What is the treatment for an epiglottic entrapment?
(Axial midline division of the subepiglottic mucosa that is covering the epiglottis, make sure to not cut the epiglottis)

Equine BCM Lecture (16 decks)

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