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LA DX & TX I > Exam 2 - Equine Lower Respiratory Tract > Flashcards

Exam 2 - Equine Lower Respiratory Tract Flashcards

1
Q

what are some important components of your general physical exam for a horse with lower respiratory tract disease?

A

TPR, MM, CRT, nasal discharge/cough, airway noise, respiratory rhythm/rate/character

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2
Q

what are some important components of your respiratory physical exam for a horse with lower respiratory tract disease?

A

note any distress/dyspnea, pleurodynia, thoracic excursion, abdominal effort, ventral edema, or exercise intolerance

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3
Q

does guttural pouch empyema usually cause a unilateral or bilateral nasal discharge?

A

it depends - even if it’s unilateral empyema, it can cross over & cause bilateral nasal discharge

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4
Q

what conditional changes should be considered in a horse with a cough?

A

indoors vs. outdoors

rest vs. exercise

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5
Q

what is pleurodynia?

A

pleural pain

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6
Q

what are the clinical signs of pleurodynia?

A

shallow guarded respiration

anxious facial expression

abducted elbows

stiff forelimb gait

decreased thoracic excursion

grunt/escape maneuver

reluctance to cough

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7
Q

what is required for cyanosis to be present?

A

at least 5mg deoxygenated hemoglobin per 100 ml of blood - blue mucus membranes

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8
Q

how would you characterize these mucus membranes? is it a sensitive indicator of hypoxemia?

A

cyanotic

no - not sensitive

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9
Q

what are the topographic boundaries for the lung fields in the horse?

A

7th ICS - tuber coxae

16th ICS - tuber ischii

13 ICS - middle of the thorax

11 ICS - point of the shoulder

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10
Q

what do you expect to hear over the lung fields of a normal horse at rest?

A

nothing

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11
Q

what are ‘normal’ lung sounds?

A

bronchovesicular

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12
Q

what are examples of abnormal lung sounds?

A

crackles, wheezes, pleural friction rubs, attenuated lung sounds, referred large airway sounds

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13
Q

what do crackles sound like?

A

short, explosive, discontinuous non-musical sounds

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14
Q

what do wheezes sound like?

A

continuous musical sounds

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15
Q

what does a pleural friction rub sound like?

A

continuous or discontinuous, low pitch, mirror-image sound

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16
Q

how are attenuated lung sounds characterized?

A

silent regions of the lung field

decreased bronchovesicular sounds

can’t be appreciated without a rebreathing bag

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17
Q

what are some differentials of thoracic pathology that result in attenuated lung sounds?

A
  1. pleural effusion
  2. pleural or pulmonary abscess
  3. pulmonary granuloma
  4. pleural or pulmonary tumor
  5. pericardial effusion
  6. diaphragmatic hernia
  7. pneumothorax
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18
Q

how are referred large airway sounds characterized?

A

tracheal and/or mainstem bronchial sounds heard within the lung fields

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19
Q

what are some examples of thoracic pathology that result in referred lung sounds?

A
  1. pulmonary consolidation
  2. pleural or pulmonary abscess
  3. pulmonary granuloma
  4. pleural or pulmonary tumor
  5. pulmonary atelectasis
  6. pleural effusion
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20
Q

what are some differentials for percussable dullness?

A

pleural effusion

pleural abscess

pulmonary abscess

pulmonary granuloma

pulmonary consolidation

pleural/pulmonary tumor

pericardial effusion

diaphragmatic hernia

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21
Q

what are some differentials for percussable hyper-resonance?

A

pneumothorax

emphysematous bullae

enlarged lung fields

diaphragmatic hernia

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22
Q

what is endoscopy used for?

A

diagnosis of URT abnormalities

look at turbinates

look at pharynx/larynx

arytenoids

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23
Q

what are some diseases that may be seen on pharyngoscopy/laryngoscopy of the pharynx?

A
  1. cicatrix
  2. dorsal displacement of the soft palate
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24
Q

what are some diseases that may be seen on pharyngoscopy/laryngoscopy of the guttural pouch?

A
  1. mycosis
  2. empyema
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25
Q

what are some diseases that may be seen on pharyngoscopy/laryngoscopy of the larynx?

A
  1. laryngeal hemiplegia
  2. arytenoid chondropathy
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26
Q

what are some diseases that may be seen on pharyngoscopy/laryngoscopy of the epiglottis?

A
  1. aryepiglottic fold entrapment
  2. sub-epiglottic cyst
  3. aryepiglottic flutter
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27
Q

what is the pathogenesis of this pictured pathology?

A

nasopharyngeal cicatrix - unknown etiology

common in east & central tx, may be environmental exposure

progressive disease

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28
Q

what disease is pictured?

A

cicatrix

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29
Q

what is the pathogenesis of this pictured pathology?

A

dorsal displacement of the soft palate - caused by the impairment of the pharyngeal branch of the vagus nerve

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30
Q

what clinical signs are seen with dorsal displacement of the soft palate?

A

exercise intolerance, noise at exercise, diagnosed on dynamic endoscopy

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31
Q

how is this disease process treated?

A

tie forward surgery

staphylectomy

tenectomy of the strap muscles

cornell collar

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32
Q

what is this?

A

dorsal displacement of the soft palate

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33
Q

what is this?

A

aryepiglottic fold entrapment

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34
Q

what is the pathogenesis of aryepiglottic fold entrapment?

A

epiglottis is caught in the redundant tissue surrounding it - can be intermittent or chronic

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35
Q

what are the clinical signs associated with aryepiglottic fold entrapment?

A

respiratory noise & may affect swallowing

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36
Q

what is this?

A

laryngeal hemiplegia

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37
Q

what is the pathogenesis of laryngeal hemiplegia?

A

progressive paralysis of the left arytenoid cartilage - caused by neuromotor function of the left recurrent laryngeal nerve

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38
Q

what abnormality is seen here?

A

cleft palate

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39
Q

what are the benefits of using dynamic video endoscopy?

A

real time upper airway exam during normal training or exercise with the head in the normal position while avoiding the risk of the treadmill

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40
Q

what 3 scopes are available for dynamic scoping?

A

dynamic respiratory scope, OPTOMED, & france

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41
Q

what pathology is seen on this radiograph of the thorax?

A

pulmonary abscess

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42
Q

what pathology is seen on this radiograph of the thorax?

A

pleural effusion & pulmonary abscess

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42
Q

what pathology is seen on this radiograph of the thorax?

A

pneumothorax

43
Q

what pathology is seen on this radiograph of the thorax?

A

bronchial pattern - equine asthma

44
Q

what pathology is seen on this radiograph of the thorax?

A

miliary interstitial pattern

45
Q

what pathology is seen on this radiograph of the thorax?

A

interstitial pneumonia

46
Q

why is thoracic ultrasound used for peripheral lungs in horses?

A

localize & characterize the disorders, such as:

atelectasis, consolidation, abscessation, necrosis, & neoplasia

47
Q

why is thoracic ultrasound used for the pleural space in horses?

A

localize & characterize disorders of the pleural space, such as:

pleural effusion, ‘gas echoes’, pleural fibrin, loculations, abscessation, & pneumothorax

48
Q

why is thoracic ultrasound used for the mediastinum in horses?

A

localize & characterize disorders, such as:

effusion, abscessation, & neoplasia

49
Q

what artifact is seen on this ultrasound of equine lungs? what does it indicate?

A

comet tails

50
Q

what pathological process is going on in this ultrasound? where is the lung?

A

pleural effusion

51
Q

how would you likely characterize this effusion? why?

A

transudate - anechoic

52
Q

how would you likely characterize this effusion? why?

A

exudate - mixed echo pattern

53
Q

how would you likely characterize this effusion? why?

A

hemothorax - homogenous & echogenic

54
Q

what pathology is seen on this ultrasound of equine lungs?

A

gas echoes in pleural fluid

55
Q

what pathology is seen on this ultrasound of equine lungs?

A

pleural fibrin

56
Q

what pathology is seen on this ultrasound of equine lungs?

A

pleural loculae

57
Q

what diagnostics will you primarily use from tracheobronchial aspiration?

A

cytology, differential cell counts, & gram’s stain

58
Q

what is the purpose of tracheobronchial aspiration?

A

retrieve diagnostic sample of airway secretions for cytology, gram’s stain, & cell differentials

59
Q

what are the main 3 ways we obtain tracheobronchial aspiration?

A

percutaneous tracheal aspirate

trans-endoscopic tracheal aspiration with guarded catheters

BAL - blind BAL or trans-endoscopic

60
Q

what are the advantages of percutaneous trans-tracheal aspiration? disadvantages?

A

advantages - aerobic sampling for microbiologic culture & samples pooled secretions from the entire lung

disadvantages - invasive, complications - SQ cellulitis/abscess/emphysema, & no visualization

61
Q

what is the technique of doing a percutaneous trans-tracheal aspirate?

A

introduce catheter

infuse 30-60 ml of sterile saline

aspirate fluid

reposition catheter

re-aspirate

remove catheter

inject SQ amikacin

62
Q

what are the advantages of trans-endoscopic tracheal aspiration? disadvantages?

A

advantages - less invasive, avoid complications, assess URT, & direct visualization of collection process

disadvantages - potential contamination from the endoscope or URT

63
Q

what is the technique used for trans-endoscopic tracheal aspiration?

A

standing horse, +/- sedation

disinfect endoscope & channel - cidex solution for 20 minutes & rinse scope/biopsy channel

advance scope into pharynx, aseptic handling of catheter & insert, advance past end of the scope, advance internal catheters, plug comes out, remove stylet

infuse 30-60 ml of sterile saline & aspirate sample from tracheal puddle

64
Q

what should you do with a sample from a trans-endoscopic tracheal aspiration?

A

cytology - edta tubes

aerobic bacterial culture & susceptibility

anaerobic bacterial culture & susceptibility

65
Q

what would be seen on cytology from a trans-endoscopic tracheal aspiration supportive of sepsis?

A

predominance of neutrophils

degenerative neutrophils

bacteria - intracellular or extracellular

66
Q

why is a positive culture of off a trans-endoscopic tracheal aspiration not necessarily indicative of a bacterial infection? how should you interpret it?

A

pathogenic & non-pathogenic bacteria can be isolated from TTW of normal horses!!

interpret the cultures in conjunction with: method of collection, cytologic findings, clinical signs, & other findings

67
Q

T/F: BAL yields a more representative sample of lower airways than tracheal aspirates

A

true

68
Q

what are BALs used for?

A

retrieve fluid & cells lining the distal airways & alveoli

excellent cell morphology

69
Q

why is BAL only used for cytology?

A

contamination from the upper airway

70
Q

T/F: there is a good correlation between BAL cytology & histological findings of distal airways & airway reactivity

A

true

71
Q

what is a BAL suitable for when using it as a diagnostic test?

A

assessment of diffuse lower airway disorders such as:

recurrent airway obstruction, SPA-OPD, & inflammatory airway disease

72
Q

what is a BAL NOT suitable for when using it as a diagnostic test?

A

localized lung disorders such as:

bacterial pneumonia/pleuropneumonia & lung abscesses

73
Q

where are samples usually taken with BAL?

A

caudodorsal lung region - suitable for detecting exercise-induced pulmonary hemorrhage

74
Q

T/F: BAL samples airway secretions from multiple lung segments

A

false - only one

75
Q

what is the general technique used for BAL?

A

test inflate cuff on BAL tube

restrain horse, well sedated, clean 1 nostril, small amount of KY on tube

push tube up ventral meatus so the tube enters the pharynx

stretch horses head out & advance tube into trachea - most horses cough

infuse 30-60cc of epinephrine without lidocaine near tracheal bifurcation

advance tube until it wedges into bronchus & inflate cuff, hold tube securely against nostril

infuse 100ml of warmed sterile saline, use 3-way stop cock, aspirate fluid gently

repeat infusion & aspiration 2 more times for a total of 300 ml infused

% of fluid recovery increased with each infusion

76
Q

how should you handle samples from BAL?

A

mix all 3 together & place into EDTA tubes & submit to lab for direct smears, gram stains, cytology, & differential cell counts

77
Q

what are the benefits of trans-endoscopic BAL?

A

need endoscope > 160cm

allows visualization of lower airways

visual selection of BAL site

aseptic prep of endoscope - use biopsy channel

78
Q

what should normal BAL fluid look like?

A

clear to mildly turbid with a thick layer of surface foam (surfactant)

79
Q

what is the predominant cell type in normal BAL fluid?

A

macrophages > lymphocytes > neutrophils > mast cells > eosinophils

80
Q

what percentage of neutrophils is normal in normal BAL fluid?

A

<5%

81
Q

how does cytology of BAL compare to TA?

A

cytologic features & differential cell counts are different!! cytology is better preserved

BAL will have lower neutrophils, higher macrophages/lymphocytes, & fewer epithelial cells

82
Q

what cell is seen on this cytology of normal BAL fluid?

A

alveolar macrophage

83
Q

what cell is seen on this cytology of normal BAL fluid?

A

lymphocytes

84
Q

what is a normal BAL cell differential?

A

macrophages: 40-70%

lymphocytes: 30-60%

neutrophils: < 5%

mast cells: < 2%

eosinophils: < 1%

85
Q

BAL cytology is useful for what common disorders in horses?

A

equine asthma - inflammatory airway disease, recurrent airway obstruction, & summer-pasture associated obstructive pulmonary disease

exercise induced pulmonary hemorrhage

86
Q

in what situation would you chose to perform a tracheal aspirate on a horse with respiratory disease?

A

when you suspect septic, focal, or multifocal pulmonary disease

87
Q

in what situation would you chose to perform a BAL on a horse with respiratory disease?

A

when you suspect diffuse, non-septic, pulmonary disease

88
Q

in what situation would you chose to perform both a tracheal aspirate & BAL on a horse with respiratory disease?

A

if you’re not sure

when one fails to provide adequate diagnostics

89
Q

T/F: BAL may not detect focal or multifocal pulmonary disorders

A

true

90
Q

what are the 2 most common causes of pleural effusion in horses?

A
  1. pleuropneumonia
  2. neoplasia
91
Q

what are the classifications used for pleural effusion in horses?

A
  1. transudate
  2. modified transudate
  3. exudate - septic or non-septic
  4. hemorrhagic effusion
92
Q

when is a lung biopsy used?

A

reserved for horses in which histologic examination of lung tissue is essential for diagnosis & treatment

performed after all other efforts have failed

not recommended for horses with increased respiratory rate & effort

93
Q

what are potential complications of lung biopsies?

A

intrapulmonary hemorrhage, intrapleural hemorrhage, epistaxis, respiratory distress, pneumothorax, & death

94
Q

what are some indications for pursuing a lung biopsy?

A

sonographically visible pulmonary mass

minimal risk of complications

diagnostic challenge - miliary rad pattern (fungal, EMPF, interstitial, neoplasia)

95
Q

what is the technique used for lung biopsy?

A

ultrasound for site selection, aseptic prep, local anesthesia, stab incision in skin

12 gauge needle, advance through intercostal muscles, obtain biopsy quickly

submit sample in formalin to histopath lab

96
Q

how should your patient be monitored after a lung biopsy?

A

monitor closely for 24 hours!!!!

look for: epistaxis, tachypnea, respiratory distress, & ultrasound of pleural space/peripheral lung

97
Q

what are the clinical indications of pulmonary scintigraphy?

A

assess regional perfusion & ventilation

determine ventilation to perfusion ratios

detect occult sites of pulmonary infection

98
Q

what are the research indications of pulmonary scintigraphy?

A

assess mucociliary clearance

detection of pulmonary bleed sites

study of deposition of aerosolized medications

99
Q

what are pulmonary function tests?

A

tests that assess mechanical properties of lungs, lung volume, & gas exchange

usually require specialized equipment & personnel, so rare in private practice

100
Q

what diagnostic test can be easily done in practice & yield useful lung function information?

A

arterial blood gases

101
Q

what does PaO2 indicate on arterial blood gas analysis?

A

most sensitive measure of lungs ability to oxygenate blood

102
Q

what does PaCO2 indicate on arterial blood gas analysis?

A

most sensitive measure of ventilation

103
Q

where can you sample arterial blood from a horse?

A

carotid artery

transverse facial artery

facial artery under ventral mandible - under anesthesia

dorsal metatarsal artery in foals

brachial artery in foals

104
Q

what is seen on this perfusion study using pulmonary scintigraphy?

A

cold spot associated with lung abscess

105
Q

what is seen on a pulmonary scintigraphy study of normal horses?

A

ventilation evenly distributed throughout lung fields

106
Q

what is seen on a pulmonary scintigraphy study of abnormal horses?

A

bronchoconstriction, airway edema, & inflammation

LA DX & TX I (45 decks)

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