Exam 3 - Mare Breeding Soundness Exam

Question 1

what is a ‘problem mare’ in regards to this lecture?

Answer 1

horses that can’t become pregnant!!! can be from a variety of very different things

Question 2

why do you need to do your reproductive exam of a mare prior to palpation per rectum? what should you do before?

Answer 2

you lose the ability to assess conformation of the mare!!!!

perineum, rectum, vulvar conformation, mammary gland exam (check for impending parturition, enlargement, maiden mares will have small glands tucked up against the abdomen), & clitoral culture

need to look at the external angle & tone of the vulva - 75% below pelvic rim with good apposition

Question 3

what are the physical barriers to uterine contamination?

Answer 3

vulvar seal

vestibulovaginal sphincter/fold

vagina

cervix - best evaluated in diestrus

Question 4

when is the best time to evaluate a mare’s cervix for a BSE exam?

Answer 4

during diestrus!!

Question 5

what is the purpose of the vestibulovaginal fold in the mare? what should you check the vestibule for during the mare’s BSE?

Answer 5

fold that separates the vestibule & vagina

need to check for wind-sucking, evaluate bacterial status, & anatomy

Question 6

T/F: on the BSE exam of a mare, the vagina should not have any air or fluid in it

Answer 6

true!!! potential space that should not be full of anything!

Question 7

what should you evaluate the vagina for on a mare BSE?

Answer 7

check the floor for the angle, urine, pus, or blood

evaluate for bacterial status

Question 8

what should you evaluate on rectal palpation for a mare BSE? what must you determine before progressing any farther?

Answer 8

cervix - length, width, & tone

uterus - tone, size, symmetry, adhesions

ovaries - size, activity, texture, & ovulation fossa

MUST DETERMINE SHE IS NOT PREGNANT

Question 9

what makes up the preparation for the internal exam of a mare BSE?

Answer 9

once the rectal exam is complete, isolate the tail/ensure no hairs are in the field, remove lube/fecal material prior to cleansing

scrub the perineal area using the vulva as the surgical site (include the hair on the side of the flanks as well)

apply 3 scrubs & water rinse after each - final scrub should remove all scrub to prevent any irritation & spermicidal

clean the vestibule with cotton material - not sterile because we want to culture!!!

Question 10

what are the routine procedures typically done on the internal exam of a mare BSE?

Answer 10

digital examination of vagina & cervix

endometrial culture & cytology

endometrial biopsy

Question 11

T/F: for the mare BSE, the cervix must be in diestrus/under the influence of progesterone to be properly evaluated

Answer 11

true

Question 12

what is used to get an endometrial culture/cytology during a mare BSE? why? how is it done?

Answer 12

double guarded cotton swab - minimizes contamination from the vagina

critical to withdraw the cotton swab & plunger in THAT ORDER!!! if the plunger is withdrawn first, the cotton swab may break & be left in the uterus

Question 13

what is the purpose of doing a uterine cytology in a mare BSE?

Answer 13

detects the presence of endometritis with swab + low volume lavage

interpretation relies on neutrophils/hpf (1-2 = mild, 3-4 = moderate, & >5 = severe)

must interpret alongside palpation, ultrasound, & culture results

Question 14

what is the most common pathogen isolated from uterine culture of a mare that grows on blood agar?

Answer 14

streptococcus zooepidemicus - beta-hemolytic strep, will cause hemolysis around it

Question 15

what are the limitations of doing a uterine culture during a mare BSE?

Answer 15

it only samples a very small area of the endometrium - only samples the surface not the gland crypts

false positives due to contamination

Question 16

when would you use a MacConkey medium for a uterine culture taken during a mare BSE?

Answer 16

if you suspect gram negative bacteria - it only grows gram negative bacteria

Question 17

why do a speculum examination of a mare during a BSE prior to digital palpation? what is the risk of doing this?

Answer 17

you get to view all the parts before you mess it up!

may contaminate the caudal cervix

Question 18

what should you evaluate when using a speculum on a mare BSE?

Answer 18

vestibulovaginal seal, persistent hymen, vaginitis/cervicitis, urine pooling, pus, lacerations, adhesions, & varicosities

Question 19

how do you differentiate a cyst/cystic remnants from a developing follicle in a mare BSE?

Answer 19

developing follicle will get larger, progress, & eventually ovulate

cysts will not change in size over time

Question 20

what are cystic epoophorons that may be found on a mare BSE? what are the often misinterpreted as?

Answer 20

leftovers of the male reproductive tract!

can be misinterpreted as a follicle on ultrasound

Question 21

T/F: fossa cysts on mare ovaries may limit normal ovulation

Answer 21

true

Question 22

T/F: in a mare BSE, an endometrial biopsy is the single most informative procedure that is done

Answer 22

true

Question 23

why is an endometrial biopsy so valuable in a mare BSE?

Answer 23

can determine the mare’s ability to become pregnant & carry a foal to term

identifies - periglandular fibrosis, cystic gland distribution, lymphatic lacunae, & endometritis

Question 24

what are some pathologic changes that may be seen on endometrial biopsy taken during a mare BSE?

Answer 24

inflammation, cystic gland distension, lymphatic lacunae, & peri-glandular fibrosis

Question 25

what are some changes associated with chronic inflammation that may be seen on endometrial biopsy taken during a mare BSE?

Answer 25

MOST COMMON PATHOLOGIC CHANGE!!!!

due to infection or is residual - it is reversible

Question 26

where are lymphatic lacunae found in the uterus of a mare? what should you be careful of confusing it for?

Answer 26

present in the endometrium & myometrium

epithelial lining - beware of artifact!

Question 27

what are the different grades given for uterine/endometrial biopsy?

Answer 27

chance of becoming pregnant & carrying a foal to term

grade I - > 80%
grade IIa - 50-80%
grade IIb - 10-50%
grade III - 10%

not all category IIIs are equal! some are reversible!

Question 28

how is an endometrial biopsy performed during a mare BSE?

Answer 28

pass the instrument deep into the uterus & pull multiple pieces from the uterus!!!

glands go deep into the endometrium - very important to evaluate the entire tissue & not just the surface epithelium!

Question 29

what are some reasons you may be called in to do a BSE on a mare?

Answer 29

pre-purchase exam

pre-season (breeding)

problem mare

Question 30

what are some reasons that a mare may fail to conceive?

Answer 30

endometritis, pyometra, anatomic defects, & oviductal dysfunction

Question 31

what is shown on this ovary?

Answer 31

cystic epoophoron - remnants of the mesonephric tubules

Question 32

what pathology is seen on this endometrial biopsy taken during a mare BSE?

Answer 32

periglandular fibrosis

Question 33

what pathology is seen on this endometrial biopsy taken during a mare BSE?

Answer 33

glandular atrophy

Question 34

what is seen on this endometrial biopsy taken during a mare BSE?

Answer 34

lymphatic lacunae

Question 35

which of these endometrial biopsies is a reversible grade III?

Answer 35

left - irreversible

right - reversible