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CAEM Pt. 2 > Exam #4: Respiratory Pt. 1 > Flashcards

Exam #4: Respiratory Pt. 1 Flashcards

1
Q

What are the most common infectious equine respiratory diseases (4)?

A

1) Strangles (Strep equi or Strep zoo)
2) EHV-1, EHV-4 (EHV-2)
3) Equine influenza
4) Equine viral arteritis

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2
Q

What are the two general questions we ask when presented with respiratory signs?

A
  • Contagious or non-contagious

- Upper or lower respiratory tract

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3
Q

Historical questions we ask with respiratory cases

A
  • Daily management
  • Performance
  • Recent travel or movement
  • Medical and vax history
  • General history of the animal
  • Farm history
  • Clinical signs of animal, duration, severity
  • Previously treated? Effective?
  • Diet and feed
  • Deworming history
  • Current activity
  • Other animals affected?
  • Housing, ventilation, bedding types
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4
Q

How to perform the PE of a respiratory case

A
  • If traveled, let them settle for 15 minutes
  • Observe from a distance = mental status, demeanour, stance, dyspnea, noise, RR, nasal discharge
  • TPR = prior to manipulating the horse
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5
Q

Where does inspiratory noise localize us to?

A

Upper respiratory tract

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6
Q

Where does expiratory noise localize us to?

A

Lower respiratory tract

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7
Q

Ratio of normal inspiratory, expiratory and pause phase of respiration?

A

1:1:1

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8
Q

When do we consider coughing chronic?

A

When it’s occurred for > 3 weeks

  • Rule acute causes of cough
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9
Q

What do you suspect if there’s coughing and abnormal lung sounds?

A

Pulmonary or lower respiratory tract disease

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10
Q

What causes coughing?

A

Stimulation of irritant receptors in the airways - defense mechanism to enhance airway clearance

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11
Q

Common origin of hemoptysis

A

Comes from airway or lung parenchyma = indicative, usually, of lower respiratory tract disease

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12
Q

Common cause of nasal flaring

A

+ Distension of nares on inspiration to increase air intake

*Usually indicative of upper respiratory disease

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13
Q

Where does nasal discharge localize you to?

A

Can originate from any level of the respiratory tract

  • Lower respiratory tract discharge can be swallowed and unapparent
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14
Q

DDx for nasal discharge (3)

A
  • Respiratory infection - sinusitis, rhinitis, pneumonia, etc
  • Tooth root abscess
  • CHOKE = make sure to rule it out
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15
Q

DDx and origin of epistaxis (2)

A
  • Can be from both upper and lower respiratory tract
  • May be swallowed if from lower respiratory tract
  • DDx = bleeding disorder
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16
Q

DDx for conjunctivitis (3)

A
  • Conjunctivitis
  • Obstruction of nasolacrimal duct
  • Obstruction of nasal passage, guttural pouch, or sinuses
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17
Q

What does erosion of the mucocutaneous border of the nostrils indicate?

A

Chronic nasal discharge

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18
Q

Normal adult and foal RR’s

A
  • Adult = 12- 20 bpm
  • Foal post-foaling-30 min = 60-80 bpm
  • Foal 1-12 hrs post foaling, sternal = 30-40 bpm
  • Foal (1 month) = 12-30 bpm

*Activity level and temperature affect respiratory rate = compare to normal horses if you’re concerned

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19
Q

Eupnea

A

Normal, quiet, effortless breathing with 1:1:1 ratio (ins, exp, pause)

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20
Q

Tachypnea

A

Rapid frequency and shallow depth, or small tidal volume breathing

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21
Q

Hyperpnea

A

Increase in depth and rate of breathing

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22
Q

Apnea

A

Period of no respiratory effort is made and air flow has ceased

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23
Q

Dyspnea

A

Difficulty breathing - animal is distressed, increased work to breathe is evident

+ Heave line w/ dyspnea = acute
+ Heave line w/ eupnea = chronic problem

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24
Q

Hypoventilation

A

> ARTERIAL SAMPLE ONLY

- Respiratory pattern that alters gas exchange to cause arterial HYPERCAPNIA (high PaCO2)

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25
Q

Hyperventilation

A

> ARTERIAL SAMPLE ONLY

- Respiratory pattern that increases alveolar ventilation and results in arterial HYPOCAPNIA (low PaCO2)

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26
Q

Cyanosis

A

> When the Hgb isn’t saturated (< 80%)
- Occurs with PaO2 < 50 mm Hg
+ Bluish discoloration of the mucous membranes
*Anemia may mask the signs of cyanosis

> > Examine PaO2, PaCO2, and oxygen saturation

27
Q

Localization and respiratory phase of stridor

A

+ Abnormal respiratory sign, high pitched (turbulent air flow), usually INSPIRATORY
- Usually due to upper airway disease

*Compare sound over trachea to lung sounds to ensure it’s not a referred airway noise

28
Q

PE of the upper respiratory tract - things to look for

A
  • Symmetry of posture and airflow
  • Respiratory movement?
  • Inspiratory flaring (occurs with increased respiratory effort)
  • Air flow, normally, doesn’t create any noise
  • Paralysis of nostril will result in collapse = inspiratory obstruction
  • Exertion or gallop-normal expiratory sound (“high blowing”)
  • Malodorous?
  • Skin depigmentation from chronic discharge
  • Nasal discharge
  • Epistaxis
29
Q

What does skin depigmentation of the nares indicate?

A

Chronic nasal discharge

30
Q

What does asymmetrical nasal airflow, unilateral nasal discharge, or epistaxis indicate?

A

Upper respiratory lesion, rostral to the caudal extent of the nasal septum

31
Q

What does a malodorous nasal discharge indicate?

A

Likely a bacterial infection, commonly anaerobic

32
Q

Things to examine if you suspect sinusitis

A
  • Facial symmetry or swelling
  • Look inside mouth = cheek teeth, tongue, hard palate deviation
  • Percuss the sinuses, compare side to side (sound is louder if mouth is held open)
33
Q

Things to do during your larynx, trachea, and LN exam

A

> Larynx = palpate for symmetry, evaluate w/ endoscope (slap test?)
Trachea = squeeze trachea and look for cough, palpate for cartilage abnormalities
LN’s = palpate retropharyngeal and submandibulars (throat-latch area) for swelling
- DDx = LN, salivary glands

34
Q

Examination of the thorax

A
  • Observe respiratory rate and pattern at a distance
  • Expiratory = double effort = abdominal lift during natural diaphragmatic relaxation, 2nd “lift” with muscular contraction of body wall
  • Auscultation of the ENTIRE lung field (3-17 ICS)
  • Compare noise to over trachea and larynx
  • Use a rebreathing bag to accentuate normal and abnormal lung sounds
35
Q

Heave line, and what does it indicate?

A

Outline to a hypertrophied external abdominal oblique muscle

  • Indicates increased EXPIRATORY effort
  • May be normally well defined in a fit horse
36
Q

Is open mouth breathing a problem?

A

YES - ER CASE (horses are obligate nose breathers)

37
Q

True or false - you should use a rebreathing bag to examine every respiratory case

A

FALSE - contraindicated in horses with increased respiratory effort at REST

38
Q

Crackles, where do they come from, when do you hear them?

A

> Snapping open of collapsed airways, implies fluid or infiltrate accumulation in airways/alveoli

  • Commonly heard on INSPIRATION
  • Common with pneumonia
39
Q

Wheezes, where do they come from, when do you hear them

A

> Longer, musical sound due to resonant vibration of airway walls before closing or opening

  • Implies decreased airway lumen diameter = thickening of airway or collapse due to surrounding pressure
  • More commonly EXPIRATORY, but can be inspiratory
40
Q

Absence of lung sounds dorsally and ventrally mean?

A
  • Dorsal = pneumothorax

- Ventral = pleural effusion, lung consolidation, or mass

41
Q

Dx? Pain on palpation of ICS

A

Pleurodynia, usually due to pleuritis or trauma

42
Q

Diagnostics for respiratory disease (besides history and PE)

A
  • Arterial blood concentrations
  • U/S
  • Radiographs
  • Endoscopy
  • Fluid collection = sinuses, guttural pouch, tracheal, bronchoalveolar, thoracic –> PCR, culture, cytology
  • Biopsy
43
Q

Pros/cons of percutaneous tracheal lavage

A

+ Cleaner sample = aseptic sampling avoids URT contamination = good for CULTURE and CYTOLOGY
+ Lower cost
+ Simpler than endoscopic

  • Can cause tracheal reactions
  • Can lose sampling tube
44
Q

Pros/cons of transendoscopic tracheal lavage

A

+ Avoids complications of transtracheal approach
+ Can visualize your specimen
*In good agreement with TT approach

  • Can get oral and pharyngeal contamination
  • Use guarded tubing to prevent contamination if you’d like to culture
45
Q

What diagnostic do you use if you suspect diffuse alveolar disease?

A

Bronchoalveolar lavage - use with endoscope and cuffed BAL tube

46
Q

Comparison of TTW and BAL, which do you do first if you do both

A

> Do TTW first and BAL second (will contaminate trachea)

> TTW = samples all parts of lung

  • Good for focal disease
  • GOOD for culture
  • Worse for cell morphology

> BAL = samples small segments of the lung

  • Good for diffuse disease
  • Questionable for culture
    - BETTER cell morphology
47
Q

What is the diagnostic of choice to examine the pleural surface and space?

A

> U/S - atlectasis, pleural effusion, monitor progression
*Can guide thoracocentesis (CRANIAL to rib at 6-7th ICS)

*Can also be used to evaluate the parenchymal disease = consolidated (difficult on aerated lung) or abscesses near the surface

48
Q

Bacterial and viral samples to send to lab for diagnostics

A
  • Bact = flush or guttural pouch or nasal cavity, sterile swab (w/ approriate media)
  • Virology = collect EARLY in disease, nasopharyngeal swabs - GOOD, send in viral transport media, keep swabs cold and damp
49
Q

Where can we draw arterial samples from?

A
  • Facial artery (ventral)
  • Transverse facial artery
  • Carotid artery, if they won’t sit still
  • Sedatives can affect your blood gas results
  • Keep pressure on site 3-5 minutes after sampling
  • Analyze within 10 min or place on ice and examine in 90 min
50
Q

Causes and level of hypoxia

A

> Hypoxia = PaO2 < 85 mm Hg

  • Vent/perfusion inequality
  • Hypoventilation
  • Low inspired O2
  • Shunts
  • Diffusion impairment

*Use the arterial and alveolar gradient for oxygen to diagnose the source of hypoxemia

51
Q

What is the most sensitive indicator for adequacy of ventilation?

A

PaCO2 (also assesses perfusion)

52
Q

DDx for nasal discharge in a young foal (6 mo)

A

1) Sinusitis
2) Guttural pouch disease, Ex: empyema
3) Pharyngitis, abscess

  • Lymphoid hyperplasia = common in young horses, but doesn’t cause nasal discharge
53
Q

Most common cause of lower respiratory signs in young foals

A

Pneumonia - bacterial (MOST COMMON), fungal, +/- viral

54
Q

Diagnostic tests of young foal respiratory disease

A
  • CBC
  • Endoscopy
    +/- Radiographs of lungs or guttural pouch
  • Thoracic U/S
    +/- Blood gas if severely infected (difference between arterial and alveolar O2 to ID mismatch)
  • Cytology and culture of airway infiltrate
55
Q

Dx? Bilateral nasal discharge in a young foal, retropharyngeal swelling, history of URT infections, CBC = mature neutrophilia, hyperfibrinogenemia, fluid line on guttural pouch rads

A

Guttural pouch empyema, etiologic agent = Strep equi equi or Strep zoo

*Suspect the animal also has LRT disease

56
Q

Treatment of guttural pouch emypema

A
  • Flush and drain guttural pouches = common to have to repeatedly flush
  • Look for chondroids (flushing won’t help)
  • Systemic antibiotics = penicillin for Strep
  • NSAID’s (Banamine)
  • Elevate feed off ground
  • Surgery if irresponsive after 14 days or if chrondroids are present
57
Q

Medial and lateral guttural pouch contents

A
  • Medial = LARGER, where most exudate accumulates = internal carotid a. CN IX-XII (branch of X), cranial sympathetic ganglia
  • Lateral = external carotid a., maxillary a., CN V, VII (branch of), VIII
58
Q

Pathology of empyema in younger foals

A

Ascending infection from the lower respiratory tract = chronic and localized in nature

Can also be a rupture of a retropharyngeal LN

59
Q

Dx and Tx? Non-painful, soft swelling behind the mandible, dyspnea, dysphagia

A

> Guttural pouch tympany = redundant fold of plica salpingopharyngea

  • Medical tx = pass cannula through nose to release air, leave it in for 6 weeks to see if it enlarges the opening
  • Surgical tx = enlarge the opening
60
Q

Dx? Unilateral or bilateral spontaneous epistaxis in a resting animal, dysphagia, Horner’s syndrome, facial paralysis, laryngeal hemiplegia

A

Guttural pouch mycosis, commonly due to Aspergillosis

*Likes to grow on the internal carotid or branches of external maxillary arteries

DDx = EIPH but doesn’t have neurologic signs

61
Q

How do you differentiate between EIPH and guttural pouch mycosis?

A
  • Does it occur at rest or after exercise?

- Do you concurrent neurologic signs?

62
Q

Treatment of guttural pouch mycosis

A
  • Stop bleeding with surgery and fluids

- Med tx = not great results

63
Q

Dx? Ptosis, miosis, enophthalmos, ispilateral facial sweating, regional hyperthermia, congested MM

A

Horner’s syndrome - often due ear or guttural pouch infections

CAEM Pt. 2 (27 decks)

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