Intro to nasal discharge

Question 1

What is unilateral discharge normally from

Answer 1

rostral to the nasal septum (nasal passages and sinuses)

Question 2

What is a bilateral nasal discharge where is it normally from

Answer 2

caudal to the nasal septum (guttural pouch, pharynx, larynx, trachea, bronchi and lungs), but sometimes these can present as unilateral discharge

Question 3

define upper respiratory tract

Answer 3

refers to structures rostral to the larynx.

Question 4

define lower respiratory tract

Answer 4

refers to structures caudal to the larynx.

Question 5

List 7 history questions clinical signs of nasal discharge to get from owner

Answer 5

Unilateral/bilateral (anatomical location)
Type of discharge (type of disease)
Swelling, pain, lymph node enlargement (URT)
Respiratory noise (URT)
Cough (pharynx/larynx or LRT)
Exercise tolerance
Appetite, demeanour
Respiratory rate and effort (LRT)

Question 6

Describe how to perform physical examination of the upper and lower respiratory tract

Answer 6

Exam at rest
use of rebreathing bag
examination after exercise
Depending on history and clinical examination findings:
- Oral/dental examination
- Neurological examination

Question 7

List 5 clinical signs that localise disease to head/ pharyngeal region with nasal discharge

Answer 7

Submandibular or retropharyngeal lymph node enlargement
Guttural pouch swelling
Draining tracts
Dental abnormalities
Respiratory noise

Question 8

List 7 clinical signs of lower airway disease in horses

Answer 8

cough
increased resp rate
increased resp effort
Increased respiratory noise on auscultation
Stance and demeanour (pneumonia)
Exercise intolerance
+/- systemic signs

Question 9

List the differentials of a Haemorrhagic nasal discharge

Answer 9

trauma- injury, foreign body
vascular damage- ethmoid haematoma, exercise-induced pulmonary haemorrhage
erosive conditions - neoplasia, mycosis

Question 10

List the differentials of a mucoid or serous nasal discharge

Answer 10

viral infection
non-infectious inflammatory disease (asthma)

Question 11

List the differentials of a purulent (no odour) nasal discharge

Answer 11

bacterial
possibly secondary to viral infection

Question 12

List the differentials of a purulent (foul odour) nasal discharge

Answer 12

Usually mixed bacteria with anaerobes – check for underlying cause
dental disease
neoplasia
mycosis
foreign body

Question 13

List the differential of food material in nasal diacharge

Answer 13

Breakdown of pharyngeal anatomy (cleft palate, oral fistula, dental disease)
Choke
Grass sickness

Question 14

what is radiography good at helping you to diagnose with nasal discharge

Answer 14

dental, sinus and guttural pouch conditions

Question 15

what is endoscopy good at helping you to diagnose with nasal discharge

Answer 15

Most URT and LRT lesions, visualising inside spaces, soft tissue and mucosal lesions

Question 16

what is most useful on haem and biochem when investigating nasal dischage

Answer 16

infectious processes or systemic involvement
haem- WBC
fibrinogen
serum amyloid A

Question 17

what type of horses are more likely to get strangles or flu

Answer 17

young horses

Question 18

what does nasal discharge + massive LN enlargement suggest

Answer 18

strangles

Question 19

what does nasal dischagre + ocular oedema suggest

Answer 19

equine viral arteritis

Question 20

what is quidding

Answer 20

dropping bits of chewed food

Question 21

Describe how to use a rebreathing bag

Answer 21

place a bag over the horses nostrils and allow carbon dioxide to build up, as the horse takes deep breaths you can take the bag off and then you can hear sounds easier

Question 22

Describe how to test for strangles

Answer 22

nasal swab
guttural pouch lavage and serology