Medicine Flashcards
List the major differentials for recurrent episodes of stiffness and reluctance to move in the adult horse. Describe your approach to this case, including relevant history, clinical findings, further diagnostic tests, immediate treatment and future management. (4,4,4,10,4,4)
Recurrent exertional rhabdomyolysis, Polysaccharide storage disease, white muscle disease (vit E and selenim deficiency)
Diet, exercise history, level of fitness, previous episodes, clinical signs, signalment, concurrent medication, time of episode relating to exercise.
Hard, painful hot muscles, high grade bilateral/all limb lameness, neurologically normal, dark urine, reduced volume of urine, pain- colic signs, typically only move FLs so circle around HLs.
Bloods, elevated lactate, AST, CK. Urinalysis- concentrated, myoglobninurea, may progress to renal failure (increaed urea, decreased volume of dilute urine). If warmblood or quarter horse, genetic test for PSSM. Muscle biopsy. Rule out laminitis or foot abscess, or septic joint using hoof testers, clinical exam of limbs for wound.
Fluids (oral via stomach tube or IV) to prevent renal disease via myoglobin, NSAIDS, possible dantrolene (muscle relaxant). Sedation may be useful. Box rest briefly, PSSM cases benefit from turnout after a couple of days.
Alter diet to a oil based energy source to reduce soluble carbohydrate levels. Ensure regular exercise of a consistent amount. Feed to work done not to work about to be done.
List 4 specific disorders that might lead to endotoxaemia in the horse. Describe the clinical signs indicative of endotoxaemia irrespective of initial cause and outline a treatment plan for one of the differentials you listed. (4,4,4)
Retained foetal membranes, strangulating obstruction of the small or large intestine, penetrating wounds into the abdominal cavity (incluuding full thickness rectal tear) or joints. Foal septicaemia (rhodococcus, e.coli, salmonella, klebsiella, pseudomonas, clostridia via umbilcus, placenta, GI tract, respiratory).
Dehydration, increased heart rate, decreased BP, weak peripheral pulses, endotoxic red rim around gums, or congestion, or necrosis (black). General depession/lethargy with anorexia. Pyexia, progressing to subnormal temperature. WBC changes, cool extremities, tachypnoea, DIC, siezures, renal failure, diarrhoea, laminitis, abortion.
Retained foetal membranes- Oxytoxcin, ensure exposed membranes tied up, add a weight to them (rectal glove of water), see if can manually detach them by passing hand between uterine wall and membranes- apply no pressure. IV antibiotics (broadspectrum) eg crystapen and gentamycin. NSAIDS- flunixin for proven antiendotoxic effect. Ice feet, ideally using game ready machine to keep dry. Fluids if indicated. Colostrum for foal.
You are asked to administer a vaccine to an 11 year old warmblood that is used for eventing. On cardiac auscultation, you hear an irregularly irregular rhythm that you consider is likely due to atrial fibrillation.
A) what is another common cause of dysrhythmia in the adult horse.
B) what clinical signs are associated with AF
C) how would you investigate this further
D) describe the availiable treatment options
(1,4,5,2)
Second degree AV block
Sudden onset exercise intolerance, poor performance or collapse. May have no clinical signs until auscultation. Cyanosis or pallor of mucus membranes possible. An iregularly iregular heart rhythm that doesnt become regular with exercise. Often resolves on its own within 48 hours (paroxysmal AF), maybe associated with underlying disease, and show clinical signs associated, eg jugular pulse, ventral oedema, pulmonary oedema.
Electrocardiography, assess P waves to see if always associated with a QRS, often see no P waves with F waves instead. Ventricular complexes may look normal if no other underlying changes.
Echocardiography using linear and doppler probes to assess size of chambers, especially for atrial enlargement, also to look at flow across the valves.
Auscultation, bloods for muscle enzymes (CK), lactate and cardiac troponin 1 a marker of heart disease.
Most cases resolve spontaneously, quinidine is a type 1a antidysrthythmic agent that can block fast acting sodium channels in a use dependant manner. It causes multiple side effects including depression, GI signs and other arrythmias and has a narrow therapeutic index. Other drug options include digoxin, though this is even more dangerous and should only be used if the AF is refractory to other methods of conversion. Electrocardioconversion can be done under GA, and resets the electrical conduction through the heart.
You are called to an 18 year old cob which has been dull and depressed with mild colic signs for the last 6 hours. The horse has a heart rate of 44 bpm. On questioning the owner, the horse has not passed faeces within the last 12 hours. The horse has been stabled on a straw bed. On rectal examination you can palate a large doughy mass in the left caudal abdomen.
A) what is your most likely diagnosis
B) how would you treat this case
C) what is the prognosis in this case
D) what advice would you give the owner on future management of this horse (1,6,1,4)
A large colon impaction (most likely at the pelvic flexure)
NSAID- phenylbutazone or flunixin (finadyne) IV.
Buscopan to aid rectal, relaxation of smooth muscle particularly of the caudal GI tract, especially rectum. May need sedation to rectal and pass tube (alpha 2 agonist/torbugesic)
Stomach tube, check for reflux. Give 2L warm water to check for reflux. If no reflux (as we would expect), give liquid paraffin (3L), with 7L warm water with electrolytes. Magnesium salts (Epsom salts) are an alternative. Aim to soften the impaction by drawing water into the GI tract. Some people use high volume paraffin on its own. Withhold food until impaction passed. Offer water.
Check horse again within 6-12 hours to assess sytemic status and look for passage of faeces. May need re-tubing.
Prognosis is good, only mild pain, currently systemically well. Impactions normally pass, though there is a risk of secondary displacement of the large colon.
It is likely this horse has been eating his bed, many horses find straw palatable, change bed to shavings or paper. Gradually increase feeds of soaked hay or grass until back to normal. Try and turn out to reduce bed eating and increase liquid intake. Ensure all changes in management are undertaken gradually. Check teeth to ensure able to break down food properly.
You are called to a livery yard where three horses are present with fever, bilateral submandibular lymphadenopathy and bilateral mucopurulent nasal discharge that you consider might be due to strangles.
A) what is the likely aetologic agent
B) List three diagnostic procedures you could perform to confirm your presumptive diagnosis
C) what diagnostic tests should you submit your samples for
D) the owner asks you about complications of this infection, briefly describe three complications that can occur and outline the presenting clinical signs of each. (1,3,2,6)
streptococcus equi var equi
nasopharyngeal swab
guttural pouch wash via endoscopy
ELISA to show rising antibody titre on blood
submit samples for culture and sensitivity and PCR
complications-
bastard strangles- metastatic absecesses found elsewhere on body- hard hot lump depending on location. may be systemically ill.
guttural pouch empyema/chondroids- recurrent infection, swollen gutuural pouches, yellow plaques/chondroids on endoscopy of GP form a carrier state- new outbreaks, may look healthy
purpura haemorrhagica- immune complex deposition causing vasculitis and petechiation of mucus membranes. Also possible glomerulonephritis.
An owner calls you because she has an 8 year old miniature donkey that has nit been eating for 3 days. While relaying some details, the owner tells you that the donkey foaled down 4 weeks previously.
A) what initial advice do you give the owner
B) the owner has a trailer and decides to bring her donkey and foal into the practice for you to evaluate. You take a blood sample and it sits on the counter for 20 mins while you ffinish your clinical exam. Visual inspecion after this timw reveals the plasma to be markedly opalescent. What condition do you expect to be occurring?
C) List 3 common causes of this condition and state the underlying pathological principle.
D) Describe a treatment plan for this donkey and explain your rationale
E) What sequale of this condition should you monitor closely for? (1,1,3,1,5,1)
Ensure the foal has been getting milk, possibly top up with artificial foal milk. Tempt the mare to eat if at all possible.
Hyperlipaemia syndrome
Pregnancy, systemic disease, malnutrition. High energy requirement and lack of food mean negative energy balance leads to excesive mobilisation of fatty acids from adipose tissue. Leads to hypertriglycerideamia and fatty infiltration of the liver and liver damage.
Correct any underlying disease, IV fluids and nutritional support to prevent further damage- an electrolyte solution containg dextrose and potassium should be given if hypoglycaemic and hypokalemic patients. Voluntary enteral nutrition preferred if the animal will eat adequate quantities, frequent feedings of high carbohydrate low fat diet with supplemental tube feeding if needed. Monitor body weight, total fluid intake and faecal consistency.
Monitor closely for liver disease.
A 3 week old TB foal has been in hospital undergoing corrective surgery for an angular limb deformity and now presents with teeth grinding, excessive salivation, and mild intermittent abdominal pain.
A) What is your most likely diagnosis?
B) Describe how you would confirm your diagnosis.
C) List the treatment options available
D) What possible complications are there
E) ho would you prevent the development of this condition? (1,3,4,2,2)
Gastroduodenal ulcers
Response to treatment, endoscopy, radiography ultrasound
Omeprazole, rantidine/cimetidine, sucralfate, management to decrease stress, analgesia (not steroids or non steroidals) misoprostal (pgs to repair) supportive care
Perforation, peritonitis, haemorrhage, anorexia, ill thrift
Prophylactic omeprazole, reduce stress, promote sucking or tube feed, aggressive treatment
Discuss intrauterine fluid accumulations after covering in the mare and how you would treat this. (8,4)
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- You are called to a busy eventing yard to examine a 3 year old gelding with a bilateral mucopurulent nasal discharge. On clinical examination, the horse is dull and depressed, with a temperature of 39.2°C and has enlarged submandibular lymph nodes. What is your most likely diagnosis in this case (1 mark)? Describe how you would manage this case (7 marks) and any advice that you would give to the owners of the yard (2 marks).
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A 15 year old Cob mare with mild weight loss, depression and partial anorexia is admitted to the hospital for investigation. You are informed by your colleague in the field that a preliminary blood screen is suggestive of liver disease. How would you approach the management of this case? Include:
a. history (3 marks)
b. clinical signs of liver disease (3 marks)
c. differential diagnoses (6 marks)
d. relevant clinical pathology and interpretation (6 marks)
e. further diagnostic tests (6 marks)
f. treatment options (4 marks)
g. prognosis (2 marks)
History - weight loss, dentition, worming history, access to ragwort or other phylloerythins, any diarrhoea, any jaundice, depression, other problems or concurrent diseases, feed.
Clinical signs - weight loss, anorexia, depression, photo sensitisation, hepatic encephalopathy, endotoxaemia, haemorrhage, steatorrhoea, icterus, colic.
DDx - parasitism, dental problems, Cushings, inappropriate food, EHV, IBD, lymphoma.
Clinical pathology - non regenerative microcytic anaemia, hypoalbuminaemia, increased coagulation times, hypoglycaemia, raised liver enzymes like GGT, ALP, AST, GLDH, bilirubin, decreased BUN, neutrophilia.
Further tests - liver biopsy, urinalysis, basal ACTH, dental exam, fwec, rectal biopsy, ultrasound, radiography, abdominocentesis, endoscopy, laparoscopy for biopsies if no answer.
Treatment - steroids, fluids and correct electrolytes, lactulose for hepatic encephalopathy, antibacterials, antifibrinolytics, specific diet (grass/hay, low AAA:BCAA ratio of protein, SAMe.
Prognosis - depends on cause and if liver disease, liver is very good at regeneration, if not too much damage prognosis good, however if too much damaged then not good.
- You receive a phone call from a client who is concerned that her 12 year old pony is reluctant to move. On questioning, she reports that 2 days previously, the pony had broken into the feed shed.
a. What the likely diagnosis in this case (1 mark)?
b. How would you confirm this diagnosis (2 marks)?
c. How would you go about treating this pony (5 marks)?
d. How may this condition have been prevented or alleviated following the feed shed incident (2 marks)?
Laminitis due to carbohydrate overload
Clinical exam, resting weight on heels, general TPR for pain, unwilling to lift feet. Pain on hoof testers around solar margin. Just in front of frog digital pressure. DPs bounding. Can do x rays if unsure.
Management- box rest for min 6 weeks on a deep bed that packs into feet (shavings), can use frog supports, soak hay for up to 24 hours and no hard feed apart from balancer. Reduce amount of hay and feed in double nets to spread out. Give pain relief- bute. Can sedate using acp.
Radiographs to assess rotation and corrective farriery if needed longer term.
Icing the feet or using a game ready machine to reduce toxin supply to the feet. Minimise concussive trauma by box rest. Use bio sponge to attempt to absorb toxins.
You have been asked by a horse and pony fan club at a local school to give a talk to pupils and their parents on basic horse health management. This is intended as a guide to prospective new horse owners. What advice would you include in this talk to assist your audience in preventing disease in their animals (10 marks)?
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List four basal and/or dynamic function tests that can be used for the diagnosis of Equine Cushing’s Disease (4 marks). Choose three of these tests and for each test highlight any advantages and disadvantages (6 marks).
Basal ACTH TRH stimulation test Overnight dexamethasone test Combined dexamethasone suppression - TRH stimulation test Alpha-MSH
Basal - seasonal variation, false negatives and false positives, sometimes inconclusive. Ice quickly, separate in 8 hours.
TRH stim test - basal ACTH, inject then thirty minutes later, false positives in one in three, safe and rapid.
Overnight dex - 5pm basal cortisol, 2nd 19hours later, false negatives and false positives possible. Two visits, time, cost more?
A 9 hour-old foal starts to exhibit signs of abdominal pain consistent with meconium retention. Briefly describe:
a. How you would confirm your diagnosis (5 marks).
b. How you would treat this case (5 marks).
History- signalment (colt>fillies), passed meconium?,
Clinical exam- intermittent colic signs, so increased heart rate and respiratory rate, rolling, bruxism, off suck, continuous straining
Ultrasound possible for distended large intestine
Radiography for distended small intestine
? treat anyway?
phosphate enemas not effective acetylcysteine enemas used butorphanol and hyoscine (buscopan) to reduce straining and relieve pain liquid paraffin probably uneccessary could attempt careful digital removal
An owner wants to get her 5 year old Thoroughbred mare covered by a stallion at a leading Newmarket Stud. Describe the tests that are required (4 marks) and the pre-breeding work up you would do on this mare (6 marks)
Tests - CEM - one negative culture or PCR cliteral swab and one negative endometrial swab taken during oestrus for taylorella equigenitalis, klebsiella pneumoniae, pseudomonas aeroginosa, post first January.
EVA - after first January one blood sample if seronegative, if seropositive take a later sample for declining titre.
EIA same again.
Strangles if history on yard coming from.
Dourine if from Italy.
Prebreeding work up - history, clinical exam of all parameters, reproductive exam, vaginoscopy, rectal for ultrasound of reproductive tract. Check udder, lameness check.
You are called to see a horse with ingesta at both nostrils. List three likely differential diagnoses (3 marks). Pick the most common of these and briefly outline your treatment plan for it (7 marks).
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. Why is it important to routinely examine the mare’s placenta post partum (3 marks)? Describe how you would assess the term equine placenta for normality and the structures involved (7 marks).
Any of the placenta left behind in the uterus could cause an endometritis leading to endotoxaemia and laminitis which can be rapidly fatal.
It is useful to identify signs of potential disease and at risk foals. Can identify placentitis, signs of a twin, villous atrophy, likely route of disease entry and risk to mare.
I would weigh the placenta- should be around 11% of foals body weight, too small and the foal is likely to be malnourished and too large likely placentitis
Lay the chorioallantois out in a F or Y shape. Look at colour (expect pale pink outer, red velvet makes you suspect early placental separation. Look for completeness- most likely area to be left behind is the tip of the non pregnant horn. The placenta should have ruptured at the cervical star.
Turn the chorioallantois inside out, should be covered with red velvet everywhere except the cervical star, tips of the horns (fallopian tube entry) and where the endometrial cups have regressed.
There may be some solid material- a hippomane, and the amnion should be translucent and relatively hypovascular. The cord should not be excessively torsed or dark.
An appointment has been booked for you to examine an 8 year old Irish draught mare, with a history of stiffness and reluctance to move on 3 previous occasions in the last 6 months. In this current episode, the mare is slightly stiff behind, and the muscle enzymes 12 hours after the clinical signs presented are elevated at CK 1200u/l (ref range 0-50 u/l), and AST 1200 u/l (ref range 150-230u/l).
Describe your approach to this case, including relevant history (6 marks), clinical findings (6 marks), further diagnostic tests (6 marks), immediate treatment (6 marks) and future management (6 marks).
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A 16 year old pony gelding is found colicking by its owners at 9am. It had been seen the previous evening at 7pm and appeared normal, and has no previous history of colic. Describe how you would approach the diagnosis (15 marks) and the management of this case including a brief outline of the treatment options available (15 marks).
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Briefly describe the three stages of parturition in the mare including the important characteristics of each (10 marks).
First stage- start of myometrial contractions, 6-24 hours, mare can appear to go into quiesence if stressed, see mild colic signs, restlessness, leaving herd, flank watching, may run milk, sweating. Foal rotates so spine parallel to mares (correct position)
Second stage start of abdominal contractions and thus expulsion of the allantoic and amniotic fluids. Should take 20 minutes, foal likely to be dead if over an hour. See abdominal straining and mare often down. Foal to be expelled, should start to see foal after 5 mins. Check foal presentation, position and posture.
Third stage expulsion of foetal membranes, should be rapid- under 2 hours, tie placenta so not damaged so can be inspected.
You are called to a 12 year old Cob gelding with an acute onset blepharospasm and periocular swelling. List the likely differentials (4 marks) and briefly discuss how you would investigate this case (6 marks).
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A 17 year old mare develops a mucopurulent vaginal discharge and starts to lactate in mid to late pregnancy. Briefly list the possible causes (3 marks). Briefly outline how you would investigate the most likely cause (7 marks).
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A 17 year old mare develops a mucopurulent vaginal discharge and starts to lactate in mid to late pregnancy. Briefly list the possible causes (3 marks). Briefly outline how you would investigate the most likely cause (7 marks).
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A 25 year old Shetland pony presents with depression and lethargy, tachycardia (heart rate 62 beats per minute) and icterus. History reveals that the owner has been trying to manage a subsolar abscess and has kept the pony stabled away from its usual field mate. The pony has not eaten for 5 days and a blood sample reveals milky serum.
What is the most likely diagnosis (1 mark)? What single test would confirm this diagnosis (1 mark)? Briefly describe your management of this case (8 marks).
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