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MODULE 15 - Cardiorespiratory and Haematopoietic Disease > PATHOLOGY - Equine Lower Respiratory Disease > Flashcards

PATHOLOGY - Equine Lower Respiratory Disease Flashcards

1
Q

What are seven general signs of respiratory disease in horses?

A

Cough
Nasal discharge
Altered respiratory rate, rhythm and/or effort
Respiratory noise
Altered airflow at the nostrils
Poor performance
Weight loss

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2
Q

Which questions can be useful to ask when gathering a history if you suspect respiratory disease?

A

Vaccinations/deworming?
Duration of the clinical signs?
Seasonality of the clinical signs?
Has any poor performance been sudden or progressive?
Any recent travel?
Are any other horses affected?
Ask questions about the enviornment the horse lives in?

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3
Q

What should you do during subjective observation of a horse with suspected respiratory disease?

A

Assess the environment such as ventilation, bedding and forage
Assess respiratory rate, rhythm and effort

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4
Q

What is the normal respiratory rate for a horse?

A

8 - 16 breaths per minute

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5
Q

What can be indicative of increased respiratory effort in horses?

A

Biphasic breathing pattern noticable at rest

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6
Q

What are three key signs of dyspnoea in horses?

A

Nostril flaring
Increased abdominal effort
Noise on inhalation/exhalation

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7
Q

What is indicated by rapid, deep breathing in the horse?

A

Rapid, deep breathing indicates respiratory distress

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8
Q

What is indicated by rapid, shallow breathing in the horse?

A

Rapid, shallow breathing can indicate pain, particularly pleural pain

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9
Q

What is indicated by slow, deep breathing in the horse?

A

Slow, deep breathing can indicate an underlying disease process such as equine asthma

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10
Q

Which eight factors should you assess during the clinical exam of the head and neck in a horse with suspected respiratory disease?

A

Assess for nasal discharge
Assess airflow at the nostrils
Palpate the lymph nodes
Assess facial symmetry
Assess for ocular discharge
Palpate the trachea
Auscultate the trachea
Listen for any upper respiratory noise

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11
Q

Which lymph nodes should you palpate on a horse?

A

Submandibular lymph nodes
Retropharyngeal lymph nodes

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12
Q

What is a tracheal pinch test?

A

If you pinch the trachea and this elicits a cough, this can be indicative of tracheal sensitivity

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13
Q

What is indicated by unilateral nasal discharge in horses?

A

Unilateral nasal discharge in horses is typically associated with disease of the sinuses or nasal passages

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14
Q

What is indicated by bilateral nasal discharge in horses?

A

Bilateral nasal discharge in horses is typically associated with disease of the lower respiratory tract

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15
Q

What are the different classifications of nasal discharge?

A

Mucoid
Mucopurulent
Epistaxis (blood)

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16
Q

What can be indicated by epistaxis at rest in horses?

A

Guttural pouch mycosis
Ethmoidal haematoma
Nasal polyp

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17
Q

What can be indicated by epistaxis during exercise?

A

Exercise induced pulmonary haemorrhage

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18
Q

Why might you get epistaxis following nasogastric intubation in the horse?

A

Nasogastric intubation can cause ethmoidal trauma and haemorrhage

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19
Q

What are the boudaries for equine thoracic auscultation?

A
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20
Q

What can be indicated by wheezes at the end of exhalation on equine thoracic auscultation?

A

Wheezes at the end of exhalation can indicate equine asthma

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21
Q

What can be indicated by pleural friction rubs on equine thoracic auscultation?

Pleural friction rubs sound like sandpaper

A

Pleural friction rubs can indicate pleuritis

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22
Q

What can be indicated by the absence of lung sounds on equine thoracic auscultation?

A

The absence of lung sounds can indicate pleural effusion or pneumothorax

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23
Q

What is a rebreathing exam?

A

A rebreathing exam involves placing a bag over the horse’s nose and mouth for one minute, which allows for the build-up of carbon dioxide stimulating the horse to take deeper breaths. It should then be easier to detect lung sounds on thoracic auscultation

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24
Q

(T/F) Coughing is normal during and following a rebreathing exam?

A

FALSE. Coughing is abnormal during and following a rebreathing exam

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25
Q

When should avoid doing a rebreathing exam?

A

Avoid doing a rebreathing exam if the horse is in respiratory distress

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26
Q

Which diagnostic tests can you do to investigate respiratory disease in a horse?

A

Endoscopy
Infectious disease sampling
Lower respiratory sampling and cytology
Ultrasound
Radiography
Thoracocentesis

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27
Q

How do you grade tracheal secretions seen during endoscopy?

A

Grade 0: No visible mucus
Grade 1: Single to multiple small blobs of mucus
Grade 2: Larger but non-coalescing blobs of mucus
Grade 3: Coalescing or stream forming mucus
Grade 4: Pool forming mucus
Grade 5: Profuse mucus

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28
Q

How should the guttural pouches appear on endoscopy?

A

The guttural pouches should appear transparent

There may be areas of black in horses with a dark coat due to melanocyte

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29
Q

When should you not assess the larynx during endoscopy?

A

If the horse has been sedated, as this can impede results

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30
Q

Which sampling method do you use for infectious disease sampling?

A

Nasopharangeal swab

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31
Q

Which sampling methods do you use for lower respiratory sampling and cytology?

A

Tracheal wash
Bronchoalveolar lavage

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32
Q

What is the main benefit of carrying out a tracheal wash?

A

Because respiratory secretions are brought up from the lungs via mucocilliary clearance, the sample obtained from the tracheal wash will be representative of all areas of the lungs

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33
Q

What are the two methods that can be used to carry out a tracheal wash?

A

Trans-tracheal (percutaneous) wash
Trans-endoscopic tracheal wash

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34
Q

How do you carry out a trans-tracheal (percutaneous) wash?

A
  1. Sedate your patient
  2. Palpate the ventral midline of the neck and carry out sterile prep instill local anaesthetic onto the area
  3. Carry out a small incision at the level of the tracheal ‘sump’ between two tracheal rings
  4. Insert the introduction catheter through the incision and into the trachea
  5. Thread the long collection catheter through the introduction catheter and when it is correctly positioned, slowly infuse 20ml of sterile saline and then start aspirating slowly
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35
Q

What kind of tube do you submit a tracheal wash sample in?

A

EDTA tube

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36
Q

What are the benefits of using an opioid in combination with the sedative drug when carrying out a trans-tracheal (percutaneous) wash?

A

Opioids are antitussive and thus will reduce coughing which could potentially displace the tracheal puddle, making it more difficult to aspirate

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37
Q

Why can you use a trans-tracheal (percutaneous) sample for both cytology and culture?

A

A trans-tracheal (percutanous) wash is done aseptically and thus there is minimal risk of contamination

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38
Q

Which two types of catheter can be used for trans-endoscopic tracheal wash?

A

Single lumen catheter
Triple lumen catheter

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39
Q

Which catheter should you use for a trans-endoscopic tracheal wash if you want to send the sample for cytology and culture?

A

Triple lumen catheter to reduce the risk of contamination

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40
Q

Which bacteria can commonly contaminate tracheal wash samples?

A

Pseudomonas

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41
Q

Which two cell types should mainly be found in a tracheal wash sample?

A

Macrophages
Lymphocytes

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42
Q

What is the normal percentage of neutrophils present in a tracheal wash sample on cytology?

A

Less than 20%

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43
Q

(T/F) Travelling or housed horses can briefly have up to 50% neutrophils in a tracheal wash sample

A

TRUE. However these levels will be expected to decrease with no clinical signs

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44
Q

What information can be provided by bronchoalveolar lavage?

A

Bronchoalveolar lavage is done blind and often samples from the right dorsocaudal lobe. This will provide information if there is a diffuse pathology, however there is a risk of missing more focal pathology

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45
Q

What is the main sign of a successful bronchoalveolar lavage?

A

If you have managed to aspirate surfactant you know you have samples the distal bronchioles and alveoli

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46
Q

(T/F) Bronchoalveolar lavage samples are appropriate for both cytology and culture

A

FALSE. Bronchoalveolar lavage is only appropriate for collecting cytology samples

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47
Q

Which two cell types should mainly be found in a bronchoalveolar lavage sample?

A

Macrophages
Lymphocytes

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48
Q

What is the normal percentage of neutrophils present in a bronchoalveolar lavage sample on cytology?

A

Less than 5%

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49
Q

What are three key indicators of infectious respiratory disease in horses?

A

Pyrexia
Enlarged lymph nodes
Other horses affected

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50
Q

What is the most common bacteria that causes infectious respiratory disease in horses?

A

Streptococcus equi

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51
Q

Which disease is caused by streptococcis equi?

A

Strangles

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52
Q

(T/F) Streptococcus equi is a gram positive bacteria

A

TRUE.

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53
Q

Which signalement is particulalrly prone to streptococcus equi infection?

A

Young, immunologically naive horses

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54
Q

Describe the pathogenesis of acute streptococcus equi infection

A

Streptococcus equi enters the body via the mouth or nose causing pyrexia and pharangitis, and invades the upper respiratory tract lymph nodes causing lymph node abscesses

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55
Q

Why is acute streptococcus equi infection not often treated with antibiotics?

A

Acute streptococcus equi is not often treated with antibiotics and antibiotics cannot penetrate the abscesses

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56
Q

What is the prognosis for a horse with acute streptococcus equi infection?

A

Generally the abscesses will burst and the horse will clear the infection and make a full recovery

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57
Q

Describe the pathogenesis of carrier/chronic streptococcus equi infection

A

Streptococcus equi enters the body via the mouth or nose causing pyrexia and pharangitis, and invades the upper respiratory tract lymph nodes causing lymph node abscesses. When the abscesses burst, some of the pus can enter the guttural pouches and not be fully cleared by the body, resulting in a carrier/chronic infection

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58
Q

Which three methods can you use to diagnose a streptococcus equi infection?

A

Nasopharangeal swab followed by culture and PCR
Aspiration the lymph node abscesses followed by culture and PCR
Guttural pouch lavage followed by culture and PCR

59
Q

What are the three most common viruses that causes infectious respiratory disease in horses?

A

Equine influenza A
Equine herpes virus 1
Equine herpes virus 4

60
Q

Which serotype of equine influenza A most commonly causes equine influenza?

A

H3N8 serotype

61
Q

Describe the pathogenesis of equine influenza A

A

The neuraminidase breaks down the mucociliary carpet, allowing for the heamagglutinin to allow for viral attachment to the host respiratory epithelium, causing cellular necrosis and desquamation. This resultings in inflammation, oedema and exposes irritant receptors resulting in excess mucus production

62
Q

How long does it take for the normal respiratory architecture to recover from an equine influenza A infection?

A

6 weeks

63
Q

What are the seven clinical signs of equine influenza?

A

Pyrexia (39 to 41°C)
Harsh cough
Serous or mucopurulent nasal discharge
Maybe pharyngitis and tracheitis
Swollen lymph nodes
Anorexia
Depression

64
Q

Which methods can you use to diagnose influenza A?

A

Nasopharyngeal swab followed by viral culture/isolation, real time PCR and ELISA

65
Q

What can you do to treat equine influenza?

A

Hydration
NSAIDS for pyrexia
Minimise stress
Rest

66
Q

How long should a horse be rested for with equine influenza?

A

The rule of thumb is for every °C above normal, the horse should be rested for 1 week

67
Q

How can you prevent equine influenza?

A

Adequate ventilation
Biosecurity
Vaccinations

68
Q

Describe the British Horseracing Authority (BHA) vaccination protocol

A

First vaccine (influenza and tetanus), 21 to 60 days later do the second vaccine (influenza and tetanus), 120 to 180 days later do the third vaccine (infuenza). Do influenza boosters every 6 months and tetatnus boosters every 2 to 3 years

69
Q

What are the two most significant effects of equine herpes virus 1 and 4 infections?

A

Abortion
Equine herpes 1 myeloencephalopathy

70
Q

What is equine asthma?

A

Equine asthma is a general term used to describe all non-infectious lower respiratory airway inflammation

71
Q

What are the two classifications of equine asthma?

A

Mild/moderate equine asthma
Severe equine asthma

72
Q

What is the difference between mild/moderate and severe equine asthma?

A

Mild/moderate equine asthma can be seen in all ages and is distinguished from severe equine asthma by a lack of increased respiratory effort at rest

73
Q

What is the most likely cause of mild/moderate equine asthma?

A

Mild/moderate equine asthma is most likely caused by a hypersensitivity to airborne organic dust

74
Q

What are the clinical signs of mild/moderate equine asthma?

A

Cough
Exercise intolerance

75
Q

How do you diagnose mild/moderate equine asthma?

A

Assess history
Assess clinical signs
Endoscopy
Bronchoalveolar lavage and cytology

76
Q

What is a sign of mild/moderate equine asthma on endoscopy?

A

There may be mucus accumulation in the trachea

77
Q

What would you find on cytology of a bronchoalveolar lavage in a horse with mild/moderate equine asthma?

A

Neutrophilia (5 - 20%)
± Eosinophilia
± Increased mast cells

78
Q

What is the prognosis for mild/moderate equine asthma?

A

Mild/moderate equine asthma should be short duration and can resolve spontaneously or with treatment, with a limited risk of recurrence

79
Q

What is the most likely cause of severe equine asthma?

A

Severe equine asthma is most likely caused by a hypersensitivity to airborne organic dust which results in a neutrophil influx into the airways, mucus accumulation, bronchospasm resulting in airway obstruction, airway hypersensitivity and eventually fibrosis

80
Q

What are the four main forms of airborne organic dust that can cause severe equine asthma?

A

Bedding
Hay
Fungal spores
Bacterial endotoxins

81
Q

What age group tend to present with severe equine asthma?

A

Horses over 7 years old

82
Q

What are the six possible clinical signs of severe equine asthma?

A

Cough
Mucoid nasal discharge
Increased respiratory effort at rest
Exercise intolerance
Nostril flaring
Tachypnoea

83
Q

How do you diagnose severe equine asthma?

A

Assess history
Assess clinical signs
Endoscopy
Tracheal wash and cytology
Bronchoalveolar lavage and cytology
Determine if the asthma is reversible

84
Q

Which might you hear on thoracic auscultation that could be indicative of severe equine asthma?

A

End expiratory wheezes
End inspiratory crackles

85
Q

What is a sign of severe equine asthma on endoscopy?

A

Mucus accumulation (grade 3 to 5)

86
Q

What would you find on cytology of a tracheal wash in a horse with severe equine asthma?

A

Neutrophilia (above 50%)

87
Q

What would you find on cytology of a bronchoalveolar lavage in a horse with severe equine asthma?

A

Neutrophilia (over 25%)

88
Q

How can you rapidly determine if the asthma is reversible?

A

To rapidly determine if the asthma is reversible, administer buscopan to see if the horse’s condition improves in response to the bronchodilation

89
Q

What environmental changes should be made to manage severe equine asthma?

A

24 hour turnout (however this is often unrealistic)
Low dust bedding
Low dust feed
Good ventilation
Avoid deep litter bedding
Groom horses outside
Don’t muck out with horses in the stable
Don’t store forage/bedding near the stables
Don’t position the much heap next to the stables

90
Q

What can be used as low dust bedding?

A

Dust extracted shavings

91
Q

What can be used as low dust feed?

A

Haylage
Soaked hay

92
Q

How long should you soak hay for?

A

30 minutes to 2 hours

93
Q

Why is it important to avoid deep litter bedding?

A

Deep litter bedding allows for the accumulation of ammonia and faeces which contain bacterial endotoxins which can contribute to severe equine asthma

94
Q

Which drug classification can you use to control the inflammation associated with severe equine asthma?

A

Corticosteroids

95
Q

Which two systemic corticosteroids can be used in the treatment of severe equine asthma?

A

Dexamethasone
Prednisolone

96
Q

What is the main risk of using systemic corticosteroids in the treatment of severe equine asthma?

A

Systemic corticosteroids can increase the risk of laminitis

97
Q

Which three inhalational corticosteroids can be used in the treatment of severe equine asthma?

A

Ciclesonide
Fluticasone
Beclomethasone

Ciclesonide nebuliser
98
Q

Which drug classification can you use to control the airway obstruction associated with severe equine asthma?

A

Bronchodilators

99
Q

Why should bronchodilators not be used alone in managing severe equine asthma?

A

Bronchodilators do not address the underlying inflammation and thus should be combined with anti-inflammatory drugs and environmental management

100
Q

Which two drug classifications can be used as bronchodilators?

A

β2-adrenergic agonists
Anticholinergic drugs

101
Q

Which systemic β2-adrenergic agonist can be used in the treatment of severe equine asthma?

A

Clenbuterol

102
Q

What are the three key side effects of clenbuterol in horses?

A

Sweating
Mild colic
Inteferes with parturition

103
Q

Which inhalational β2-adrenergic agonists can be used in the treatment of severe equine asthma?

A

Salbutamol
Salmeterol

104
Q

When is salbutamol indicated in the treatment of severe equine asthma?

A

Salbutamol is used as an emergency treatment

105
Q

When is salmeterol indicated in the treatment of severe equine asthma?

A

Salmeterol is used for more long term control of severe equine asthma

106
Q

Why should β2 specific adrenergic agonists be used intermittently?

A

β2 specific adrenergic agonists should be used intermittently to avoid tolerance through internalisation of the β2 receptors in response to excessive stimulation

107
Q

Which two anticholinergic drugs can be used in the treatment of severe equine asthma?

A

Atropine
Buscopan

108
Q

When is atropine indicated in the treatment of severe equine asthma?

A

Atropine is used as an emergency treatment when a horse is in severe respiratory distress

109
Q

When is buscopan indicated in the treatment of severe equine asthma?

A

Buscopan is used as a diagnostic to determine if the asthma is reversible with bronchodilation

110
Q

What is the prognosis for severe equine asthma?

A

Severe equine asthma has a long duration and is recurrent

111
Q

What is pasture associated equine asthma?

A

Pasture associated equine asthma has an almost identical presentation to severe equine asthma except it is associated with horses on pasture rather than stabled horses

112
Q

What is the signalement for exercise induced pulmonary haemorrhage (EIPH)?

A

Exercise induced pulmonary haemorrhage (EIPH) is most commonly seen in racehorses following strenuous exercise

113
Q

What are the five possible clinical signs of exercise induced pulmonary haemorrhage (EIPH)?

A

Asymptomatic
Epistaxis post exercise
Repeated swallowing post exercide
Poor performance
Prolonged recovery post exercise

114
Q

How do you diagnose exercise induced pulmonary haemorrhage (EIPH)?

A

Endoscopy

115
Q

How do you treat exercise induced pulmonary haemorrhage (EIPH)?

A

Rest the horse for 2 to 4 weeks

116
Q

What is the signalement for equine multinodular pulmonary fibrosis?

A

Older horses

117
Q

How do you differentiate equine multinodular pulmonary fibrosis from severe equine asthma?

A

To differentiate equine multinodular pulmonary fibrosis from severe equine asthma, administer buscopan to determine if the clinical signs are reversible or not. If the signs are not reversible, this is more likely to be equine multinodular pulmonary fibrosis

118
Q

Which species of trichostrongloidea causes lungworm in horses?

A

Dictyocaulus arnfieldi

119
Q

What is an important history question to ask if you suspect a dictylocaulus arnfieldi infection?

A

Ask if the horse has been in contact with any donkeys or mules as they are asymptomatic reservoirs of dictyocaulus arnfieldi

120
Q

How do you treat dictyocaulus arnfieldi in horses?

A

If you suspect dictyocaulus arnfieldi from the history and clinical signs, treat the horse with ivermectin or moxidectin

121
Q

What is the most common infectious agent that causes bronchopneumonia in horses?

A

Bacteria

122
Q

Descripe the pathogenesis of bacterial pneumonia

A

Bacteria in the upper respiratory tract can contaminate the lower respiratory tract, which usually is not a problem unless there is an overwhelming bacterial infection or impairment of the host defences, which will then result in bacterial pneumonia

123
Q

List six factors which can cause bacterial pneumonia?

A

Aspiration
Laryngeal/pharyngeal dysfunction
Transport
Exercise
Viral infection
General anaesthetic

124
Q

How does laryngeal/pharyngeal dysfunction cause bacterial pneumonia?

A

Laryngeal/pharyngeal dysfunction increases the risk of aspiration which can result in bacterial pneumonia

125
Q

How can transport cause bacterial pneumonia?

A

Transport causes stress which reduces the horse’s immune system and horses will typically have their head elevated during transport which impairs mucocilliary clearance, which further impairs the immune system which can result in bacterial pneumonia

126
Q

How can exercise cause bacterial pneumonia?

A

Exercise can result in aspiration of dirt etc and can comprimise the immune system which can cause bacterial pneumonia

127
Q

What is one of the most common cause of bacterial pneumonia in foals?

A

Aspiration of milk

128
Q

What is pleuropneumonia?

A

Pleuropneumonia is a severe manifestation of bronchopneumonia where the infection has extended into the pleural cavity

129
Q

What are the clinical signs of bacterial pneumonia?

A

Pyrexia
Soft cough
Inappetence
Exercise intolerance
Mucopurulent nasal discharge
Tachypnoea
Hypopnoea
Respiratory distress

130
Q

What can you hear on auscultation in a horse with bacterial bronchopneumonia?

A

Increased inspiratory noise with ventral crackles and wheezes

131
Q

What is a key clinical sign of bacterial pleuropneumonia on auscultation?

A

Reduced ventral lung sounds indicative of a pleural effusion

132
Q

How do you diagnose bacterial pneumonia?

A

Assess history
Assess clinical signs
Haematology
Biochemistry
Endoscopy
Tracheal wash with cytology and culture
Thoracocentesis

133
Q

What changes on haematology would be indicative of bacterial pneumonia?

A

Neutrophilia or in severe cases neutropenia

134
Q

Which proteins would be elevated when there is bacterial pneumonia?

A

Fibrinogen
Serum amyloid A
Globulins

135
Q

What is a sign of bacterial pneumonia on endoscopy?

A

Mucopurulent material in the trachea

136
Q

What would you find on cytology of a tracheal wash in a horse with bacterial pneumonia?

A

Neutrophilia (between 40 - 100%)
Degenerate neutrophils
Intracellular bacteria

137
Q

When would you do a thoracocentesis in a horse with bacterial pneumonia?

A

Do a thoracocentesis if there is an signs of pleural effusion to determine if it is a bacterial pleuropneumonia

138
Q

How do treat bacterial pneumonia?

A

Administer first line antibiotics while you wait for the culture and sensitivity results. When the results come back pick an appropriate antibiotic for the bacteria that is present. Often antibiotics have to be given for 6 - 8 weeks

139
Q

Which two first line antibiotics are commonly used in horses?

A

Penicillin
Gentamicin

140
Q

What supportive treatment can you provide horses with bacterial pneumonia?

A

NSAIDS
Intravenous fluid therapy
Provide good ventilation
Thoracocentesis or chest drain if there is pleural effusion

141
Q

When should horses begin to improve following antibiotics and supportive care for bacterial pneumonia?

A

Horses should begin to improve between 48 to 72 hours

142
Q

How can you assess if a horse is responding to treatment for bacterial pneumonia?

A

Improvement in clinical signs
Decreasing fibrinogen and serum amyloid A levels

143
Q

What are four of the main complications of bacterial pneumonia?

A

Abscesses
Pleural adhesions
Broncho-pleural fistulas
Laminitis

144
Q

What is a broncho-pleural fistula?

A

A broncho-pleural fistula is an abnormal connection between the bronchi and the pleura

MODULE 15 - Cardiorespiratory and Haematopoietic Disease (21 decks)

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