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Respiratory > PE and Investigation Respiratory Disease > Flashcards

PE and Investigation Respiratory Disease Flashcards

0
Q

What can be noted from distance observation?

A
  • behaviour and demeanor
  • resp rate, effort and pattern
  • inspiratory and expiratory noise
  • nostril flare
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1
Q

What can be determined through history and signalment?

A
  • individual v herd/ infectious problem
  • neonate, juvenile or adult
  • performance, pleasure or production animal
  • gneral management and environment
  • disease course and features
  • response to tx
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2
Q

WHat can be noted on PE?

A
  • BCS
  • posture
  • abdominal effort
  • hypertrophy of abdo muscles
  • mm
  • eyes (ocular discharge seen with resp infection)
  • jugular veins (^ jugular pulse height)
  • pectoral oedema
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3
Q

What are the landmarks of the maxillary paranasal sinus?

A
  • dorsal line from medial canthus to nasoincisive notch
  • rostral line at right angles to the rostral part of the facial crest
  • floor parallell and slightly below facial crest
  • caudal middle of orbit to facial crest
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4
Q

Landmarks of frontal paranasal sinus?

A
  • caudal line rostral to the TMJ
  • lateral line form the medial canthus to nasoincisive notch
  • rostral line 2/3 distance from medial canthus to rostral end of facial crest
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5
Q

What are you looking for for serious sinus problems?

A
  • facial asymmetry (only seen with very serious disease)
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6
Q

What structures are present in the pharyngeal area?

A
  • gutteral pouches (look for swelling)
  • lymph nodes (looking for enlargement and discharges if abscessated)
  • larynx (looking for assymmetry of cricoarytenoideus dorsalis muscle [RLN], can assess movement in repsonse to a slap over the withers- though probably cant feel this)
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7
Q

What can be heard on equine thoracic Ausculatation and percussion?

A
  • only just audible in adult, louder in foals and thin animals
  • abscence of noise does not indicate lack of disease!!
  • radiating heart sounds with pleural effusion
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8
Q

Where are the borders for thoracic auscultation in the ruminant?

A
  • 6th intercostal space (point of elbow)
  • 9th intercostal space (midway)
  • 11th (level with tuber coxae)
  • diaphragmatic border straight dorsoventral
    (horses triangular region of auscultation)
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9
Q

What do crackles and wheezes indicate?

A
  • crackle: small airways and alveoli problems

- wheeze: partial obstruction larger airways

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10
Q

What may shift of apex beat indicate?

A

displacement of heart due to scpae occupying lesion (only in small animals?)

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11
Q

What should further diagnostic testing decisions be based on?

A
  • whether it will change tx or management of case

- specific advantages and disadvantages of each test

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12
Q

What can be examined on endoscopy of the equine?

A
  • nasal passages
  • gutteral pouches
  • nasopharynx
  • soft palate
  • larynx
  • trachea
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13
Q

What can be examined on endoscopy of small animals? How is it performed?

A
  • trachea, mainstem bronchi and larger divisions or main bronchi
  • must be performed under GA and trachea must be of sufficient diameter
    > patient in sternal, radiographs taken prior
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14
Q

Strengths and weaknesses of enodscopy?

A

+ diseases of major airways
+ dynamic disease of URT
- unable ot visualise smaller airways or parenchymal lesions

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15
Q

What further techniques can be performed via endoscopy?

A
  • aspiratio nof samples
  • biopsy of discrete lesions
  • retrieval of FB
16
Q

What tests can be carried out if a viral cause is suspected?

A
  • paired serology
  • virus isolation from bubffy coat
  • virus iolation from nasopharyngeal swabs
  • vrial antigen detection by FAT from nasopharyngeal swabs and PCR to identify RNA/DNA of specific viruses
17
Q

What samples of respiratory tract can be collected?

A
  • nasopharyngeal swabs
  • endoscopically guided tracheal aspirate
  • transtracheal aspirate
  • bronchoalveolar lavage
  • pleural fluid
  • lung biopsy
  • gutteral pouch lavage
18
Q

When is nasopharyngeal swab suitable?

A
  • bacterial culture of specific orgnaism NOT normal commensals of the pharynx
    > eg. in horses only bacteria in horses STREP EQUI EQUI as all others found will be normal commensals
    > culture and PCR
19
Q

What is endoscopically guided tracheal aspirate in equines also known as? What does this provide information on?

A
  • tracheal wash

- secretions from ALL of lungs that pooled at the thoracic inlet

20
Q

Pros and cons of tracheal aspirate/wash?

A 
\+ easy to perform
\+ sample representative of whole lung
- contamination by equipment and pharyngeal flora 
- wide range normal cell populations
- cells poorly preserved
21
Q

Which procedure helps avoid oropharyngeal contamination? Outline how this is carried out?

A

> transtracheal aspirate

  • surgically prepare site in lower 1/3 trachea
  • instil local and insert catheter or needle between tracheal rings
  • instilll saline and withdraw sample
  • remove sample catheter first and guide catheter last to avoid contamination
22
Q

Pros and cons or transtracheal aspirate?

A

+ no pharyngeal contamination
+ no specialised equipment required
+ useful in young foals (endoscopes too large)
- horse may cough catheter into pharynx anyway
- invasive
- cellulitits and subcut emphysema possible side effects

23
Q

How is endoscopically guided tracheal aspirate performed in SA?

A
  • GA
  • go in through ET tube (NOT in cats as wont fit, pull ET tube first)
  • blind wash and suck out
24
Q

Transtracheal aspirate in equine common?

A

No unless 100% accuracy required eg. pleuropnuemonia caused by inhaling oro-pharyngeal pathogens

25
Q

Indications for transtracheal aspirates in smallies? What must be punctured during this procedure?

A

Endoscopy not available (eg. if GA contraindicated)
- direct access in the concious pateint
> puncture cricothyroid ligament

26
Q

What is the downside to bronchoalveolar lavage?

A

horse will cough throughout procedure!

27
Q

Method of BAL?

A
  • guide catheter inserted
  • BAL tube into bronchus until it will not advance further
  • inflate balloon and insert saline 120-200ml
  • withdraw
28
Q

ADVANTAGES AND DISADVANTAGES OF BAL?

A

+ sample is from area of tract most liekly affected eg. EIPH, COPD
+ narrow cell population aids interpretation
+ equipment required cheap and accessible (good for all LA)
- site sampled may not be appropriate in animals with loalised pulmonary abscesses or pnumonias (caudodorsal lung lobes most commonly sampled)

29
Q

How is thoracocentesis often performed in horses?

A

Under ultrasound guidance
- select site in 7/8th intercostal spac, above lateral thoracic vein, prepare surgically, instill local, make stab incision, blunt teat cannula or drain CLOSED FROM ATMOSPHERE

30
Q

What is analysed from a thoracocentesis sample?

A
  • cytology (ID type of cells)
  • protein (differentiate transudate, modified transudate, exudate)
  • TG:cholesterol ratio (ID chylothorax in SA only not large)
  • culture and sensitivty
31
Q

When is lung aspiration indicated?

A

Discrete intrapulmonary lesion exists which cannot be accessed in any other way

  • ultrasound or fluoroscopic guidance
  • only in severely ill patients
32
Q

When is lung biopsy indicated? Pros and cons?

A
  • not frequently performed
  • ID specific forms of pathology eg. interstitial pneumonia and neoplaisa
  • very invasive (potential complications include uncontrollable haemorrhage and pneumothorax)
33
Q

Why may feacal examination be indicated?

A

Angiostrongylus vasorum larvae in small animals

34
Q

WHa is radiography useful for?

A

visualising pulmonary structures, pleural cavity, mediastinum

35
Q

What is CT useful for?

A
  • not horse!
  • pleural, mediastinal and parenchymal areas
  • high quality image, more detailed anatomical structure
  • cheaper, quicker and better detail of lungs than MRI
36
Q

What is thoracic US useful for?

A

Pleural effusion

- taking smaples eg. pleurocentesis, lung biopsy

37
Q

What are pulmonary function tests?

A
  • track excercise tests, treadmill excercise tests, oesophageal manometry, flow-volume loops, oxygen uptake and blood gas analysis
  • rarely used

Respiratory (18 decks)

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