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Equine Final > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Describe the pathophysiology of exercise induced pulmonary hemorrhage (EIPH)

A

Exercise causes increased transmural pressure which leads to hemorrhage (can lead to epistaxis as well)

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2
Q

What clinical signs are associated with exercise induced pulmonary hemorrhage?

A

Poor performance, prolonged recovery post racing, cough, frequent swallowing after racing, epistaxis (only 5% cases)

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3
Q

How is exercised induced pulmonary hemorrhage diagnosed?

A

Tracheal endoscopy 30-60min post exercise; BAL up to 14 days post race looking for RBCs or hemosiderophages- can use Prussian blue stain; thoracic rads may show alveolar or mixed alveolar-interstitial opacities in caudodorsal lung fields.

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4
Q

How is exercise induced pulmonary hemorrhage treated?

A

Furosemide to decrease BP, nasal strips to decrease vacuum in lungs. Lots of treatments w/ little-no evidence

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5
Q

Mild/moderate equine asthma effects a large number of this subset of horses

A

Race horses, sport horses

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6
Q

What are differential diagnoses for equine asthma?

A

Viral infection, bacterial bronchitis, bacterial pneumonia, parasitic pneumonitis, EIPH, pulmonary infiltrative disease, upper airway disease, myopathy, lameness, cardiac disease

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7
Q

What clinical signs are associated with equine asthma?

A

Cough, chronic airway inflammation, increased mucus production, airway hyperreactivity, heave lines, increased RR and effort, crackles/wheezes, weight loss

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8
Q

What BALF cytology is consistent with equine asthma?

A

> 7% neutrophils and/or >3% mast cells and/or >2% eosinophils

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9
Q

What sample is best for diagnosing equine asthma?

A

BAL

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10
Q

What might you see on endoscopy of a horse with equine asthma?

A

Mucus grade 2/5

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11
Q

How is equine asthma treated/managed?

A

Find and remove triggers, bring horse inside in summer, don’t store hay above stalls. For severe- buscopan to bronchodilate, corticosteroids, oxygen, bronchodilation. For new diagnosis- systemic steroids (dexmeth, prednisolone, triamcinolone), inhaled steroids (expensive), +/- bronchodilator therapy, omega-3 supplementation

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12
Q

What clinical signs are associated with interstitial pneumonia?

A

Cough, weight loss, nasal discharge, exercise intolerance, severe dyspnea, cyanosis, restrictive breathing pattern, fever variable

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13
Q

How is interstitial pneumonia diagnosed?

A

Inflammation on blood work, extensive interstitial and bronchointerstitial pulmonary patterns, increased neutrophils and macrophages on tracheal wash/BAL, lung biopsy with histopath for definitive ddx

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14
Q

What are acute causes of interstitial pneumonia?

A

Infections, inhaled chemicals, smoke, toxins, adverse drug reaction, hypersensitivity, endotoxemia, ALI/ARDS, endotoxemia, systemic inflammatory response syndrome, DIC, idiopathic, etc.

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15
Q

What are causes of chronic interstitial pneumonia?

A

Chronic infections, inhaled inorganic dust, silicosis, hypersensitivity, ingested toxins, collagen/vascular disorders, idiopathic

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16
Q

What is the most serious disease associated with EHV-5 infection?

A

Equine multinodular pulmonary fibrosis (EMPF)

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17
Q

What is the likely cause of EMPF?

A

EHV-5

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18
Q

What is the common signalment for horses with EMPF?

A

Middle-aged to older horses with range of severity of symptoms that don’t improve with bronchodilation

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19
Q

How is EMPF diagnosed?

A

Clinical signs, rads, U/S, PCR for EHV-5, percutaneous lung biopsy is gold standard

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20
Q

How is EMPF treated?

A

Dexamethasone, doxycycline, acyclovir, prognosis poor

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21
Q

Describe acute lung injury/acute respiratory distress syndrome

A

Sudden severe respiratory distress usually in foals 1-9 months old; ALI <300mmHg, ARDS <200mmHg, with pulmonary edema, infiltration, and activation of inflammatory cells. Mortality 30-40%

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22
Q

How is ALI/ARDS treated?

A

Antivirals (acyclovir, valacyclovir), corticosteroids, bronchodilators, antimicrobials (ceftiofur, gentamicin), supportive care

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23
Q

What are differential diagnoses for ALI/ARDS?

A

Upper airway obstruction, pneumothorax, pleural effusion, aspiration pneumonia, bacterial/viral/fungal pneumonia, CHF, congenital cardiac malformation

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24
Q

What type of tumors are seen in horse lungs? What are their symptoms?

A

Pulmonary granular cell tumor, bronchiolar adenocarcinoma, thoracic mets from hemangiosarcoma, mesothelioma, chondrosarcoma. Show weight loss, inappetence, maybe fever, pleural effusion and masses on rads.

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25
Q

What part of the lungs does bronchopneumonia occur in?

A

Bronchial, bronchiolar, and alveolar lumens, usually cranioventral

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26
Q

When does pleuropneumonia occur?

A

When infection from bronchopneumonia extends to pleural space

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27
Q

What are clinical signs of pneumonia?

A

Fever, cough, lateral discharge (bilateral), abnormal lung sounds, tachypnea/dyspnea, nostril flare, hemoptysis, weight loss, inappetence, abducted elbows, colic

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28
Q

What CBC findings might you find in a horse with pneumonia?

A

Mature neutrophilia +/- left shift or neutropenia +/- left shift, lymphopenia, monocytosis, anemia, or nothing

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29
Q

What chem findings might you find in a horse with pneumonia?

A

Hypoalbuminemia, hyperglobulinemia, hyperbilirubinemia, mild electrolyte derangements, or nothing

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30
Q

Which diagnostic is not a good choice for diagnosing pneumonia?

A

BAL- not sterile

31
Q

What might you see on ultrasonography of a horse with pneumonia?

A

Comet tails

32
Q

What are causative agents of parasitic pneumonia/pneumonitis?

A

Dictylocaulus arnfieldi and Parascaris equorum

33
Q

What findings are consistent with parasitic pneumonia/pneumonitis?

A

Eosinophilia, increased liver enzyme activity, increased mast cells, eosinophils, or larvae on TTW or BAL

34
Q

What is a risk factor for a horse developing D. arnfieldi?

A

Living with a donkey

35
Q

Which horses are prone to fungal pneumonia?

A

Immunocompromised horses

36
Q

What are predisposing factors for bacterial pneumonia?

A

Long distance travel, aspiration of feed or water, asthma, anesthesia

37
Q

What organisms are common in bacterial pneumonia?

A

Strep, Pasteurella, Actinobacillus, E. coli, Klebsiella, Enterobacter, Bacteroides, Fusobacterium

38
Q

What (general) treatment is indicated in bacterial pneumonia?

A

Pleural drainage, endotoxemia prophylaxis, supportive care

39
Q

What type of antimicrobials are used against bacterial pneumonia?

A

Start with broad spectrum, can use ceftiofur, gentamicin. G+ penicillin, ceftiofur; G- gentamicin, enrofloxacin; anaerobic metronidazole

40
Q

Describe Rhodococcus equi

A

Gram positive facultative intracellular coccobacilli. Affects foals 1-6 m/o

41
Q

What is the classic presentation of Rhodococcus equi pneumonia in foals?

A

Multifocal pulmonary abscessation, pyogranulomatous inflammation

42
Q

Where does Rhodococcus equi live?

A

In the soil

43
Q

What are clinical signs associated with Rhodococcus equi?

A

Bilateral nasal discharge, cough, tachypnea, crackles/wheezes, polysynovitis, osteomyelitis, diarrhea, uveitis, internal abscessation

44
Q

How is Rhodococcus equi diagnosed?

A

TTW and culture, PCR for vapA. CBC will show neutrophilia and hyperfibrinogenemia

45
Q

How is Rhodococcus equi treated?

A

Macrolide (can cause hyperthermia, anhidrosis) + rifampin (stains things) + supportive care

46
Q

What signs are associated with upper respiratory tract viruses?

A

Pharyngitis, laryngitis, tracheitis, high fever, dry hacking cough, serous nasal discharge, harsh lung sounds, conjunctivitis

47
Q

How are URT viruses diagnosed?

A

Clinical signs and history, blood PCR for EHV or EAV, look for abortion or neuro signs to identify herpes, nasopharyngeal swab for isolation/culture/PCR

48
Q

What is pharyngeal lymphoid hyperplasia?

A

Hyperplasia of diffuse follicular lymphoid tissue in the pharynx, usually due to non-specific immunologic response

49
Q

What is the treatment for pharyngeal lymphoid hyperplasia?

A

Rest, isolation (3-4w past clinical signs), supportive care, listen for crackles/wheezes to indicate pneumonia, NSAIDs if high fever, antibiotics if bacterial pneumonia, NO steroids

50
Q

Describe equine influenza?

A

Myxovirus, spreads very easily, easily killed by disinfectants, causes cough, high fever, myalgia, myositis, myocarditis, pericarditis. Prognosis good but risk for secondary bacterial infection. Vaccinate every 6-12 months (IN or IM), can use MLV during outbreaks

51
Q

Describe equine rhinopneumonitis

A

Herpesvirus EHV-1 and 4; frequent latent infections, persists in environment, can cause abortion or neuro signs, no effective vaccine.

52
Q

What are the clinical signs of EHV1?

A

Late term abortion, neurological disease, neonatal weakness/death, biphasic fever

53
Q

How is EHV-1/4 diagnosed?

A

PCR of nasopharyngeal swab and whole blood, placenta and fetus for abortions

54
Q

Describe equine rhinitis A and B

A

Rhinovirus with high prevalence, seen in young horses. Can exacerbate asthma. Vaccine is available but uncommonly used. Can cause abortion or neuro signs.

55
Q

Describe equine viral arteritis

A

Arterivirus, REPORTABLE, stallions are carriers, can cause edema and ocular signs, abortion, neonatal interstitial pneumonia, petechiation, urticaria. Diagnose on PCR and virus isolation. Prognosis for respiratory signs is good. Vaccinate with MLV

56
Q

Describe Streptococcus equi equi (strangles)

A

Gram positive cocci taht forms long chains, associated with abscessations of URT lymph nodes

57
Q

What are the clinical signs of strangles?

A

Depression, decreased appetite, mucopurulent nasal discharge, moist cough, pharyngitis, respiratory distress or stridor

58
Q

Describe the pathogenesis of strangles

A

Infection via purulent discharge or fomites, has short incubation period and is very contagious, high morbidity low mortality, may persist in guttural pouches

59
Q

How is strangles diagnosed?

A

Clinical signs, culture and PCR (nasopharyngeal swab, guttural pouch lavage, LN aspirate), serum titers (SeM titer)

60
Q

How is strangles treated/managed?

A

Quarantine, drain abscess, provide nursing care and NSAIDS, only use antibiotics if complicated or immunosuppressed (penicillin/ceftiofur)

61
Q

Describe guttural pouch disease from strangles

A

Ruptured retropharyngeal LN drains into guttural pouches which can lead to emphysema, inspissated material, and chondroids. Can require repeated lavage and topical antimicrobial treatment with a catheter. Large chondroids may require surgery.

62
Q

Describe bastard strangles

A

Abscessation outside of the upper respiratory tract, SeM titer will be high, treat similarly to strangles but more likely to use antimicrobials if not draining well or systemically ill horse

63
Q

Describe immune mediated myositis

A

Rapid onset muscle atrophy in quarter horse after infection with S. equi equi (due to MYH1). Treat with corticosteroids then other rhabdo and strangles treatments as necessary. Only give these horses vax as necessary. Prognosis good.

64
Q

Describe purpura hemorrhagica

A

Immune-mediated vasculitis (type III hypersensitivity), typically in horses with high SeM titers. Present with fever, petechia, ventral edema/distal limb edema, glomerulonephritis. Treat supportively and with anti-inflammatories (steroids). Don’t vax horses with high SeM titers. Prognosis good depending on complications.

65
Q

How should a strangles outbreak be controlled?

A

Quarantine entire barn for at least 3 weeks, dispose of purulent material, disinfect equipment, monitor temps. Test all horses 3w after last case. May vaccinate- controversial.

66
Q

What disease is associated with a hoarse roar?

A

Laryngeal hemiplegia

67
Q

What disease is associated with a rattle, gurgle, or grunt?

A

Dorsal displacement of the soft palate

68
Q

What is the therapy for dorsal displacement of the soft palate?

A

Laser cautery of the soft palate, sternothyroid myectomy, staphylectomy, epiglottic augmentation, tie forward, etc.

69
Q

What are symptoms of guttural pouch disease?

A

Epistaxis, mucupurulent nasal discharge, cranial nerve dysfunction

70
Q

What are causes of guttural pouch disease?

A

Masses, infection (mycosis), empyema, trauma, tympany

71
Q

What is the treatment for guttural pouch disease?

A

Lavage, antibiotics, endoscopic anti-fungal, or surgery

72
Q

How are larynx diseases treated?

A

Endoscopically with laser or injection or with ventral surgical approach

73
Q

How is laryngeal hemiplegia treated?

A

Laryngoplasty, vocal cord or ventriculectomy

74
Q

How are tracheal diseases treated?

A

Endoscopic surgery, permanent or temporary tracheostomy

Equine Final (5 decks)

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