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LAM I > Respiratory > Flashcards

Respiratory Flashcards

1
Q

T or F:
Bilateral nasal discharge can be associated to upper OR lower respiratory disease.

A

True.

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2
Q

T or F:
Cough is associated with upper and lower respiratory disease.

A

True.

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3
Q

T or F:
Unilateral nasal discharge is associated with upper and lower respiratory disease.

A

False!
*unilateral discharge is usually associated with upper respiratory disease…
—> anatomic location that delineates: CAUDAL edge of the nasal septum*

{Rostral to this: unilateral—>UR;
Caudal to this: bilateral—>LW}

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4
Q

T or F:
A horse can manifest a neutrophilic leukocytosis and hyperfibrinogenemia with either upper OR lower respiratory disease.

A

True; indicates infectious disease (irrespective of location)

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5
Q

2nd most common clinical sign of guttural pouch mycosis?

A

Dysphagia!

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6
Q

First most common clinical sign of GPM?

A

Epistaxis!

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7
Q

What specific structures are usually affected in GPM?

A

Internal carotid a. (located in the medial pouch);

Maxillary a. (Located in the lateral pouch) *these can be combinations*

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8
Q

If we are suspecting ethmoid hematoma, but cannot confirm on endoscopy, what should we do?

A
  • *Run skull radiographs**;
  • Ethmoid hematomas can be in deeper tissue (not accessible by scope)*
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9
Q

How do we medically treat ethmoid hematomas?

A

Inject with formalin

*can eat into cribiform plate, so if the hematoma has breached, we do NOT want to inject with formalin, because it will go to the brain*

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10
Q

What is the most common cause of epistaxis in the horse?

A

Trauma!

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11
Q

What’s the classic signalment for an ethmoid hematoma?

A

Older,
male,
warm-blood (thoroughbred) horses

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12
Q

Why do we think GPM lesions are usually over arteries?

A

Attracted to oxygen tension…

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13
Q

Why do GPM (or empyema) horses present with dysphagia?

A

Nerves, most notably the Vagus (with branches, Pharyngeal especially)
… comes off near the middle of the pouch, run at the back of the pouch and run on the floor of the pouch
—> they get a dorsally displaced soft palate
(dysphagia is associated with this resulting dysfunction)

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14
Q

How do we diagnose IAD?

A

**BAL**…and cytological evaluation revealing:

Neutrophilia >10%;

Mast cells >5%;

And Eosinophils >5% using 250mL saline

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15
Q

What is the pathophysiology behind airway thickening in RAO?

A

Exposure to particulates —>Peribronchial infiltrates and epithelial metaplasia

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16
Q

How would we diagnose RAO?

A

Cytological analysis revealing:
suppurative nonseptic inflammation
—> neutrophilia >25%,
…decrease lymphocyte and alveolar macrophages —> tracheal mucus accumulation

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17
Q

How do we treat RAO?

A

Decrease env’t challenges (need this element for the anti-inflammatories to be effective) Bronchodilator Anti-inflammatories

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18
Q

How can we manage the environment in treating RAO?

A

Good ventilation in housing,
Adequate bedding,
Minimized dust,
Pellet feed, hay cubes, soak hay in water

19
Q

What are the 3 main classes of bronchodilators that we should use in treating RAO?

A

Anticholinergics,
Beta-2 agonists,
Phosphodiesterase inhibitors

20
Q

How do beta-2 adrenergic agonists relax smooth muscle?

A

By increasing the intracellular levels of cAMP

21
Q

If you’re treating a horse with bronchodilator and steroids, which one should be administered first?

A

Bronchodilator first;
To improve glucocorticoid deposition

22
Q

What is the normal Pulmonary Arterial Pressure (PAP) at rest vs. during exercise?

A

at rest (pretty much the same across all species): 25-30 mmHg

​exercise: 125 mmHg

23
Q

What is the bronchial system MABP at rest vs.exercise?

A

Rest: 100 mmHg

​Exercise: 220 mmHg

24
Q

What is the bronchial system pressure reflective of?

A

The SYSTEMIC circulation (high-side of system)

25
Q

How do we begin the physical exam evaluation of respiratory disease?

A

start with differential airflow:

  • evaluate sinuses
  • evaluate/palpate larynx and trachea

THEN go into auscultation

26
Q

Where are we located?
Does this look normal?

A

Distal nasopharynx

NO because we can’t see the epiglottis;
think dorsally displaced soft palate

27
Q

Where are we located?

A

Distal trachea

28
Q

What is this structure?

A

Ethmoid turbinate
left side

29
Q

Which compartment of the guttural pouch do main structures go thru?

(internal carotid a, nerves)

A

Medial (~200mL)

vs lateral ~100mL

the 2 compartments are separated by the stylohyoid

30
Q

If we are suspecting infectious, focal disease, what procedure is indicated?

A

TTW!

31
Q

If we are suspecting non-infectious, diffuse disease, what procedure is indicated?

A

BAL!

32
Q

What is the anatomic location where the distinction is made as to whether the horse will have unilateral vs. bilateral discharge?

A

Caudal edge of the nasal septum

rostral to the caudal edge of nasal septum?
—> should be UNILATERAL

caudal to the caudal edge of nasal septum?
—> should be BILATERAL

33
Q

T or F:
A horse can manifest a neutrophilic leukocytosis and hyperfibrinogenemia with either upper or lower respiratory disease.

A

Trueeee

34
Q

What is the location of the lesion?

A

Medial compartment of RIGHT guttural pouch

35
Q

How is the discharge different in ethmoid hematomas from GPM?

A

EH: intermittent/purulent

GPM: mucoid type, possible between episodes

36
Q

Older male horses are more likely to succumb to ______, whereas younger horses are more likely to succumb to ______.

A

Older male horses: Ethmoid hematoma

younger: GPM

37
Q

What is the normal respiratory rate for a horse anyhow?

A

8-20 bpm

*foal: 12-24*

38
Q

What are 2 terms we use to describe abnormal lung sounds?

A
  1. Crackles: low-pitched, non-musical sounds
    - short, explosive sounds
  2. Wheezes: high-pitched, musical sounds
    - long, musical sound associated w narrowing of airways generated by oscillation of bronchial and bronchiolar walls
39
Q

On pulmonary evaluation via ultrasonography, how would an atalectic lung differ from a consolidated one?

A

Atalectic: very sharp, concave/convex borders with reduced volume

​Consolidated: rounded borders - two convex borders meeting

40
Q

In progressive ethmoid hematoma, is the epistaxis typically unilateral or bilateral?

A

Unilateral!

41
Q

What is the signalment for progressive ethmoid hematoma?

A

4 yrs +
thoroughbred, warmbloods, Arabians

42
Q

What would confirm our diagnosis of EIPH on endoscopy?

A

Direct observation of blood in tracheobronchial tree

43
Q

What is the reasoning behind treating EIPH with furosemide?

A

Profound diuresis—>volume reduction—>decreased blood pressure in lung
(*thus diminishing work and pressures)

**
also bronchodilation*

LAM I (8 decks)

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