Respiratory Flashcards by Corinne Perra

The large airways include?

Nasal passages
Larynx
Trachea
Major bronchi

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What are the small airways?

Small bronchi

Bronchioles

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What is the pressure of the pulmonary arteries at rest vs during exercise?

PAP at rest= 25-30 mmHg

During exercise= 125 mmHg

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T/f: Rate of respiration is coupled to foot fall in a 1:1 ratio

True

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At rest the upper airway continues 2/3 of total airway resistance. During exercise the airway can contribute up to 80% of total airway resistance. What accounts for this difference?

Dynamic airway collapse as airway pressure becomes more negative

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What is the normal respiratory rate for horses

8-12bpm

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Abdominal press indicates (expiratory/inspiratory) difficulty and is a sign of (upper/lower) airway deficiency

Expiratory; lower

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An extended head and neck indicates (expiratory/inspiratory) difficulty and is a sign of (upper/lower) airway dysfuntion

Inspiratory; upper (obstruction)

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What clinical sign can indicate pleural pain?

Abducted elbows

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What does a tracheal rattle indicate?

Exudate in trachea

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How can you assess if there is irritation of the trachea?

Palpation elicits a cough

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What are the borders of the auscultation field of the lungs?

17th ICS at tuber coxae
16th ICS at tuber ischial

13th ICS at mid thorax

11th ICS at shoulder
5th ICS at elbow

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What disease will you consider is your lung fields are expanded on auscultation ?

COPD

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What diseases will you consider if your lung fields are decreased on auscultation?

Pulmonary consolidation
Pleural effusion
Diaphragmatic hernia

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Crackles are associated with what occurrence in the lungs?

Short explosive sounds due to bubbling secretions OR sudden opening of collapsed airways

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Wheezes are an abnormal lung sound associated with occurrence of what in the lungs??

Narrowing of the airways generated by oscillation of the bronchial and bronchiolar walls

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What would you suspect if you have absent or radiating cardiac sounds?

Pleural effusion

Consolidation

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You do a percussion on the thorax and get a dull sounds back… what could this mean? And how could you differentiate between these causes?

Fluid accumulation OR increased tissue density

Fluid accumulation will have a well demarcated horizontal “fluid line” across thorax where the tone ventrally is dull but it is not dorsally

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Localized ares of diminished sounds on percussion could have what DDX?

Fibrin accumulation
Adhesions
Pulmonary consolidation

If focal - superficial pulmonary abscessation

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T/F: rebreathing procedure is indicated for all horses for compete pulmonary auscultation

True

You do a rebreathing procedure on a horse and the rate and depth of inspiration increases, lung sounds are accentuated.. what is the pathology?

None here.. this is normal

You do a rebreathing procedure on a horse.. it develops coughing, anxiousness, and respiratory distress.. is this a normal response or abnormal?

Abnormal — pulmonary pathology present

What are you looking for on a CBC in a horse with respiratory problems??

Infection ? — neutrophilic leukocytosis
Fibrinogen? — inflammatory vs not; chronic vs acute; severity
Blood gases — O2 vs CO2 tensions

What is the most relevant method of diagnosing upper airway disease?

Endoscopy

How many large cassette view do you need to radiograph an entire horse chest?

US on the thoracic cavity shows a focal, densely shadowing, bring interface surrounded by a fluid pocket of echogenic fluid.. what would you suspect as your DDX?

Foreign bodies

US shows anechoic fluid in the pleural space.. what could cause this?

Non-septic (viral induced) uncomplicated effusion Heart failure Malignancy

US shows bright echos within pleural fluid.. what could cause this???

Presence of gas. —> fistula or anaerobic bacteria

Increased echogenicity within the pleural space indicates?

Increased cell count (WBC/ RBC) or fibrin

What can you see on ultrasound that can indicate a “dry pleuritis” ?

Spastic movement of the lung along the parietal pleura (not a smooth motion) Detection of irregular lung surface —> “comet tail” artifacts

Lung is hyperechoic with focal areas of hyperechogenicity.. what is going on?

Collapsed lung - atelectasis and puss

How can you tell the difference between a consolidated lung and an atelectasis on ultrasound?

Consolidated lung - rounded borders -> two convex borders meeting Atelectic lung —> very sharp concave, convex borders with reduced volume

Hypoechoic foci in the lungs indicate?

Areas of pus or inflammatory fluid accumulation

Hyperechoic areas in the lung can indicate?

Areas of fibrosis

An irregularly shaped air-filled region surrounded by hypoechoic lung is characteristic of???

Abscessation filled with anaerobes

What method do you use for transtracheal wash?

Sterile technique Go into trachea just above the bifurcation of the sternothyroideus muscle Inject 60cc saline to wash and aspirate back

T/F: you can culture a sample from a transtracheal wash

True

What test is indicated for local/focal disease ? A. Bronchoalveolar lavage B. Transtracheal wash C. Pulmonary aspirate/biopsy

Transtracheal

What test is indicated for diffuse pulmonary disease ? A. Bronchoalveolar lavage B. Transtracheal wash C. Pulmonary aspirate/biopsy

Bronchoalveolar lavage

You want to do both a bronchoalveolar lavage and a transtracheal wash on your horse.. which will you do first.?

Transtracheal wash—> uses sterile techniques — culture Brochoalveolar wash —> not sterile

T/F: bilateral nasal discharge localizes disese to lower airways

False | Can be either upper or lower airway

Inspiratory difficulty localizes airway disease where?

Upper airway - will also have absence of abnormal lung sounds

Serous, mucoid, or mucopurulent discharge with fever can indicate what type of airway disease?

Infectious

What would you see on a CBC of a horse with infectious airways disease?

Neutrophilic leukocytosis | Hyperfibrinogenemia

You have a serous bilateral nasal discharge. The horse has inspiratory difficulty but the horse does NOT have a fever and CBC is normal.. what would your top DDX be for this horse.?

Non-infectious upper airway disease - allergic rhinitis - dorsal displacement of the soft palate - left laryngeal hemiplegia

You have a horse with.. bilateral mucopurulent discharge, inspiratory difficulty, and a fever.. CBC shows a neutrophilic leukocytosis and hyperfibrogenemia.. what is your top DDX?

Upper airway inflammatory disease - infectious sinusitis - strangles - viral respiratory disease

You have a horse that has a bilateral serous nasal discharge, expiratory difficulty with an normal CBC. What is you top DDX?

Non-infectious lower airway disease - recurrent airway obstruction (COPD) - smoke inhalation

You have a horse with mucous bilateral discharge, bilateral flow from the nostrils, fever, and expiratory difficulty.. CBC shows neutrophilia and hyperfibrinogenemia.. top DDX?

Infectious lower airway disease - pleuropneumonia - foal pneumonia