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ClinSci 2 Exam 2 > Respiratory Exam > Flashcards

Respiratory Exam Flashcards

1
Q

clinical examination of respiratory issues in horses

A
  • resp rate, effort
  • resp pattern
  • resp quality
  • cough, sneeze, rattle
  • air flow
  • nasal dc
  • sinus percussion
  • lymph nodes: only ones palpable are submandibular
  • palpation and auscultation of trachea
  • rebreathing exam
  • lung auscultation
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2
Q

what are the only lymph nodes palpable in a horse?

A

submandibular

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3
Q

how do you assess nostrils for discharge?

A
  • present or absent
  • unilateral vs bilateral. continuous unilateral = problem w URT
  • quality of discharge
  • odor of discharge
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3
Q

how do you assess nostrils for airflow?

A

is it present or absent

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4
Q

bilateral nasal dc indicates

A

lower respiratory tract or bilateral dz process

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5
Q

unilateral nasal dc indicates

A

upper respiratory tract issue

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6
Q

you walk into a barn and smell a horse that has unilateral nasal discharge with a strong odor. what immediately goes on your differential list?

A

tooth root abscess! usually nasal discharge that smells is caused by anaerobic bacteria

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7
Q

dynamic obstruction

A

noise only occurs during inspiration OR expiration
most commonly during inspiration (esp if URT)

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8
Q

fixed obstruction

A

noise during inspiration AND expiration

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9
Q

T/F: characterizing the respiratory noise with noise level allows you to confidently make a diagnosis

A

FALSE: characteristic of noise does NOT equal diagnosis. need further testing

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10
Q

loudness cannot be used to

A

grade the degree of obstruction

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11
Q

you are listening to a horse being lunged and hear loud respiratory noise during both inspiration and expiration. what type of obstruction is this?

A

fixed obstruction

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12
Q

abnormal phonation

A

altered vocalization typically caused by diseases that affect the vocal cords

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13
Q

what are examples of abnormal phonation?

A

vocal cord paralysis (cranial nerve X), inflammation, infection, physical deviations due to tumors, cysts, etc

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14
Q

what is often one of the earliest signs of vocal cord disease?

A

altered phonation. whinny is often abnormal; sounds like horse has been smoking

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15
Q

your client tells you that they are concerned about their horse because their “whinny sounds different”. what are you concerned about?

A

vocal cord disease

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16
Q

injected/congested mucous membranes suggests that what issues could be going on?

A

endotoxemia/sepsis

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17
Q

cyanotic mucous membranes suggests that what issues could be going on?

A
  • difficult to see in pigmented skin
  • unsaturated hemoglobin!
  • O2 saturation <80%
  • PaO2 <40mmHg
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18
Q

what are the only lymph nodes that can be easily palpated in a horse?

A

submandibular: drain head, oral cavity, nasal cavity, eyelids, paranasal sinuses, guttural pouch

retropharyngeal lymph nodes may be palpated if enlarged

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19
Q

what structures do the submandibular lymph nodes drain?

A

head, oral cavity, nasal cavity, eyelids, paranasal sinuses, guttural pouch

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20
Q

sinus percussion

A

compare the resonance on both sides by tapping: is it hollow? air within sinus vs fluid?
- also note if the horse seems painful
- also check for facial symmetry

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21
Q

what 2 sinus compartments are easily percussed?

A
  • frontal sinus
  • caudal maxillary sinus

rostral maxillary sinus is a bit small but can be percussed

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22
Q

what is the “slap test”?

A

fingers around larynx, onto muscles that are the abductors of arytenoid processes, and use other hand to slap the horse on the withers. = reflex test = what should happen is you should get a tiny little twitch of the muscles that go to the arytenoids. difficult to feel because many moving parts! if you slap the horse rlly hard, will jump back and affect placement of the hand

what does it tell you = tests recurrent laryngeal nerve to assess abnormal function to larynx

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22
Q

how do you examine the larynx?

A
  • palpate dorsal aspect of larynx noting any asymmetry
  • palpate retropharyngeal area for retropharyngeal lymph node enlargement
  • “slap test” fingers around larynx, onto muscles that are the abductors of arytenoid processes, and use other hand to slap the horse on the withers. = reflex test = what should happen is you should get a tiny little twitch of the muscles that go to the arytenoids. difficult to feel because many moving parts! if you slap the horse rlly hard, will jump back and affect placement of the hand
  • try to elicit a cough
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23
what can you do instead of the slap test?
endoscope
24
how do you examine the trachea?
palpate for abnormalities like irregular cartilage rings or fractures - listen to it!! very important. listen to it for abnormal sounds = mucous rattles - respiratory sounds are very intense at the trachea
25
what is the most common thing to hear when listening to trachea in a horse?
mucous rattles! if fluid accumulates from lungs, moves to trachea
26
why is it important to listen to the trachea?
- hear mucous rattles here - respiratory sounds are most intense here! compare tracheal sounds to lung sounds
27
subcutaneous emphysema
can be caused by disruption of the respiratory tract distal to the larynx ex: tracheal rupture, penetrating foreign body, iatrogenic
28
SQ emphysema is indicative of
gas under the skin escaping or bubbling under the skin think infection or defect somewhere in the resp tract allowing air to escape: iatrogenic, trauma - need to be careful if doing a wash/injection: air can escape - in most cases is benign complication, just annoying rather than bad prognosis
29
subcutaneous emphysema prognosis
- usually benign complication but can result in death if very severe and migrates
30
what is the normal breathing pattern in most species?
costoabdominal breathing: means that there is 1/2 of motion/action during respiration costo and 1/2 is abdominal certain disease processes can change the breathing pattern (ex severe equine asthma)
31
severe equine asthma
air trapped in lower airways, loss of elasticity of lung tissue animal has to really force expiration out with abdominal musculature
32
you go to visit a horse that the owner is concerned has respiratory disease. you notice that its abdominal muscles are very well defined, and you note a "heave line" on the abdomen. what do you suspect is occurring?
severe equine asthma: the horse is using the abdomen to force/push air out. the muscles become bigger as they hypertrophy, which leads to the heave line
33
classical heave line
line does not go away: true hypertrophy of the abdominal muscles
34
what are causes of a restrictive breathing pattern
reduced chest/wall compliance, pleural effusion often large amounts of fluid in chest, mass in chest, lung that is fibrotic and cannot expand anymore. see a severe abdominal breathing pattern (ex orange cat video in class)
35
what is paradoxical breathing
on inspiration, the chest collapses (opposite of normal) - thoracic disease (trauma to wall) or some sort of neuromuscular dysfunction of the diaphragm
36
physics of breath sounds
- breath sounds created by turbulent airflow - laminar flow = silent: occurs in low flow situation (small airways <2mm) - turbulent flow = produces breath sounds. occurs when high velocity flow passes thru large diameter airway
37
what is laminar flow?
- parallel running layers of fluid or air running by each other; do not create sound - silent - low flow situation: small airways <2mm
38
what is turbulent flow?
- produces breath sounds - occurs during states of velocity (ex large airway)
39
what are causes of turbulent flow?
obstruction and high velocity
40
airflow turbulence is determined by
- airflow velocity - airway lumen architecture: the smaller the diameter, the quicker you will have turbulent flow smooth surface = stays laminar for longer period of time rough surface = turbulent flow. mucous, tumor, etc
41
decreased cross-sectional area (at equal V) does what to airflow velocity?
increases airflow velocity
42
irregular lumen architecture does what to airflow turbulence?
increases airflow turbulence
43
what can increase lung sounds when you are auscultating a patient?
1. increased velocity 2. reduced # of airways (will increase velocity) 3. any kind of narrowing within airway (will increase velocity)
44
if you go to the end of the resp tree and alveoli, is there turbulent flow?
no
45
how can you increase the amount of airways that can generate turbulent airflow?
increasing the amount/volume: increases the amount that you are hearing which starts to generate sound from smaller and smaller airways
45
turbulent flow is dependent on
speed of flow and the architecture of the surface that it flows over
46
how do you auscultate at rest?
- compare sounds in ventral, dorsal and mid thorax - compare sounds ausculted in L and R thorax - compare lung sounds to tracheal sounds - trachea has the biggest volume going thru when pt takes a breath: = loudest noise to use as baseline for resp sounds
47
rebreathing exam
- ausculte subtle airway sounds that you cannot hear at rest (esp horses bc they have such big lungs) - allows assessment of tolerance of exam - allows assessment of RECOVERY TIME - allows assessment of COUGHING
48
you want to evaluate a horse for coughing and recovery time. what kind of exam will you perform?
rebreathing exam: put bag over nose so they become anxious and breathe faster, and then take bag off and watch how long it takes to recover. should be back to resting respiratory rate within 5 breaths
49
how long should it take for a horse to return to normal respiratory rate?
5 breaths! if longer, have an issue
50
the sounds generated in the middle aspect of the lung have to travel thru many layers, meaning that they are _____ on auscultation
softer. have to travel thru many layers of tissue
50
intensity of sound depends on
- amount of turbulence: velocity + architecture - acoustic characteristics of tissue - thickness of tissue the more layers/changes in layer that the sound has to travel thru = the less you will hear
51
what can cause abnormal sound transmission?
- extrapulmonary factors: chest deformities, obesity - intrapulmonary factors: mechanical properties of lung (like emphysema), addition of medium between lung and stethoscope: air, fluid, masses
52
normal lung
aerated: sound must move thru multiple air-tissue interfaces
53
consolidated lung with patent airways
- fewer air-tissue interfaces - less attenuation - increased intensity! less layers that the sound has to travel thru = louder sound than in the normal animal
54
consolidated lung with blocked airways
loss of breath sounds
55
if you have a calf with bronchonpeumonia that has patent airways what you will hear is
INCREASED bronchovesicular sounds/increased intensity where you won't expect it to be. as long as there is still airways, they will be more intense
56
if you have a calf with bronchopneumonia with blocked airways, what you will hear is
loss of breath sounds. because the airways are blocked
57
abnormal breath sounds
additional respiratory sounds superimposed on normal breath sounds. being generated IN ADDITION to the normal breath sounds that are present
58
stridor
turbulent flow thru narrowed segment of URT, inspiratory
59
stridor is anything ____ to the larynx
caudal
60
stertor
"stridor" originating from airway rostral to larynx
61
wheezes
long and musical; high or low pitched, may be inspiratory or expiratory; due to narrowing of airway
62
crackles
short, explosive, nonmusical heard on inspiration; due to sudden inspiratory opening of small airways
63
how will a normal lung sound on percussion
clear quality, moderate intensity, low pitch if fluid present, hear a much duller sound (can tell you where the fluid level is)
64
trapped air percuss
ex: pneumothorax: clear quality, loud intensity, low pitch
65
solid tissue percuss
ex: pleural effusion, consolidation, mass dull quality, soft intensity, high pitch
66
diagnostics of resp issue
- CBC, chem, culture, viral testing - endoscopy - radiographs - ultrasonography

ClinSci 2 Exam 2 (11 decks)

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