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Equine Medicine > Respiratory system- Respiratory diagnostics > Flashcards

Respiratory system- Respiratory diagnostics Flashcards

1
Q

dyspnea

A

Difficulty in breathing. Noticable increased work to breathe or distres

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2
Q

Tachypnea

A

icnreased respiratory rate with reduced tital volume (fast, shallow breathing)

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3
Q

Hyperpnea

A

increased respiratory rate with increased tidal volume (fast, deep breathing)

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4
Q

Hypoventilation and CO2

A

Increase in PaCO2

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5
Q

Hyperventilation and PaCO2

A

Decreased PaCO2

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6
Q

Normal respiratory rate in adult horses

A

8-16bom

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7
Q

Normal respiratory rate in equine neonates

A

60bpm at birth, 30vpm at 30 days

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8
Q

If you have unilateral nasal discharge, where is the origin

A

origin is rostral to the larynx, bilateral disease may originate from the upper and lower airways

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9
Q

define hemoptysis

A

coughing up blood from the airways or lungs

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10
Q

define epistaxis

A

presence of blood at the nares.

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11
Q

What does it mean when you have cyanotic oral mucosal membranes

A

bluish discoloration of oral, nasal, vulvar mm. This is the result of a greater than 30% deoxygenation of hemoglobin - Presence of cyanosis is an indication of lack of oxygensaturation and SEVERE hypoxemia

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12
Q

What is cyanosis dependent on?

A

deoxygenated hemoglobin

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13
Q

can a severely anemic animal be cyanotic

A

no they do not have enough hemoglobin to demonstrate the characteristic bluish color

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14
Q

A foal is cyanotic immediately at birth- is this situation comomn?

A

this is normal for the first few breaths and only become pink when they have established neonatal cardiorespiratory circulation and have fully inflated their lungs to allow for gas exchange

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15
Q

When you have a eupnic patient, how do you perform an adequate respiratory examination?

A

Patients that present eupnic at presentation require induction of hyperpnea using a rebreathing bag. The rebreathing bag increases the inspired CO@ and increases the PaCO2 and depth frequency of breath. This allows for easier recognition of abnormal lung sounds

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16
Q

What situation would the use of a rebreathing bag be contraindicated

A

dyspneic patients or those with a history of aspiration

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17
Q

What is the location in the respiratory tree that serves as the source for normal lung sounds?

A

Airways distal to the larynx to the level of the segmental bronchi are responsible for the generation of lung sounds.

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18
Q

What would you suspect when you have reduced, or absent ventral lung sound

A

Pleural effusion

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19
Q

What would you suspect when you have reduced or dull dorsal lung sounds?

A

pneumothorax

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20
Q

What is the source of Crackles. Explain how this occurs and situations where this happens

A

generated by sudden pressure equalization when collapsed airway segments reopen -air fluid interface is required to create crackles - Often end-inspiratory and associated with reinflation of an atalectatic lung. -Disease conditions: pneumonia, interstitial fibrosis, COPD, CHF, atelectasis

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21
Q

What is the source of Wheezes? Explain how this sound is generated

A

Oscillation of airway walls before complete closing or opening - intrathoracic airways are usually involved in the expiratory wheezes (distal trachea and main, lobar, and segmental bronchi_ wheezes that disappear with coughing indicates secretory rather than tissue component origin

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22
Q

What are disease processes associated with wheezes?

A

airway stenosis or external compression, airway lumen compromise by a foreign body, purulent material, cyst or neoplasm, bronchoconstriction

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23
Q

Expiratory wheezes and the disease indications

A

Obstructive airway diseases including asthma.

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24
Q

When would you auscultate pleural friction rubs?

A

rubbing or creakign adventitious sounds generated by sliding or stretching of inflammed pleural surfaces

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25
Q

When ausculting a patient over the lung fields, what would ventral hyporesonance indicate

A

pleural effusion

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26
Q

When ausculting a patient over the lung fields, what would dorsal hyperresonance indicate

A

Pneumothorax

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27
Q

is a resting endoscopic exam sufficient in evaluating the respiratory changes?

A

no a dynamic upper airway obstructions can be missed with resting endoscopy alone. - using video endoscopy, slow motion and freeze-frame features can aid in the diagnosis process

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28
Q

What is the benefit of an overground dynamic endoscopic evlauation

A

This allows for examination under a more natural exercise scenario and with the horse under saddle

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29
Q

What can you use upper airway endoscopy to diagnose?

A

pharyngitis/lymphoid hyperplasia, laryngeal hemiplegia/recurrent laryngeal neuropathy, epiglottic deformities and entrapment, DDSP, pharyngeal cysts, and gutteral pouch disease.

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30
Q

a Lateral radiograph of the gutteral pouch can be utilized to diagnose what?

A

empyema, chondroids, and tympany

31
Q

Describe alveolar radiographic patterns

A

opaque areas coalesce and fully obliterate vessels and bronchi, and air bronchograms may be prominent Commonly found in pulmonary edema, pulmonary hemorrhage, EMPF, ARDS, pneumonia with lung consolidation, and neoplasia.

32
Q

Name the radiographic pattern

A

Alveolar radiographic pattern

33
Q

Name the radiographic pattern

A

Mixed bronchiointerstitial pattern

34
Q

Name the radiographic pattern

What condition is this commonly assocaited with ?

A

Bronchial radiographic pattern

A pure bronchial pattern is rare in horses, it is usually seen in association with an interstitial pattern

35
Q

When you see a rectangular interstitial radiographic pattern, what is the diagnosis commonly?

A

this is more common with diffuse infectious diseases, pulmonary edema, intersitital pneumonia and pulmonary fibrosis.

36
Q

What is the best method in identifying rib fractures in horses/

A

Ultrasound

37
Q

what is the advantage of CT over MRI in horses in a hospital setting?

A

Horses do not require general anesthesia while imaging is being collected.

Imaging is rapid in comparison.

38
Q

True/False: pulse oxymetry is a replacement for arterial blood gas analysis

A

false

39
Q

define hypoxemia

What causes hypoxemia to develop?

A

decreased oxygen tension of the arterial blood (decreased PO2)

Lo FiO2 (high altitude)

Hypoventilation

V/Q mismatch

diffusion limitation

intrapulmonary or intracardiac right-to-left shunting

40
Q

Define Hypoxia?

A

decreased oxygen concentration at the level of the tissue, with, or without hypoxemia. This occurs as a result of hypoxemia, decreased perfusion, or decreased oxygen carrying capacity.

41
Q

What occurs in response to acute hpercapnia:

A

typically results in a relatively dramatic drop in blood pH

Results in respiratory acidosis that can lead to circulatory collapse in hypoxemic and hypovolemic patients.

42
Q

What occurs in the blood gas analysis in response to chronic hypercapnia

A

this has a less obvious change as time allows for adaptation.

Kidneys increase bicarbonate absorption from the proximal tubules to compensate, resulting in normalization of the pH.

43
Q

What samples do you collect with TBA?

A

airway secretions

Appropriate for lower respiratory secretion sample for bacterial culture.

44
Q

BAL is performed to obtain samples from where?

A

Terminal airways and alveolar region.

It is recommended for this procedure to use a bronchodilator such as albuterol right before performing.

45
Q

Why is butorphanol used during a bronchioalveolar lavage?

A

helps reduce procedural cough

46
Q

Why is lidocaine used during a bronchioalveolar lavage

A

Reduces swallowing attempts and coughing

47
Q

How much fluid should you expect to aspirate from a bronchioalveolar lavage?

A

50-75% of the instilled volume.

48
Q

True/False Bronchioalveolar Lavage samples are appropriate for use for bacterial culture

A

False

49
Q

Would you use TBA or BAL for diagnosis in asthma?

A

BAL

50
Q

When a case requires both a TBA and BAL, what should be performed first?

A

TBA should be performed first

51
Q

What anatomical location do you use for a thoracocentesis

A

6th-7th intercostal space, approximately 10cm dorsal to the olecranon and above the lateral thoracic vein. incision is made at the caudal border of the rib.

52
Q

With a case of pleuropneumonia, what are the diagnostics utilized?

A

TBA is the preferred culture sample.

Pleural fluid is suibtable for microbiali culture, cytology, fluid analysis but TBA should also be preformed

53
Q

When is sinus trephination waranted?

A

when there is suspicion or evidence of sinus disease

This is useful for diagnostic aspiration, drainage and flushing of the sinuses.

54
Q

where is the common anatomic location where the sinuses communicate and drain into the nasal passage?

A

Nasomaxillary opening

55
Q

How do you access the maxillary sinus?

A

draw a line from the medial canthus and perpendicular to the facial crest.

56
Q

what are the 2 options available for sampling the gutteral pouch?

A

Endoscopic biopsy channel - aspirating or injecting sterile fluid into the pouch

Chamber’s catheter- this is blindly entering via. the ventral meatus

57
Q

What diagnostics are appropriate to run on a sample obtatined from the gutteral pouch via Endoscopsy or chambers catheter

A

microbial culture

cytologic examination

molecular diagnostics

58
Q

What is a downfall of endobronchial biopsies using a biopsy probe in horses?

A

the small sample sizes.

59
Q

What are complications of lung biopsies?

A

this is an invasive procedure, but is considered reasonably safe

Complications: hemoptysis, epistaxis pleural or pulmonary hemorrhage

60
Q

How do immunologic tests aid in identifying respiratory pathogens?

A

These rely on the interaction between the bacteria, viral and fungal interactions and the labeled antibodies.

Immunofluorescence and virus neutralization are highly sensitive and specific, but is labor intensive and time consuming

ELISA is readily available but can be subject to false-negatives adn false-positive results

Immunohistochemistry is used to identify viral, bacterial and protozoal pathogens using monoclonal or polyclonal antibodies that target the antigen

61
Q

True or false

PCR samples can be frozen when submetted for evaluation.

A

False.

PCR samples should not be frozen, but rather refrigerated and processed within 2-3 days.

62
Q

What is the recommended method for Streptococcus testing?

A

for PCR it is recommended using nasopharyngeal swabs or gutteral pouch lavage fluid.

63
Q

True/ False

Bronchioalveolar lavage sample is appropriate for bacterial culture.

A

FALSE

It is appropriate for cytology and PCR

64
Q

Why would you use Pulmonary function testing in a horse

A
  • This attempts to obtain information caused by non-infectious airway obstruction and inflammation
    • Objective measures and data to assist with the understanding of the pathogenesis, pathophysiology, epidemiology, diagnosis and treatment of lung disease in the horse
65
Q

In regards to Pulmonary Function Testing (PFT), what is the difference between static and dynamic testing of mechanical breathing?

A

Static tests are performed with the respiratory system at equilibrium and zero flow.

Measures of static compliance or elastic recoil of the lung require breath holds and have applications only to the anesthetized patient.

Dynamic tests- performed with the respiratory system in motion (during quiet breathing)

  • Pulmonary resistance is defined as the friction of air molecules against the airway walls.
  • Pulmonary resistance using a flow meter to measure transpulmonary pressure change is rarely used in the clinical setting
  • increases in resistance are insensitive and may bhave a greater utilitiy in diagnosing mild asthma.
66
Q

What are causes of a reduced lung compliance?

A

increased fibrous tissue (pulmonary fibrosis)

Atelectasis

Increased pulmonary venous pressure, in which the lung becomes engorged with blood

67
Q

What is increased lung compliance associated with?

A

emphysema and normal aging of the lung.

68
Q

What are Forced Oscillation Techniques used to diagnose?

A

Mild asthma

this applies external forces to the respiratory system to measure mechanical lung function.

This is commonly combined with bronchoprovovation tests for early diagnosis of mild asthma.

69
Q

What is Histamine Broncoprovocation?

A

this is a challenge test that assesses the response of the respiratory system to a bronchoconstrictor agonist (inhaled histamine)

70
Q

What is airway hyperreactivity?

A

this is an exaggerated narrowing response to a bronchoconstrictive stimulus. This is first found in horses with asthma and is considered the hallmark of inflammatory airway disease

71
Q

How is a Forced Oscillation Technique performed?

A

Horses are subjected to external forces to the respiratory system while wearing a fitted mask. The forces are conducted through the mask, and resistance measures are recorded

72
Q

What is Respiratoory Inductive Plethysmography?

A

objective assessment of the respiratory function and breathing pattern

2 elastic bands measure the circumference and volume of the thorax and abdomen during normal respiration. Nasal flow measurements are obtained through a face mask

This assesses the synchronicity of the breathing pattern and the individual contribution of the thorax and abdomen to respiration.

73
Q

What are forced maneuvers used for?

A

This attempts to measure the lower airway obstruction, including flow limitation in horses with early signs of mild asthma that was worse in animals with severe asthma.

this technique is commonly used in humans with suspected asthma.

Equine Medicine (5 decks)

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