Respiratory Tract Flashcards
General impression (distant exam?)
Behaviour Posture Gait Body Condition Abnormal sounds/noises, breathing
Dyspnoea
Abdominal resp component
Steps of the physical exam
Nose and paranasal sinuses Guttural pouches Cough Larynx Trachea Thorax
Methods of physical exam
Inspection Smell Palpation Auscultation Percussion
Exam of nose
All methods can be used! (IPAPOM)
Direct auscultation
Percussion of bones with the tip of the middle finger
Normal findings of the nose
Temp is equal to the surroundings
Palpation not painful
Percussion sound: sharp, bone-like
Nasal Discharge
Continuous or temporary
Uni or bilateral
Amount and grade of discharge- mild, moderate or severe
Quality, colour and smell of discharge- serous, mucous, purulent, haemorrhagic, frothy, containing food particles
Origin- nose, paranasal sinuses, pharynx, guttural pouch, trachea, lung, stomach
Expired air from the nose
Intensity and temp of airflow
Smell
Normal findings of expired air
Medium strength and temp
Odour not unpleasant (characteristic)
Airflow symmetric bilaterally
Exam of the paranasal sinuses
Almost totally communicate!
Thin septum between the rostral and caudal maxillary sinuses
Which sinus is most commonly affected?
The maxillary!
Primary disease
Diseases of the upper cheek teeth
Physical methods of examining the paranasal sinuses
Inspection
Palpation
Percussion (flexed middle finger)
Normal findings of the paranasal sinuses
Skin intact! no alopecia/ abnormalities
Temperature equal to surroundings
Palpation not painful
Percussion sound: sharp, bone-like
Exam of the Guttural pouches
Diverticulum of the Eustachian tube (300-500ml)
Btw the base of the skull, atlas and pharynx
Split by the stylohyoid into lateral and medial (larger) recesses
Left and right pouches do not communicate
Physical methods of examining the guttural pouch
Inspection
Palpation
Percussion (finger to finger or plessimeter and hammer)
Normal findings of the guttural pouch
Skin intact- no alopecia
Temp is equal to the surroundings
Palpation not painful
Percussion sound is RESONANT!!
Endoscopy of the guttural pouches
Enter the nasomaxillary sinus- the medial meatus is medial- check for sinusitis here!
Pharyngeal recess
‘Butterfly’ at end of the soft palate is the entrance to the guttural pouch and is usually closed! only open when swalloing
Put wire through flap dorsally
Medially: internal carotid and N.vagus
Laterally: external carotid
Ventro-medial: ln retropharyngeal if it’s enlarged
The tendinous part of M. longus capitis could be damaged with hyperextension- hematoma and nosebleeds
Ear movement visible!
Problems associated with the guttural pouch
Dysphagia: aspiration pneumonia
Neurovasc bundles sensitive to infection/ injuries
Nosebleeds: trauma, coagulopathy, tubing
Mycotic/fungal infections are very common because the environment is favourable!-
If already bleeding go in very carefully not to disturb the thrombus
usually aspergillus sp
DONT USE IODINE- neurotoxic, use saline or antispetic
Medial septum can be destroyed
Cysts
Masses
Ethmoid hematoma- benign
Cough
Mode of emergence: spontaneous or induced Frequency Intensity Tone Occurrence- at rest or during exercise Duration Amount of secretion Pain
Induction of cough
Press the arytenoid cartilages and the first tracheal rings
Normal findings of an induced cough
No spontaneous or very difficult to induce Characteristics of the induced cough: strong sharp low short dry non-painful snapping does not recur
Physical examination of the larynx
Inspection
Palpation
Auscultation
Normal findings of the larynx
Skin intact, no alopecia, no abnormalities
Temp equal to the surroundings
No alterations on palpation
Very mild stridor on auscultation
Physical exam of the trachea
Inspection
Palpation
Auscultation
(same as larynx)
Normal findings of the trachea
Skin intact, no alopecia, no abnormalities
temp equal to the surroundings
no alterations on palpation
laryngeal noise is audible in a weaker form on auscultation (as its travelling)
Endoscopy of the trachea
Small vessels are visible usually
The lower the more oval shaped
Carina marks the bifurcatio
Physical exam of the thorax
Inspection
palpation
auscultation
percussion
Inspection of the thorax
Shape, size and symmetry of hemithoraces
Breathing:
resp rate and rhythm, type and depth
dyspnoea: inspiratory, expiratory or mixed
Auscultation:
resp noises of the horses are weak
start behind the scapula, move 2-4 IC spaces caudally
start dorsally and then move 5-10cm ventrally
check at least one inspiration and expiration at each spot -longer if there are abnormalities
examine both hemithoraces
Basic resp noises
weak and soft normally!
Weaker than normal:
Decreased airflow and superficial breathing
Missing:
pleural effusion
consolidated lung
Increased intensity, louder and harsher:
Dyspnoea and increased airflow
Adventitious resp sounds
Muscial: whistling- wet
Non-musical (crackles)-dry!
clicking, rattling, crackling
Percussion of the thorax: method
Use pleximeter and percussion hammer
Features of the normal percussion sound
Intensity: strong/sharp
Frequency: low
Tone: resonant
Duration: short
Normal lung borders
Tuber coxae: 16 IC
Tuber ischiadica: 14th IC
point of shoulder: 10th IC
Deltoid tuberosity: 7th IC
Ancillary diagnostic methods: endoscopy
Resting:
to diagnose laryngeal/pharyngeal cysts
unstable epiglottic folds
Dynamic: NO SEDATION! because it would change muscle reactions if the issue is with the larynx/pharynx
treadmill
telemetric(overground) with rider! better than treadmill
dorsal displacement of soft palate-gurgling sound, loss of power and the stopping of movement
left-sided laryngeal hypoplasia- not always visible in static because only the complete ones are very obvious
What are the ancillary diagnostic methods
Endoscopy US Radiography CT Thoracocentesis Thoracoscopy Lung function tests Nasal and pharyngeal swabs Tracheal wash Bronchoalveolar lavage Arterial blood gas analysis Pulmonary function tests
Ancillary diagnostic methods ultrasonagraphy- artefacts
Reverberation aretfact
Comet tail artefact
Pleural effusion
Ancillary diagnostic methods US- what is normal
Pleura should be a bright smooth line under the probe- the first sign of trouble is bumpy pleura
There shouldn’t be any fluid- but 1-2ml is ok- it should be black (echogenous)
US abnormalities
Visible lung tissue but no air inside= consolidated lung
Causes: edema, inflamm
any hyperechogenic parts-gas production from bacteria!
Fluid: if its clear (just black) this is better because it can be easily drained form both sides
“Snowflakes” hyperechogenic- pus, protein, fibrin- will block draining tubes so both sides need to be drained separately
Abscesses: but if they are over 5-6cm away from the thoracal surface they won’t be visible
Ancillary diagnostic methods: radiography
Normal and concave diaphragm
Increased interstitial pattern (does this mean in Eq the normal pattern is interstitial)
Ancillary diagnostic methods: thoracocentesis
Exudate—pleuritis
Blood– hemothorax
Ancillary diagnostic methods: tracheal wash
Suitable for bacterial and fungal culture
Cytology exams
Ancillary diagnostic methods: Bronchoalveolar lavage
Cytology
Ancillary diagnostic methods: Pulmonary function tests
Transpleural pressure change Pneumotachograph, flow measurement Resistance Dynamic compliance Arterial blood-gas analysis
