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Equine Surgery and Medicine > Respiratory Tract > Flashcards

Respiratory Tract Flashcards

1
Q

General impression (distant exam?)

A 
Behaviour
Posture
Gait
Body Condition
Abnormal sounds/noises, breathing
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2
Q

Dyspnoea

A

Abdominal resp component

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3
Q

Steps of the physical exam

A 
Nose and paranasal sinuses
Guttural pouches 
Cough
Larynx
Trachea
Thorax
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4
Q

Methods of physical exam

A 
Inspection
Smell 
Palpation
Auscultation
Percussion
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5
Q

Exam of nose

A

All methods can be used! (IPAPOM)
Direct auscultation
Percussion of bones with the tip of the middle finger

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6
Q

Normal findings of the nose

A

Temp is equal to the surroundings
Palpation not painful
Percussion sound: sharp, bone-like

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7
Q

Nasal Discharge

A

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

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8
Q

Expired air from the nose

A

Intensity and temp of airflow

Smell

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9
Q

Normal findings of expired air

A

Medium strength and temp
Odour not unpleasant (characteristic)
Airflow symmetric bilaterally

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10
Q

Exam of the paranasal sinuses

A

Almost totally communicate!

Thin septum between the rostral and caudal maxillary sinuses

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11
Q

Which sinus is most commonly affected?

A

The maxillary!
Primary disease
Diseases of the upper cheek teeth

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12
Q

Physical methods of examining the paranasal sinuses

A

Inspection
Palpation
Percussion (flexed middle finger)

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13
Q

Normal findings of the paranasal sinuses

A

Skin intact! no alopecia/ abnormalities
Temperature equal to surroundings
Palpation not painful
Percussion sound: sharp, bone-like

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14
Q

Exam of the Guttural pouches

A

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

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15
Q

Physical methods of examining the guttural pouch

A

Inspection
Palpation
Percussion (finger to finger or plessimeter and hammer)

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16
Q

Normal findings of the guttural pouch

A

Skin intact- no alopecia
Temp is equal to the surroundings
Palpation not painful
Percussion sound is RESONANT!!

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17
Q

Endoscopy of the guttural pouches

A

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!

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18
Q

Problems associated with the guttural pouch

A

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

19
Q

Cough

A 
Mode of emergence: spontaneous or induced 
Frequency
Intensity
Tone 
Occurrence- at rest or during exercise 
Duration
Amount of secretion
Pain
20
Q

Induction of cough

A

Press the arytenoid cartilages and the first tracheal rings

21
Q

Normal findings of an induced cough

A 
No spontaneous or very difficult to induce 
Characteristics of the induced cough: 
strong 
sharp
low
short
dry
non-painful
snapping 
does not recur
22
Q

Physical examination of the larynx

A

Inspection
Palpation
Auscultation

23
Q

Normal findings of the larynx

A

Skin intact, no alopecia, no abnormalities
Temp equal to the surroundings
No alterations on palpation
Very mild stridor on auscultation

24
Q

Physical exam of the trachea

A

Inspection
Palpation
Auscultation
(same as larynx)

25
Q

Normal findings of the trachea

A

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)

26
Q

Endoscopy of the trachea

A

Small vessels are visible usually
The lower the more oval shaped
Carina marks the bifurcatio

27
Q

Physical exam of the thorax

A

Inspection
palpation
auscultation
percussion

28
Q

Inspection of the thorax

A

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

29
Q

Basic resp noises

A

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

30
Q

Adventitious resp sounds

A

Muscial: whistling- wet

Non-musical (crackles)-dry!
clicking, rattling, crackling

31
Q

Percussion of the thorax: method

A

Use pleximeter and percussion hammer

32
Q

Features of the normal percussion sound

A

Intensity: strong/sharp
Frequency: low
Tone: resonant
Duration: short

33
Q

Normal lung borders

A

Tuber coxae: 16 IC
Tuber ischiadica: 14th IC
point of shoulder: 10th IC
Deltoid tuberosity: 7th IC

34
Q

Ancillary diagnostic methods: endoscopy

A

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

35
Q

What are the ancillary diagnostic methods

A 
Endoscopy 
US
Radiography
CT
Thoracocentesis 
Thoracoscopy 
Lung function tests 
Nasal and pharyngeal swabs 
Tracheal wash 
Bronchoalveolar lavage 
Arterial blood gas analysis 
Pulmonary function tests
36
Q

Ancillary diagnostic methods ultrasonagraphy- artefacts

A

Reverberation aretfact
Comet tail artefact
Pleural effusion

37
Q

Ancillary diagnostic methods US- what is normal

A

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)

38
Q

US abnormalities

A

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

39
Q

Ancillary diagnostic methods: radiography

A

Normal and concave diaphragm

Increased interstitial pattern (does this mean in Eq the normal pattern is interstitial)

40
Q

Ancillary diagnostic methods: thoracocentesis

A

Exudate—pleuritis

Blood– hemothorax

41
Q

Ancillary diagnostic methods: tracheal wash

A

Suitable for bacterial and fungal culture

Cytology exams

42
Q

Ancillary diagnostic methods: Bronchoalveolar lavage

A

Cytology

43
Q

Ancillary diagnostic methods: Pulmonary function tests

A 
Transpleural pressure change 
Pneumotachograph, flow measurement 
Resistance 
Dynamic compliance 
Arterial blood-gas analysis

Equine Surgery and Medicine (10 decks)

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