Respiratory Tract Flashcards by Mary Doody

General impression (distant exam?)

Behaviour
Posture
Gait
Body Condition
Abnormal sounds/noises, breathing

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Dyspnoea

Abdominal resp component

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Steps of the physical exam

Nose and paranasal sinuses
Guttural pouches 
Cough
Larynx
Trachea
Thorax

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Methods of physical exam

Inspection
Smell 
Palpation
Auscultation
Percussion

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Exam of nose

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

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Normal findings of the nose

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

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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

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Expired air from the nose

Intensity and temp of airflow

Smell

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Normal findings of expired air

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

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Exam of the paranasal sinuses

Almost totally communicate!

Thin septum between the rostral and caudal maxillary sinuses

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Which sinus is most commonly affected?

The maxillary!
Primary disease
Diseases of the upper cheek teeth

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Physical methods of examining the paranasal sinuses

Inspection
Palpation
Percussion (flexed middle finger)

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Normal findings of the paranasal sinuses

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

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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

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Physical methods of examining the guttural pouch

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

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Normal findings of the guttural pouch

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

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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!

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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 ```