Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CRS2 > Sinus Disease & Epistaxis > Flashcards

Sinus Disease & Epistaxis Flashcards

1
Q

Which muscles dilate the nares at exercise in horses?

A

Nasolabialis muscles (facial nerve VII)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of primary sinusitis?

A
  • Bacterial – NB consider S equi var equi
  • Fungal (Aspergillus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of secondary sinusitis?

A

Usually secondary to dental disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which teeth are associated with the sinuses in the horse?

A
  • PM 4 and M1(part) are usually located in rostral maxillary sinus
  • M1, M2 and M3 are usually located in caudal maxillary sinus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What signs would you expect to see with dental disease in the first and second cheek teeth?

A
  • PM2 and 3 are not usually associated with paranasal sinuses (1st and 2nd cheek tooth)
  • So if we have dental disease in these teeth
  • The pus building at the apices of these teeth will cause facial distortion and enlargement/facial swelling as the primary finding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What diagnostics can be used for sinus disease?

A
  • History (purulent (odorous) nasal discharge (unilateral))
  • Physical examination
  • Percussion over sinuses to detect fluid
  • Nasal endoscopy
  • Sinoscopy
  • Radiography
  • Advanced imaging, esp CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which sinuses are easiest to make trephine holes into for sinoscopy?

A

The frontal sinus or caudal maxillary sinuses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do paranasal sinus cysts tend to present?

A
  • Usually in young animals
  • Expansive fluid filled lesions
  • Can cause facial distortion if they get very large
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How are paranasal sinus cysts generally diagnosed?

A
  • Radiography - soft tissue opacity throughout sinuses +/- gas / fluid line (but can be obscured by the secondary disease, e.g. secondary sinusitis)
  • Often get secondary sinusitis as normal drainage is obscured and so fluid builds up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Treatment and prognosis of paranasal sinus cysts?

A
  • Surgical removal via a frontonasal flap
    • Post-operative care as for sinusitis (promote drainage and antibiotics)
  • Good prognosis - recurrence rare if you remove all of the cysts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does primary bacterial sinusitis tend to develop?

A
  • Usually younger horses
  • Opportunistic bacteria, often Strep. sp.
  • Sequel to URT infection, related to poor drainage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical signs of primary bacterial sinusitis?

A
  • Purulent unilateral (usually) nasal discharge, not foul smelling
  • Lymph node enlargement (sometimes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnosis of primary bacterial sinusitis?

A
  • Radiography - gas/fluid lines
    • Pretty much in horizontal straight line
  • Need to determine whether it is a primary disease or a secondary disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Treatment of primary bacterial sinusitis?

A
  • Treatment to establish drainage and eliminate infection
  • Promote mucociliary clearance: Mucolytics, inhalations, feeding at floor level, exercise and antibiotics can all be used
  • Many resolve spontaneously
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would you manage primary bacterial sinusitis that is not responding to medical management?

A
  • Irrigation and drainage via trephine (or pin)
  • Frontal/maxillary flap if inspissated pus (hard, accumulated infection) to physically remove it - can be done standing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prognosis of primary bacterial sinusitis?

A

Good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When does secondary bacterial sinusitis tend to occur?

A
  • Usually older horses
  • Most often secondary to dental disease e.g. dental fracture, periodontal disease (periapical abscessation)
18
Q

Diagnosis of secondary bacterial sinusitis?

A
  • Physical examination (esp look for systemic diseases e.g. PPID)
  • Oral examination and dental assessment
  • Endoscopy (discharge from nasomaxillary opening)
  • Radiography (fluid lines and dental disease)
  • CT to evaluate tooth roots directly.
19
Q

Treatment of secondary bacterial sinusitis?

A
  • Treat primary disease
    • Remove diseased teeth
    • Pack oro-nasal fistulae
    • Irrigation and antibiotics
20
Q

What other conditions might you see in the paranasal sinuses?

A
  • Fungal granulomas
  • Ethmoidal haematomas
  • Squamous cell carcinoma
  • Other neoplasia is less common
21
Q

How does secondary mycotic sinusitis develop?

A

Occurs as a result of sequestra, chronic antibiotic administration, surgery, underlying debilitating disease

22
Q

Clinical signs of mycotic sinusitis?

A
  • Typically a destructive malodorous condition, that destroys the normal structure of the paranasal sinuses
  • Nasal discharge
  • +/- haemorrhage
23
Q

Diagnosis of mycotic sinusitis?

A
  • Sinoscopy/endscopy
  • Radiographs may be unremarkable
    • Especially if early mycotic disease
    • If chronic may see significant changes due to structural damage
24
Q

Treatment of mycotic sinusitis?

A
  • Eliminate underlying cause (or treat – eg PPID)
  • Physical lavage, then…
  • Lavage with topical antifungal agents (e.g. Enilconazole)
  • Prolonged treatment (4-6 weeks)
25
Q

Prognosis of mycotic sinusitis?

A

Good prognosis if treated adequately and not significant structural damage

26
Q

Clinical signs of mycotic rhinitis?

A

Malodorous purulent / sanguinous discharge

27
Q

How does mycotic rhinitis occur?

A
  • Occurs from within the nasal cavities themselves
  • Aspergillus fumigatus
    • In plants inc hay and straw.
    • Secondary to trauma?
28
Q

Diagnosis and treatment of mycotic rhinitis?

A
  • Serology is unreliable.
  • Topical treatment with nystatin or natamycin (powders)
  • Or endoscopically flush the cavities
29
Q

Potential sources of bilateral epistaxis?

A
  • Lungs
    • Exercise induced pulmonary heamorrhage – variable amounts (esp. racehorses/performance horses)
    • Lung neoplasia – variable, usually small amounts
  • Pharynx
    • Trauma, foreign body – variable, usually small amounts
    • Guttural pouch mycosis - large amounts
30
Q

Potential sources of unilateral epistaxis?

A
  • Pharynx
    • Guttural pouch mycosis - large amounts
  • Sinus
    • Mycotic sinusitis – usually small amounts
    • Trauma – usually small amounts
  • Nasal Cavity
    • Progressive Ethmoidal Haematoma – usually a slow trickle
    • Clotting abnormalities – usually slow and intermittent
    • Trauma
31
Q

How does iatrogenic epistaxis usually occur?

A
  • Usually a result of passing stomach tube into middle meatus
  • Should always go via the ventral meatus
  • Can be a significant amount of blood
32
Q

How should you manage iatrogenic epistaxis?

A
  • Care with passing tubes, well lubricated and care when removing the tubes too.
  • Will stop with time
  • Always warn owners that it may happen before passing anything
  • Hold head up
  • Avoid drugs to lower blood pressure (eg ACP)
33
Q

Which structures can be affected by gutteral pouch mycosis?

A
  • Usually affects internal carotid (medial compartment)
  • may be external or maxillary artery (lateral compartment)
  • cause tissue trauma and erodes into the blood vessels, usually not massive haemorrhage initially
  • may be a bilateral condition - check other GP
34
Q

Clinical signs of gutteral pouch mycosis?

A
  • Epistaxis: usually 1-3 episodes mild bleeding before the entire vessel ruptures - FATAL
  • Neurological dysfunction: facial nerve, laryngeal or pharyngeal paralysis, vagal signs
35
Q

Diagnosis of gutteral pouch mycosis?

A
  • Diagnosed most commonly by endoscopy
    • haemorrhage from guttural pouch ostia
    • DO NOT ENTER POUCH - REFER AND LET THEM DO IT!
  • Radiography
    • If you can see fluid lines in GP indicates there may be significant haemorrhage
36
Q

Immediate management of gutteral pouch mycosis?

A
  • Emergency due to potential for fatal haemorrhage
    • Very spontaneous and die very fast
  • REFERRAL
  • (Temporary cut down and occlusion of carotid can be used as in severe haemorrhage)
37
Q

Treatment of gutteral pouch mycosis?

A
  • Optimal treatment - surgical
    • Ligation and balloon occlusion of affected artery (on both sides of the fungal lesion)
    • Retrograde flow occurs therefore balloon occlusion recommended
38
Q

How does PCV alter in the horse following acute blood loss?

A
  • Initially…Loss of whole blood so no change in PCV or TP in first 4 hours
  • After this, splenic contraction in response to hypoxia causes increase in PCV, and increase in circulating RBC
  • Then, fluid recruited from Extracellular fluid, causing decline in TP and possible decline in PCV 4-6h
  • PCV changes not appreciated for 12-24 hrs
39
Q

Why do we have to take a bone marrow aspirate or biopsy in horses to classify their anaemia?

A

Horses do NOT release immature RBCs (stay in bone marrow)

40
Q

How does a bone marrow sample differentiate anaemia in the horse?

A
  • Determination of MYELOID cells
  • Determination of ERYTHROID cells
  • Ratio between them different in different anaemias
41
Q

How would you get a bone marrow sample in the horse?

A
  • Hollow needle, around a 12G, firm and hollow trochear
  • Drive into sternum to sample the bone marrow
  • Examined by clinical pathologist to determine the anaemia type.

CRS2 (64 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions