Test 2 - Cough Flashcards
The _______ is compromised of continuous waves of ciliary motion that start at the level of the bronchioles.
Mucociliary Escalator
The ______ removes secretions from the tracheobronchial tree proximal to the level of the segmented bronchi.
Cough Reflex
TRUE/FALSE:
Sneezing is an important and normal respiratory defense mechanism.
It is a sudden, forceful noisy expulsion of air through the glottis to clear particles & other material from the tracheobronchial tree and glottis.
FALSE
We’re on the cough lecture…
The mucociliary escalator works at the level of the _______ while the cough reflex works at the level of the _________.
The mucociliary escalator works at the level of the bronchioles while the cough reflex works at the level of the tracheobronchial tree (proximal to the level of the segmented bronchi)
_________________ is a constant component of cough.
Bronchoconstriction is a constant component of cough.
List the nerves involved in the cough as an involuntary reflex.
Vagus n.
Glosopharyngeal
Trigeminal
Phrenic
TRUE/FALSE.
Things such as sloughing of the airway epithelium, intra/extramural pressure (ie tumor/fibrosis), and increased epithelial permeability (pulmonary edema) can stimulate cough.
TRUE
_______ & ______ are part of the mucucilliary clearance mechanism.
Pseudostratified ciliated columnar epithelium & Clara cells are part of the mucucilliary clearance mechanism.
___________ are located in terminal and respiratory bronchioles. Source of surfactant-like substance which aids in maintaining patency of airway. Metabolize airborne toxins.
Clara Cells are located in terminal and respiratory bronchioles. Source of surfactant-like substance which aids in maintaining patency of airway. Metabolize airborne toxins.
How long does airway epitheliuam take to heal?
about 7 weeks
Nasal discharge with a foul smell is indicative of a(n) _______ infection.
Anaerobic
Fill in the cause of these lungs sounds:
- ________: ↑ lung sounds, crackles and wheezes
- ________: ventral dull sound
- ________: cardiac sound larger than normal b/c improves sound conduction
- Pneumonia: ↑ lung sounds, crackles and wheezes
- Pleuropneumonia: ventral dull sound
- Pleural effusion: cardiac sound larger than normal b/c improves sound conduction
____________ is a symptom of peracute presentation of respiratory disease and has signs similar to colic.
Pleurodynia is a symptom of peracute presentation of respiratory disease and has signs similar to colic.
TRUE/FALSE:
Infectious causes of coughing present with no fever.
FALSE
Infectious - Fever always with horses.
________ is a major cause of respiratory disease in horses.
What are some other features about this disease?
Equine Influenza is a major cause of respiratory disease in horses.
- Aerosolized respiratory secretions, >35 ft
- Young - 3 y/o
- Crowding, transport & stress
- Destroy ciliated epithelium
A young horse about 2 y/o presents with conjunctivitis, lymphadenopathy, edema,
vasculitis, and polysynovitis. What is yur most likely diagnosis?
EHV-1 or 4
Identify the right EHV virus to the signs listed.
_______: respiratory & reproduction signs
______: respiratory & neurologic signs
_____: EMPF
EHV4: respiratory & reproduction signs
EHV1: respiratory & neurologic signs
EHV5: EMPF
______ causes respiratory disease, abortions, and foal pneumonia through close contact transmission. It has a long lasting immunity (both natural and vaccines).
What is the typical age of the horse affected by this disease?
Equine Viral Arteritis causes respiratory disease, abortions, and foal pneumonia through close contact transmission. It has a long lasting immunity (both natural and vaccines).
NOT AGE RELATED
________ is associated with immunocompromised Arabian foals (SCID)
Equine Adenovirus associated with immunocompromised Arabian foals (SCID)
_______ infectious are usually clinically inapparent but may present with pharyngitis, mild bronchitis, nasal discharge.
Equine Rhinovirus infectious are usually clinically inapparent but may present with pharyngitis, mild bronchitis, nasal discharge.
________ is a commensal aerobic bacteria associated respiratory infections.
Streptococcus zooepidemicus is a commensal aerobic bacteria associated respiratory infections.
List the parastes associated with lung disease.
- Lung worms: Dictocaulus arnfieldi
- Roundworms: parascaris equorum.
_____ is the most common pathogen associated secondary fungal pneumonia.
Aspergillus is the most common pathogen associated secondary fungal pneumonia.
____________ is a major contributor for bacterial pneumonia and pleuropneumonia
Physiologic stress is a major contributor for bacterial pneumonia and pleuropneumonia
How do transportaiton and exercise contribute to the development of cough?
- Transportation: Head elevated & secure (compromise mucocilliary clearance mechanism), dehydration (↓ secretions)
- Exercise: high intensity exercise results in ↓ peripheral blood neutrophil function, oxidative burst of pulmonary alveolar macrophages, EIPH
What kind of synthetic surfaces are associated with aspiration?
Synthetic surface → fibers, sand, rubber, coated with wax
Stomach tube, choke, LH, dysphagia (neonatal encephalopathy, botulism, guttural pouch disease, strangles) are all causes of _______.
Aspiration.
What are the affects of carboxyhemoglobin?
Carboxyhemoglobin: ↓ ability for O2 to be released at the tissue site leading to hypoxia
What are the results of smoke inhalation? How can it be diagnosed?
Carboxyhemoglobin (diagnosis >10%)
Severe bronchoconstriction
Pseudomembranous cast
What are the factors related to the development of cough during anesthesia?
- Transtracheal Intubation: excessive cuff pressure → tracheal necrosis
- Dorsal recumbency
- Anesthetics cause depression of the respiratory defense mechanism
What are the primary lung tumrs in the horse?
granular cell tumor, pulmonary chondrosarcoma
A horse presents thin, with a dull attitude, tachypneic with increased respiratory effort. The presenting complaints are
Occasional Dry Cough, Exercise intolerance and Acute Respiratory Distress.
Initial Lab work shows:
↑ WBC count, ↑ fibrinogen, anemia, lymphopenia.
Radiographs show
a diffuse bronchointerstitial pattern with multiple coalescing circular nodules throughout the lung field.
What is the most likely diagnosis?
Equine Multinodular Pulmonary Fibrosis, most comomnly associated with EHV-5 Virus
What are the proposed treatments for Equine Multinodular Pulmonary Fibrosis?
corticosteroids
NSAIDs
antibiotics, antivirals (acyclovir,valacyclovir),
bronchodilators, O2 supplementation,
antifibrotic agents -colchicine
immune modulators (IFN-y)
What are the differentials for foal pneumonia in each of the following age groups?
1 Months
1-6 months
• <1 month: in utero or perinatally lung infection, meconium aspiration, aspiration
pneumonia, iatrogenic, surfactant inactivation, EVA, EHV-1, EHV-4.
• Adenovirus-combined immunodeficiency in Arabian foals
• 1-6 mos: S. zooepidemicus, R. equi, Respiratory viruses are often the 1° agents.
What are the clinical findings asociated with foal pneumonia (Chem/CBC/Blood Gas)
- CBC: Abnormal, nonspecific, reflects chronicity & severity of inflammatory process
- Acute: hyperfibrinogenemia & neutropenia
- Chronic: neutrophilia, anemia of chronic disease
- Hyperbilirubinemia: anorexia
- Azotemia: pre-renal or renal
Arterial blood gas: hypoxemia, hypercapnia, respiratory acidosis.
What does U/S assess vs. Radiographs in foal pneumonia?
• U/S → pleura irregularities, limited deeper pulmonary parenchymal
• Rads: more efficient evaluating deeper parenchyma, evaluate the amount of lung consolidation, evaluates long
term progression
What are complications of a TTW?
• Complications: cellulitis & chondritis
TRUE/FALSE
When treating foal pneumonia, chronic pneumonias rarely require fluid therapy.
TRUE.
Fluid therapy should be used in the event of acute/hypovolemic patients.
You perform a TTW in a foal with pneumonia and submit samples for cytology. Match the infectious agent with the appropriate treatment:
Agents:
- S. Zooepidemicus
- Rhodococcus Equi
- Bacteroides fragilis (anaerobe)
Treatments (note: some may not be used, some may be combined)
- Clarithromycin
- TMS
- Aminoglycosides
- Rifampin
- Penicillin
- Metronidazole
- Ceftiofur
*
- Penicillin: most common pathogen S. zooepidemicus
- Ceftiofur: convenient in foals
- Combination of TMS or aminoglycoside
- Clarithromycin and Rifampin: Rhodococcus qui
- Metronidazole: anaerobes (Bacteroides fragilis)
What is the benefit of using aerosolized anti-microbials? Which are commonly used?
- Reach 12 times higher concentration than iV administration with lower toxicity
- Gentamicin & ceftiofur
You treat your foal with an anti-microbial for its foal pneumonia. What else can you use?
- Anti-inflammatory:
- NSAIDs: phenylbutazone, flunixin meglumine
- Corticosteroids: if unresponsive to antimicrobial and anti-inflammatory therapy
- Bronchodilators: albuterol, clenbuterol
- Palatable feed: green grass → monitor body weight
- Stall rest
- Immune modulators: IFN-y
- Antivirals: acyclovir, valacyclovir
TRUE/FALSE
When treating foal pneumonia, steroids should only be used if they are unresponsive to antimicrobial and anti-inflammatory therapy.
TRUE
TRUE/FALSE
Abscessation, necrotic tissue and pleuropneumonia are all potential compllications of foal pneumonia.
TRUE
