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23 spring: med surg > Test 3: 55+ 56 > Flashcards

Test 3: 55+ 56 Flashcards

1
Q
A

smooth pleural surface sliding against each other

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2
Q
A

roughened visceral pleural surface- comet tails

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3
Q
A

pleural effusion- fluid is black, part of lung is consolidated- non aerated lung- meaty

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4
Q

TTA

A

trans tracheal aspiration/wash

good for focal lung disease- takes sample from “trash can”

can culture- sterile aspiration

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5
Q

BAL

A

bronchoalveolar lavage

only samples a random very small sample of lung- good for global lung disease

heaves, EIPH, fungal pneumonia, silicosis

can not use for culture- goes through nose

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6
Q

which lavage technique is better for focal lung disease

A

TTA- trans tracheal wash- take sample from trash can

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7
Q

which lavage technique is better for global lung disease

A

BAL- bronchoalveolar lavage

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8
Q

— can be used to diagnosis mild asthma in horses with normal physical exam

A

Open plethysmography with
histamine bronchoprovocation

shows how twitchy small airways are

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9
Q

3 general causes of lower airway disease in horses

A

infectious: viral bacterial, fungal
inflammatory- equine asthma, perilla mint, silcosis
cancer: primary and metastatic

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10
Q

training barn
7 out of 12 sick
thin nasal discharge
cough temp
occ crackles
↑resp rate

problem list
DDx
plan

A

Problem list

  • fever, cough nasal discharge, abn auscultation, multiple animals

Differential diagnoses

  • lower airway disease (crackles)
  • infection (bacterial, viral, fungal), immune-med, inflammatory (asthma), trauma, congenital

Plan:

  • Ultrasound- comet tails
  • PCR- equine influenza
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11
Q

equine influenza clinical presentation

A

fever ↑ 106
snot
cough (up to 3 weeks)

rarely fatal- similar to flu in humans

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12
Q

treatment for equine flu

A

rest
NO antibiotics- flu is viral

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13
Q

control of equine flu

A

vaccines after 6 months of age

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14
Q

equine herpes presents as

A

cough, nasal discharge (similar to flu)
biphasic fever
latent disease- flares with stress

EVH4- less severe
EHV1- abortion storm, neonatal death, myeloencephalopathy (EHM) fatal reportable

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15
Q

EHV4 can cause what reportable disease

A

myeloencephalopathy (EHM)
fatal
reportable
neuro signs often with urinary incontinence

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16
Q

treatment for equine herpes

A

rest
NO antibiotics- viral infection

vaccine q 6 months (does not protect against neuro EHV-1)

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17
Q

is EHV5 on a nasal swab and good or bad thing

A

normal- found in nose

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18
Q

flu outbreak recommendations

A

vaccinate q 6 months
quarantine affected horses
rest sick horses - one week for every day of fever

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19
Q

3 YO colt
shipped from florida last week
off feed and thick nasal dischange and cough
fully vaccinated
↑HR, resp and temp
radiating heart sounds on L
re-breathing- crackles R mid thorax
MM tachy. CRT 2.5 sec

problem list
DDx
plan

A

Problem list

  • Cough, nasal discharge, fever, tachypnea, crackles R lung, radiating heart sounds

Differential diagnoses
* Lung dx (viral, bacterial, fungal, non-infectious?)
* Guttural pouch disease?
* Sinuses?

Diagnostic plan
* Bloodwork- neutrophilia, hyperfibrinogenemia, ↑serum amyloid A
* Imaging: xray- US
* Trans tracheal aspiration- cytology and culture

Diagnosis
pleuropneumonia- shipping fever
pleural effusion- radiating heart sounds

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20
Q

how to do re-breathing exam on horses

A

Use a large plastic
bag
* At least one minute- ventilation
* Increase CO2, not decrease O2
* Increases depth and rate of breathing

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21
Q

what should be here?

A

triangle

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22
Q

lung US of horse with crackles and radiating heart sounds

A

pleural effusion
lung consolidation- fibrin
pneumonia

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23
Q

if you want to culture lavage which one to use?

A

TTA- good for focal lung disease(trash can)- more sterile

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24
Q

equine pneumonia is caused by what bacteria

A

strep equi subsp. zooepidemicus
Klebsiella pneumoniae

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25
Q

— causes strangles

A

strep equi equi
very contagious
abscesses in the lymphnodes

26
Q

how to treat step equi zoo

A

penicillin (strep gram + bacteria)

strep equi zoo is normal comensal, not contagious

27
Q

shipping fever in horses presents as

A

pleuropneumonia

ADR, anorexic
± Nasal discharge
Cough? Only sometimes.
Fever, tachypnea, pleurodynea (fake colic!)
Usually pleural effusion (not like dogs)

28
Q

diagnostic plan for horse with pleuropneumonia (shipping fever)

A

physical exam- re-breath if not distressed
Rads / U/S
CBC/fibrinogen
TTA- Bacterial culture and cytology →anaerobic culture too
tap chest- Pleural fluid- Glucose? pH? Low = septic

29
Q

treatment for pleuropneumonia

A

antibiotics- broad spectrum (penicillin for strep equi sp zoo)
NSAIDs
drain pleural effusion
supportive care → ↑calories

30
Q

what antibiotic should you not use for horse with pneumonia

A

baytril- enrofloxacin- does not cover strep equi zoo!

31
Q

how to treat pleural effusion in horse

A

drain- chest tap
penicillin for strep equi zoo

32
Q

when to stop treating pleuropneumonia

A
  • Re-check with rads or U/S
  • Normal fibrinogen/SAA (better than CBC)
  • Afebrile off all drugs for several days?

Mild cases: usually 1-3 weeks
Abscesses/necrotic lung: 1-6 months
Can cost >$5,000 (up to $20,000)

33
Q

treatment for shipping disease

A

antibiotics- penicillin (strep equi zoo), gentamicin, metronidazole

chest tap

NSAIDs
hydration
calories

34
Q

prognosis for shipping disease in horses

A

92% of STB and 52% of TB raced after abscesses. Worse with pleural effusion, much worse with anaerobic bugs

35
Q

anatomical location of pneumonia caused by shipping fever in horses

A

cranio-ventral portion of the caudal lung lobe, esp. right lung

causes by strep equi zoo- non contagious normal upper airway flora
in combo with gram + or gram-, ecoli or klebsiella

36
Q

3 YO QH mare
bought last week
now lethargic, hyporexic, bilateral purulent nasal discharge
temp 105.1
facial/lymphnode swelling

ddx
plan

A

nasal discharge
ddx:
* Strangles (Strep equi ssp equi)
* Viral URT infection
* Bacterial pneumonia
* Equine asthma (heaves)- no fever

lymphadenopathy
ddx
* Infection (strangles)
* Reactive lmyphadenopathy (virus) – usually mild swelling
* Lymphoma

lymph + fever + discharge
* strangles (strep equi ssp equi)

37
Q

plan for strangles

A

PCR- strep equi ssp equi

extremely contagious

can lead to persistent shedders- need to isolate

38
Q

how to treat strangles

A

Mild

  • Fever, mild anorexia, no resp distress
  • Symptomatic therapy
  • Drain abscesses
  • Cautious NSAID use
  • NO ANTIBIOTICS!

Severe

  • Resp distress: tracheostomy, drain abscess
  • Yes antibiotics: penicillin (kryptonite!), or ceftiofur, SMZ
39
Q

prevention of strangles

A

isolate affected horses until PCR negative

75% are immune after infection

vaccine- intranasal

strep equi spp equi

40
Q

strangles complications

A

bastard strangles
Abscesses in the abdomen, brain, liver, spleen, kidneys, etc.

guttural pouch: empyema and chondroids

41
Q

diagnosis for bastard strangles

A

metastatic strangles

strep M protein titer (SEM)
history
US, CSF tap
inflammatory blood work

42
Q

treatment of metastatic strangles

A

long term antibiotics- 1-6 months

Penicillin? 99% sensitivity. Pros and cons…
Ceftiofr (Excede) SMZ? Chloramphenicol?

43
Q

what are some immune mediated complications of strep equi exposure or vaccination

A

Purpura hemorrhagica
* Severe pitting edema (limbs,
ventrum) + Vascultitis: severe edema
* Rx: steroids and penicillin

Equine immune-mediated myositis
(IMM)
* Quarter horses and QH-related breeds
* Rapid and severe symmetrical wasting of the topline muscles, high CK, pain
* Genetic disease: MYH1 gene
mutation (codes for 2X myosin)- body makes antibodies to its own muscle

44
Q

how does body cause vasculitis after exposure to strep equi

A

M protein on strep equi looks similar to epithelial cell

antibodies will accidently bind to epithelial cells and cause vasculitis and edema → purpura hemorrhagica

45
Q

should you vaccinate recently infected strangles horses

A

no

titer before vaccinating- risk of purpura hemorrhagica and equine immune mediated myosistis (IMM)

46
Q

9 yo paso fino
treated for antibotic associated colitis 2 weeks ago, still in hospital
fever 103.5, occassional cough, crackles

ddx
plan

A

penumonia- bacterial, viral, interstitial, fungal
pulmonary edema
equine asthma (high fever would rule this out)

plan: rads/US
TTA/BAL

47
Q

pleuropneumonia on xray looks like

A

no triangle of death (opacity in cranio-ventral portion of the caudal lung lobe, esp. right lung)

fluid or patchy alveolar pattern

48
Q
A

this lung is milliary- diffuse interstitial

pleuropneumonia has ventral aveolar pattern

49
Q

ddx
fever, cough, crackles

plan?

A

DDX:
fungal pneumonia
EMPF
silicosis
cancer

Plan
BAL- global disease

extensive alveolar pattern in all lung fields in only seen in diseases with very poor prognosis

50
Q

fungal pneumonia

A

Primary
* Caused by specific fungal pathogens with discrete geographical restrictions
* Must live or have traveled in these regions!

Opportunistic (secondary)
* Immunocompromised animals
* Agents such as Aspergillus and other
environmental species

very rare

51
Q

diagnosis, treatment and prognosis of primary fungal pneumonia

A

Diagnosis
* Must get travel history
* Rads, BAL, +/- biopsy
* Serum titers? Only show exposure, so may be hard to interpret

Treatment
* Systemic anti-fungals
* 2-4 months - $$$

Prognosis
* Generally poor

52
Q

it is normal to find fungi in BAL or TTA

A

TTA- 70% normal

do not treat unless large numbers and xrays show extensive alveolar pattern

53
Q

signalment of opportunistic fungal pneumonia

A

rare
immunocompromised- sick/cancer, recent GI disease

clinical signs: cough, tachypnea, fever, adventitial lung sounds, nasal discharge

54
Q

diagnosis of opportunistic fungal pneumonia

A

rare
rads, BAL, +/- biopsy
test immune function (cornell)

treatment: anti-fungals

55
Q

clinical signs of interstitial pneumonia in horses

A

severe, tachypnea, cyanosis, fever, cough, weight loss

56
Q

diagnosis of interstitial pneumonia in horses

A

xray- diffuse, miliary, nodular
BAL- global disease
Lung biopsy

57
Q

what can cause interstitial pneumonia in horses

A

equine multinodular pulmonary fibrosis (EMPF)

infectious- acute viral or bacterial: ARDS or foals with R. equi
silicosis
toxin- perilla mint
idopathic

58
Q

ddx for equine multinodular pulmonary fibrosis

A

bacterial pneumonia
equine asthma (heaves)

59
Q

diagnosis of EMPF

A

Consistent clinical signs and imaging and

EHV-5 (+) PCR from Biopsy or BAL

EHV5(+) on nasal swab ≠ EMPF!

histopath
post-mortem

60
Q

treatment of EMPF

A

steroids- prenisolone
valacyclovir

guarded prognosis

23 spring: med surg (60 decks)

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