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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
--- causes strangles
strep equi equi **very contagious** abscesses in the lymphnodes
26
how to treat step equi zoo
penicillin (strep gram + bacteria) strep equi zoo is normal comensal, not contagious
27
shipping fever in horses presents as
pleuropneumonia ADR, anorexic ± Nasal discharge Cough? Only sometimes. Fever, tachypnea, pleurodynea (fake colic!) **Usually pleural effusion** (not like dogs)
28
diagnostic plan for horse with pleuropneumonia (shipping fever)
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
treatment for pleuropneumonia
antibiotics- broad spectrum (**penicillin** for strep equi sp zoo) NSAIDs **drain pleural effusion** supportive care → **↑calories**
30
what antibiotic should you not use for horse with pneumonia
baytril- enrofloxacin- **does not cover strep equi zoo!**
31
how to treat pleural effusion in horse
drain- chest tap penicillin for strep equi zoo
32
when to stop treating pleuropneumonia
* 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
treatment for shipping disease
antibiotics- **penicillin (strep equi zoo)**, gentamicin, metronidazole chest tap NSAIDs hydration **calories**
34
prognosis for shipping disease in horses
92% of STB and 52% of TB raced after abscesses. Worse with pleural effusion, much worse with anaerobic bugs
35
anatomical location of pneumonia caused by shipping fever in horses
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
3 YO QH mare bought last week now lethargic, hyporexic, bilateral purulent nasal discharge temp 105.1 facial/lymphnode swelling ddx plan
**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
plan for strangles
PCR- strep equi ssp equi **extremely contagious** can lead to **persistent shedders**- need to isolate
38
how to treat strangles
**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
prevention of strangles
isolate affected horses until PCR negative 75% are immune after infection vaccine- intranasal ## Footnote strep equi spp equi
40
strangles complications
**bastard strangles** **Abscesses in the abdomen**, brain, liver, spleen, kidneys, etc. guttural pouch: empyema and chondroids
41
diagnosis for bastard strangles
metastatic strangles **strep M protein titer (SEM)** history US, CSF tap inflammatory blood work
42
treatment of metastatic strangles
long term antibiotics- 1-6 months Penicillin? 99% sensitivity. Pros and cons… Ceftiofr (Excede) SMZ? Chloramphenicol?
43
what are some immune mediated complications of strep equi exposure or vaccination
**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
how does body cause vasculitis after exposure to strep equi
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
should you vaccinate recently infected strangles horses
no titer before vaccinating- risk of purpura hemorrhagica and equine immune mediated myosistis (IMM)
46
9 yo paso fino treated for antibotic associated colitis 2 weeks ago, still in hospital fever 103.5, occassional cough, crackles ddx plan
penumonia- bacterial, viral, interstitial, **fungal** pulmonary edema equine asthma (high fever would rule this out) plan: rads/US TTA/BAL
47
pleuropneumonia on xray looks like
no triangle of death (opacity in cranio-**ventral portion** of the caudal lung lobe, esp. right lung) fluid or patchy alveolar pattern
48
this lung is milliary- diffuse interstitial pleuropneumonia has ventral aveolar pattern
49
ddx fever, cough, crackles plan?
**DDX:** fungal pneumonia EMPF silicosis cancer **Plan** BAL- global disease ## Footnote extensive alveolar pattern in all lung fields in only seen in diseases with very poor prognosis
50
fungal pneumonia
**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 ## Footnote very rare
51
diagnosis, treatment and prognosis of primary fungal pneumonia
**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
it is normal to find fungi in BAL or TTA
**TTA-** 70% normal do not treat unless **large numbers** and xrays show **extensive alveolar pattern**
53
signalment of opportunistic fungal pneumonia
rare immunocompromised- sick/cancer, recent GI disease clinical signs: cough, tachypnea, fever, adventitial lung sounds, nasal discharge
54
diagnosis of opportunistic fungal pneumonia
rare rads, BAL, +/- biopsy test immune function (cornell) treatment: anti-fungals
55
clinical signs of interstitial pneumonia in horses
severe, tachypnea, cyanosis, fever, cough, weight loss
56
diagnosis of interstitial pneumonia in horses
xray- diffuse, miliary, nodular BAL- global disease Lung biopsy
57
what can cause interstitial pneumonia in horses
**equine multinodular pulmonary fibrosis (EMPF)** infectious- acute viral or bacterial: ARDS or foals with R. equi silicosis toxin- perilla mint idopathic
58
ddx for equine multinodular pulmonary fibrosis
bacterial pneumonia equine asthma (heaves)
59
diagnosis of EMPF
Consistent clinical signs and imaging and **EHV-5 (+) PCR** from Biopsy or BAL **EHV5(+) on nasal swab ≠ EMPF!** histopath post-mortem
60
treatment of EMPF
steroids- prenisolone valacyclovir **guarded prognosis**

23 spring: med surg (60 decks)

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