Trimester 3 Exam Flashcards
What is causing the issue seen in this picture?
- Left Head Tilt (Left eye lower)
- Peripheral Left Vestibular
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Horses with endotoxemia usually have the following conmination of signs
- Tachycardia, pale MM
- Bradycardia, pale MM
- Tachycardia, congested MM
- Bradycardia, congested MM
Tachycardia, congested MM
If a horse is headpressing where does this indicate the lesion is?
Forebrain
What is different in the approach to a colicky foal compared to an adult>?
You still need ot differentiate between a Surgical and Non-surgical lesion
- Differences between adult and foal
- Pain tolerance
- Rectal paplation not possible
- Abdmoinal radiography - Plain and contrast possible with foal
- Pain
- Paunch
- Pulse
- Foal <1 month 80-100bpm
- Foal <2months 70bpm
- Foal <3months 60bpm
- Perfusion
- Peristalsis
- Percussion
- Pass a Nasogastric tube
- Additional
- PCV/TP
- Lactate Concentration - good indicator of perfusion
- Rectal Palpation - digital only
- Peritoneal fluid - not routinely done in foals has increased complication
- US - Very useful
- Rads - useful in foal
When do you perform a TransTracheal Wash (TTW) or a Bronchoalveolar lavage (BAL) in a horse?
- TTW
- The horse has a history and clinical findings suggestive of infectious respiratory disease
- BAL
- The horse has history and clincal findings suggestive of non-infectious respiratory disease
- TTW & BAL
- The horse has history and clinical findings suggestive of non-infectious respiratory disease that has recently appeared to have progressed
What are teh three Guttural Pouch Diseases?
- GP Empyema (Pus in GP - Young horses, ABx)
- GP Mycosis (Fungal infection roof medial compartment Aspergillus, Haemorrhage from eroded Internal corotid, Surgery ligate Internal carotid & Anti-fungals)
- GP Tympany (Non-painful air distention of GP, Surgery)
How do you diagnose Strangles?
- History
- Clinical Signs
- Culture - highly recommended
- PCR (respiratory panel)
- Serological test - Antibodies to the m-protein portion of the bacteria
With Cervical Vertebral Stenoitc Myelopathy (CVSM) there are 2 major subtypes.
What are they, where is it located and what age horse do they effect?
-
TYPE 1 - Dynamic
- Young Horse
- C3-5
- Stenosis is dependent on neck position
-
Type 2 - Static
- Older Horse
- C6-7
- Stenosis not dependent on neck position
Most common pathologic arrythmia in the horse is?
Atrial fibrillation
What is the most common method ofr maintaining anaesthesia for up to 60 mins in the field?
Infusion (CRI) of GG, Ketamine, Xylazine
Lable the Anatomy of the upper airway /Larynx in a horse
How can you tell where the nasal discharge is originating from on a horse?
Rule of thumb =
Unilateral = URT, usually rostral from the nasal septum
Bilateral = Generally LRT
What is Bastard Strangles?
When Strepococcus Equi equi speads to the mesenteric lymphnodes, and abscesses form in the abdomen. Fever and inceased WBC and fibrinigon
List the anatomy of the colon of a horse in order
- ileum
- Caecum
- Cecocolic Orifice (Narrow - place of obstruction)
- Right ventral colon
- Sternal Flexure
- Left ventral colon
- Pelvic Flexure (narrows)
- Left Dorsal Colon
- Diaphragmic Flexure
- Right Dorsal Colon
- Transverse Colon (Narrowing)
- Descending Colon (Small colon)
What are the common pathogens that cause pneumonia in foals (>4weeks of age)
- Bacteria
- Streptococcus equi subspecies zooepidemicus
- Rhodococcus equi
- Pasteurella species, Bordetella bronchiseptica, Actinobacillus
- Salmonella, Klebsiella, Pseudomonas
- Anaerobes
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Whats the difference between a Persistent and a intermittent dorsal displacement of the soft palate in a horse?
Intermittent DDSP happens during exercise - causing Exercise intolerance
Glossopharyngeal CN IX and Pharyngeal branch of the vagus CN X
True or False
A TRH stimulation should be accurate if used between June and November
True
What are some risk factors that put horses at risk of broncho/pleuropneumonia?
- Riskfactors
- Racehorses
- Preceded by stressful event
- Viral respiratory disease
- Long distance transportation (Decreased mucociliary clearance associated with cross tying)
How do you treat a Caecal impaction?
Large Colon Non-Strangulating
- Caecal Impaction
- No feed
- Enteral and IV fluids
- Analgesia
- Surgery
How do you decrease nonstructral carbohydrates for a horse with EMS
- Diet should contain less than 10% nsc
- Remove grain & concentrates from diet
- Remove excessive consumptions of treats - apples/carrots
- No access to pasture - growing season
- Restrict to late night/early morning grazing
- Soak hay
a 22 yo SB gelding , HR90, violent colic, dark mucous membranes, no distension
- LC volvulus
- pedunculated lipoma
- ileal impaction
Pedunctulated lipoma
What is a Progressive Ethmoid Haematoma?
What aged horses normally get this?
Why does it happen?
- Progressive Ethmoid Haematoma is an encapuslated masses originating from ethmoid turbinates or within sinuses
- Usually middle aged to older horses
- Repeated submucosal haemorrage and encapsulation
- Can cause local destruction of tissue by expansion and pressure necrosis
What are some clinical signs seen with EMS?
What would some other DDx’s be for these Clinical signs?
- Clinical Signs
- Obese
- Regional obesity
- Easy keepers
- Laminitis
- DDX’s
- EMS
- PPID
- Hypothyroidism
Where is the most common neurological disease in a horse located?
In the spinal cord
You have a horse with
Fever, Quiet demeanor, Lethargy, Anorexia
Nasal flaring, increased RR, nasal discharge
Weight loss and Ventral oedema (Chronic signs)
You have Pneumonia on your DDX how do you diagnose?
- Diagnosis
- Ausculation and Percussion
- Haematology and fibrinogen
- Acute - Haemoconcentration, Inflammatory leukogram, increased fibrinogen SAA
- Chronic Hypoproteinemia
- US and Rads
- +/- Endoscopy
- Tracheal aspirate
- Thoracocentesis
- Treatment
- ABx
- NSAIDS (Flunixin, Bute)
- Drainage if significant pleural fluid
- Supportive Therapy
- Maybe hypovolaemic due to endotoxaemia
- IV fluids
- Enteral fluids
- Maybe hypovolaemic due to endotoxaemia
Why do we use benzodiazepines in combo with ketamine?
Benzo’s offset muscle rigidity associated with ketamine as benzo;s are muscle relaxants
A horse has a regular heart beat
A left sided systolic 4/6 murmur at Base
Right sided Systolic 5-6/6 murmur
What would your diagnosis me
Ventricular Septal Defect (VSD)
What is imporant to remember about Large Intestinal Volvulus in horses?
- EMERGENCY
- time is everything
- High mortality
- Periparturient broodmares at risk
- Rotation >270 = Strangulation
- Venous obstruction –> arterial obstruction
- Haemorrhage, oedema, distension
- Post op care
- Endotoxaemia - laminitis, DIC
- Colon healing - Protein loss, diarrhoea
What are teh clincial signs of Oesophageal Obstruction?
What is the Management of Oesophageal Obstruction?
What are some complications of Oesophageal Obstruction?
- Oesophageal Obstruction - Choke
-
Clinical Signs
- General/non-specific
- Initial anxiety/distress
- Inappetence
- Lethargy
- GI Signs
- Head/neck extension
- Retching
- Ptyalism
- Feed/Saliva at nares
- General/non-specific
-
Management
- Sedation
- Gentle lavage and pressure
- Motility modifying drugs
- Oxytocin
- Buscopan
- Acepromazine
-
Complications
- Aspiration pneumonia
- Repeat Choke
- Stricture/Rupture of Oesophagus
-
Clinical Signs
What paranasal sinuses are most commonly effected by disease?
- Maxillary
- Rostral
- Medial(Ventroconcal sinus)
- Lateral
- Caudal
- Rostral
- Frontochonchal
- Drains to caudal maxillary
What vital structures do the guttural pounches overly in a horse
- Medial Compartment
- Internal carotid arteries
- Glossopharyngeal nerve IX
- Hypoglossal nerve XII
- Pharyngeal branch of vagus X
- Cranial Laryngeal Nerve
- Lateral Compartment
- External Carotid Artery
What other viruses can cause Neurological issues in a horse?
- EVH1
- Tetanus
- Rabies (ABLV), Lyssavirus
- Botulism
What drugs could we use on a EMS horse to intervene to inprove insulin sensitivity?
- Thyroxine - assists with weight loss and improved insulin senseitivity
- Metformin - Insulin sensitizing drug - poor bioavailabilty in horses
What are the causes of Small intestinal non-strangulating obstrucions causing colic?
- Impactions
- ileal
- Ascarid
- Other
- Intussusceptions
- Idiopathic focal eosinophilic enteritis
If you see a colicky horse with distention in the right side of the abdomen what is it likely to be situated?
- Right
- Caecum
- Left
- Left Colons
How do we kill Strangels (Strep equi equi) bacteria in the environment?
- Rest pasture for 4 weeks
- Organism readily killed by
- Heat
- Povidone iodine
- Chlorhexidine
- Bleach
How do you tell the difference between
- Haematuria
- Haemoglobinuria
- Myglobinuria
- Haematuria
- Spin Down, urine and RBC seperate
- Haemoglobinuria
- Spin Down stays pink
- Myglobinuria
- Myopathy - clinical signs and CK/AST
What is the Pathophysiology of PPID?
- Primarily hypothalamic disease
- Loss of dopaminergic inhibition of the pars intermedia
- Leading to hyperplasia or adenoma formation of pars intermedia
- Oxidative stress and increased genetic risk
What are some predisposing factors of Laminitis?
- Excessive pasture exposure
- Carbohydrate overload
- Endotoxemia, systemic sepsis or toxaemia
- Supporting limb laminitis-laminar failure
- EMS/PPID
- Previous episodes of laminitis
- Corticosteroids
- Triamcinolone
- Long term treatment
What are the Inflammatory bowel diseases that Horses can get
- Malabsorptive, infilrative diseases
- Idiopathic IBD
- MEED
- Lymphosarcoma
- Proliferative enteropathy
- (Mycobacterium)
When using a CRI (Continuous rate infusion) what is the major advantage when sedating >45mins?
- Quicker Recovery
- Easy to Administer
- Less Side Effects
- Less Arousal
- Better Sedation
Less Side Effects
Which class of drug is most effective in treating asthma in horse?
Corticsteroids
True or False
The TRH test has a high chance of being falsely positive if used between Dec & May
True
What further endocrine testin would you do in Kevin? (multiple tests may be needed)
- What treatment would you advise for Kevin
- Testing
- Endogenous ACTH, fasting insulin (need to be aware if its normal will still need to do in feed glucose, if its abnormal then no need for further tests as this is diagnostic) in feed glucose test (better option)
- Pergolide (increases amount of dopamine to shut down pars intermedia and stop it producing all the excessive Melanotrophs/POMC’s)
What is the treatment for acute laminitis?
- Treat primary disease and remove predisposing factors
- Confinment
- Sole support-palmer half of foot to point of frog
- Sand box, sole pack, dense foam, suppprot shoes
- Analgesia and anti-inflammatories
- Flunixin or phenylbutazone
- ICE feet-ice boots, changed ice q2Hrs until resolution of endotoxic insult
Post Acute Stage
- Farrier attention
- Rocker toe, bring break over back
- Bar shoe with sole pack –> palmer support
- Continued palmer sole support and analgesia
- Regular hoof care
- Repeat reds to monitor progression
- Avoid predisposing factors
- Salvage procedures
You have a horse in mild/moderate abdominal pain (can become severe). Is dehydrated. On Rectal palpation you can feel you feel bands of the colon running transversley across the pelvic inlet, you cannot palpate the cecum.
US- mesenteric vessels are against the body wall
What is causing this?
- Right Dorsal Displacement of the Large Colon
- If the pain isnt too high you can withhold food and see if it clears naturally.
- If painful surgery is required.
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What are some viruses that cause Arboviral encephalomyelitides?
- Alphavirus
- Flavivirus
- Alphavirus
- Ross River Virus
- Flavivirus
- West Nile Virus/Kunjin variant
- Murray Valley Encephalitis/Japanese Encephalitis
Heaves is most commonly due to a hypersensitivity to what?
Hay, Mould and Dust
What clinicopathologic abnormality is diagnostic for hyperlipaemia
- Elevated Triglycerides
How long is the gestation of a Horse?
What are the 3 stages of parturition?
- 341days (11months & 11days0
- Stage 1
- Behaviour of parturition -> rupture of membranes
- Can be days
- Stage 2
- Rupture of membranes -> deliver of foal
- Quick 11 mins average. Should be less than 20mins
- Redbag = Seperated chorium BREAK THIS NOW
- Stage 3
- Delivery of foal -> delivery of placenta
What is the differences between Primary and Secondary Peritonitis?
- Primary
- Actinbacillus equi
- Bacteral translocation
- No underlying disease
- Mild Illness
- Secondary
- Mixed inc anaerobes
- Gut compromise
- Underlying (GI) disease
- Severe illness
- Treatment
- Primary
- Antibiotics
- Penicillin/tetracyclines
- Anti-inflammatories
- Good Prognosis
- Antibiotics
- Secondary
- Antibiotics
- Broad spectrum inc anaerobes
- Treat underlying disease
- Treat endotoxaemia
- Prevent complications
- Abdominal lavage and drainage
- Guarded prognosis
- Antibiotics
- Primary
Equine Herpesvirus
What are teh strains we need to be concerned about?
- EHV-1 : Abortion, neurological, perinatal disease, respiratour disease
- EHV-4 : Respiratory Disease (Gerater Prevelance EKV4>EHV1
- Diagnosis - PCR antigen detection - Nasopharyngeal swabs
- Prevention - Commercial Vaccine for boe EHV4 & EHV1 available in Australia
What are some major causes of PU/PD in a horse?
- Major Causes PU/PD
- Renal Failure
- PPID
- Psychogenic polydipsia
- Less Common
- Iatrogenic
- Central or Nephrogenic DI
- Endotoxaemia/Sepsis
Progressive Ethmoid Haematoma
Clinical Signs
Diagnosis
Treatment?
- Clinical Signs
- Intermittent unilateral epistaxis
- Serosanguinous to sanguinous
- Low volume
- Occasionally sinusitis and malodorous breath
- Diagnosis
- HX and Clinical Signs
- Endoscopy
- Rads/CT
- Histology
- Treatment
- Surgical excision via bone flap if large
- Intralesional 4% formaldehyde injection
- Laser Ablation
A horse has a regular heart beat
A left sided systolic 1-2/6 murmur at apex
Right sided Systolic 3/6 murmur
What would your diagnosis be
Mirtal Regurg & Tricuspid Regurg
What type of virus is Equine rhinitis virus?
- Equine rhinitis A & B
- Picornavirus
- Very Common in Australia
Would you use ice boots in a horse?
- Prevent laminitis from endotoxaemia
- Treatment of acute laminitis
a 12 yo mare, 36hr colic duration, 4L net reflux, left kidney not seen on US
- Left dorsal displacement
- Right dorsal displacement
- ileal impaction
Left Dorsal Displacement
The Presenting horse at Physical Exam :-
- You are asked to examin a 3 month old thoroughbred filly that is experiencing an acute episode of respiratory distress
- The foal is well grown and was fine up until yesterday
- On examination the foal is tachpneic, tachycardic, and has a rectal temperature of 39.9C
- What is your next diagnostic test (assuming physical exam and ausculated for the above foal)
- Blood Work, CBC & Biochem
When can LACTATION TETNEY occur?
What causes this?
What are the clinical signs?
- Lactation tetany can occur 2weeks prior to foaling through to weaning
- Due to loss of large amounts of calcium in the milk
- Clinical signs
- Profuse sweating
- Tremor
- anxious expression
- tachycardia
- +/- cardiac arrythmia
- ileus
- possibly colic
- Treatment
- Slow IV calcium - calcium borogluconate
When using a rebreathing bag, when we remove it how long till the horse should have recovered in a normal Horse?
Within 5 breaths
What is the treatment/management for EMS?
- Goal - decrease insulin dysregulation and restore insulin sensitivity
- Weight Reductiuon
- Exercise
- Decrease intake
- Decrease non structural carbohydrates.
Which treatments are useful in managing lyperlipaemia?
- Parenteral insulin,
- IV glucose,
- Correct fluid and electrolyte impalances
Secondary sinusitis in a horse could be cause by what teeth most commonly?
First molar (109,209)
What steps do you take to diagnose Foal Pneumonia?
How would you manage Foal Pneumonia
- Diagnosis
- Physical Exam
- Haematology
- Imaging
- US & Rads
- Tracheal aspiration
- Gram stain, C&S
- Management
- Abx
- Penicillin (not R.equi or gram -ve)
- Ceftiofur (not R.Equi)
- Trimethoprim-sulphadiazine
- Doxycycline
- Treat until signs are gone and then some (CBC is normal)
- Bronchodilators
- Corticosteroids (rarely)
- Nebulisation
- Abx
What is IAD and Heaves called in the horse?
Equine Asthma
represent a spectrum of chronic inflammatory airway disease
What are teh signs of Placentitis in a mare?
How heavy is a normal placenta from a foal?
- Looks like parturition
- Vulval discharge
- Baggin up
- Waxing up
- Running milk
- COmmonly last trimester
- Mare usually well
- Normal Placenta = 11% of Foal body weight
What are the causes of Small intestinal sttrangulating obstructions?
- Volvulus
- Mesenteric rents (inc gastrosplenic ligament)
- Epiploic foramen entrapment
- Pedunculated lipoma
- Mesodiverticular bands
- Hernias
What are some reasons for Dysuria/Stranguria in horses?
- Inflammatory or Infection reasons
- Urolithiasis (Cystic calculi)
- Cystitis
- Neoplasia
- Idiopathic haematria
- Urethral defects in geldings
When a hose has colick and we are checking the perioneal fluid how do we do this?
What Colour should this fluid be? What are the different colors mean?
Via Abdominocentesis
A horse has a irregularly irregular heart beat
A left sided —
Right sided Systolic 2/6 murmur
What would your diagnosis me
Atrial Fibulation
Tricuspid Regurgitation
When considering a field anaesthesia of a horse what is the maximum lenght of anaesthesia time you can plan for before you should refer it to a gaseous clinic
>60mins is not approoriate to consider field anaesthesia
Horses
Inflammatory Bowel Disease
Signalment?
How is IBS characterised?
- Signalment
- Young horses
- Standardbreds
- Weightloss with good appetite
- Oedema (hypoproteinaemia)
- +/- Diarrhoea
- Characterised by cell type
- Granulomatous
- Lymphocytic-plasmacytic
- Eosinophilic
What type of Ryegrass toxicity do we see here in WA most often?
Annual ryegrass toxicity
how do you diagnose EMS in horses?
- Bloodwork -
- CBC/Biochem - WNL
- Glucose - Most will be normoglycemic
- Insulin levels - Fasting ( may be normal in upto 70% of EMS horses)
- Oral Surgar Test
- Fast as Baseline
- 15mL/100kg “Karo Light” corn syrup orally
- Blood @ 60-90mins
- Normal Insulin <45-60uU/mL
- In feed glucose test *Prefered test*
- Fast overnight
- Time 0 blood glucose reading
- Give 0.5-1g/kg glucose powder in non glycemic feed
- Measure serum insluin and plasma glucose at 2hrs
- Normal =
- 0.5g/kg: 2hr insluin <57uU/mL
- 1g/kg: 2hr insluin <87uU/mL
- The greater the post feed insluin the greater the risk of laminitis occuring
When you have a colicky horse and you need to pass a tube why do you check the HR before and after?
WHat does the volume of the reflux indicate?
- Pain from strangulation wont reduce (HR wont reduce) when you decompress therefore if HR changes you know this is non-strangulating
- Reflux -
- Large volumes - Gastric or Small Intestine origin
- Small volumes - LC compression of SI
What location is the most common cause of Colic in horses?
- Large Colon Impaction
- Pelvic Flexure –> Dorsal colon –> Elsewhere
Gutteral Pouch Disease Clinical Signs
- Clinical Signs
- Distention in the GP region
- Pain
- Nasal discharge - usually unilateral
- Respiratory noise - if compression of pharynx
- Epistaxis
- Neurological signs
- Diagnosis
- Clinical Signs
- Radiology
- Well outlined due to air density, fluid lines empyema (pus), increased density in focal regions
- Endoscopy
- Discharge from pharyngeal openings, Direct visulation of interior
What is the Grading system for rectal Prolapse?
- Grade 1
- Simple prolapse
- Grade 2
- Complex prolapse
- Grade 3
- Small colon intussusception
A horse has a irregularly irregular heart beat
A left sided —-
Right sided —-
What would your diagnosis be
AF
What is the most common cause of abortion/premature parturition in a horse?
Placentitis
You have been presented with a foal what you have deduced has a Meconium Impaction, What therapy would you suggest?
- Initial Therapy
- Supportive Care
- Rehydration +/- Glucose
- IV fluids if dehydrated
- Moderate dehydration 6% = dull, tachycardic, dry MM and increased USG
- Severe dehydration 8% = Stuporpus dehaviour
- If USG >1.020 fluids required (enteral or parenteral)
- IV fluids if dehydrated
- Control Pain
- NSAID
- Flunixin
- Meloxicam
- Ketoprofen
- Opioids
- Butorphanol
- Alpha 2 agonists (Older Foals)
- Xylazine
- NSAID
- Enema(s)
- Warm soapy water
- Foley Catheter
- 500-1000mL for 50Kg foal (Gravity fed)
- If rthis doesnt work can yse acetylcysteine 4%
- Rehydration +/- Glucose
- Supportive Care
During Anaesthesia what are the 3 H’s to remember?
- Hypoventalation - less common when using dissociative (ketamine) agents as a sole anaesthetic agent.
- Hypotension - less common when using dissociative (ketamine) agents as a sole anaesthetic agent.
- Hypoxaemia -
- Horses are not meant to lay down, atelectasis will occur within 5 mins
- Respiratory obstruction
- Dislocated soft palate
- Nasal congestion (prolonged recumbency)
What things would we expect to see on haematology/CBC with a foal with strep equi zooepidemicus?
How long should the foal be treated for?
- Neutropenia
- Leucocytosis
- Anaemia (possibly)
- Elevated fibronogen (acute phase protein)
- Serum amyloid A (not included in CBC, stand-alone test)
- Until the CBC returns to normal
A horse has a regular heart beat
A left sided systolic 3/6 murmur at Apex
Right sided —-
What would your diagnosis me
Mitral Regurgitation
When is field anaesthesia not considered appropriate?
Surgerys planned for greater than 60mins
What is it called when the soft palate covers the eppiglottis in a horse?
Dorsal Displacement of the Soft Palate (DDSP)
Impeades inspiration slightly however during expiration the soft palate will viabrate and cause noise which can distress the animal.
A Horse is severly insulin dysregulated. We are unsure whether the horse has PPID or EMS and we decide to treaty with pergolide, what are the consequenses if it doesnt have PPID?
- Cost to the owner (Pergolide is expensive)
- Clinical Signs wont improve
- Adverse effects are reasonably rare.
We have a horse we done a ACTH test and we feel we have got a false positive. What other options do we have?
- Retest endogenous ACTH (when its at highest likelihood of being true result feb/apr)
- TRH stimulation test (can be used at certain times of year, at other times has huge false positive results)
How do we do a withdrawl reflex on a horse?
- Only when they are recumbent
- or a foal