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Equine Medicine > Unit 1 - Upper Airway > Flashcards

Unit 1 - Upper Airway Flashcards

1
Q

______ is inflammation of the paranasal sinuses that results from primary microbial infection or from secondary bacterial infection associated with dental or other sinus disease.

A

Sinusitis

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2
Q

_____ ____ is the term used to describe exudate accumulation in the paranasal sinuses and may result from viral or bacterial infections.

A

Sinus empyema

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3
Q

What are the most frequent isolates of acute or chronic upper respiratory infections?

A

Strep species, followed by Staph

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4
Q

What may cause granuloma formation within the paranasal sinus?

A

C. neoformans and Coccidioides immitis may cause granuloma formation within the paranasal sinus.

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5
Q

What teeth roots communicate with the maxillary sinuses and can cause maxillary sinusitis when infected?

A

Teeth 109-111, 209-211

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6
Q

What are the clinical signs of sinusitis?

A

Unilateral nasal discharge, epiphora, facial asymmetry, altered nasal airflow, abnormal breath odor, mandibular lymphadenopathy, sinocutaneous fistula, malodorous breath

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7
Q

Headshaking syndrome is an uncommon clinical manifestation of ____ sinusitis.

A

fungal

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8
Q

How do you diagnose sinusitis?

A

Physical exam and history are usually adequate presumptive diagnosis
Radiography, sinoscopy, CT, sinocentesis fluid analysis
Endoscopy: may reveal drainage from the middle meatus via the nasomaxillary opening or expansile mass effect causing complete or partial obstruction of the nasal passage.
Necropsy gross pathology is an option post-mortem, but you need histopathology and cytology are necessary for identiying a microscopic diagnosis.

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9
Q

Dental root disease is identified radiographically by a loss of continuity of the ____ _____ and lysis of the tooth root or surrounding bone, combined with new bone formation and cement deposition.

A

lamina dura

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10
Q

How do you treat primary sinusitis?

A

Sinus lavage through a trephined hole and catheter placement

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11
Q

What must be done to make sure that recurrence is unlikely when treating primary sinusitis?

A

all inspissated material must be removed

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12
Q

Is chronic sinusitis or acute sinusitis worse?

A

chronic - it has a worse prognosis

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13
Q

_____ ____ are slowly expanding angiomatous masses originating principally from the mucosal lining of the ethmoid conchae.

A

ethmoid hematoma

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14
Q

What are the clinical signs of EH?

A

Blood-tinged nasal discharge with intermittent epistaxis from one or both nostrils is the most common CS.
- Unilateral or bilateral epistaxis varies from blood-tinged, mucoid, or mucopurulent discharge to blood spots or a trickle of blood; fulminant or fatal epistaxis is uncommon.
A history of respiratory stridor during exercise in not uncommon and may be suspected with abnormal airflow.
Facial distortion and asymmetry is uncommon, however may be seen when paranasal sinuses are involved.
Secondary bacterial and mycotic sinusitis should be ruled out if a sinus EH is suspected.

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15
Q

How do you diagnose EH?

A

Make sure to evaluate both sides - endoscopy, CT, sinoscopy

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16
Q

How do you treat EH?

A

Surgical ablation (interoperative hemorrhage can be significant and severe), intralesional injections with formaldehyde (lower morbidity), and photoablation

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17
Q

Progression of an ethmoid hematoma may result in the weakening or loss of the ____ ____ or roof of the sphenopalatine sinus.

A

cribriform plate

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18
Q

How frequently do ethmoid hematomas recur after removal?

A

17-50% of the time

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19
Q

The soft palate dives the pharynx into the _____ and ______.

A

nasopharynx, and oropharynx

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20
Q

True or false: the horse in an obligate oral breather.

A

false - obligate nasal breather with the epiglottis positioned dorsal to the caudal border of the soft palate

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21
Q

What muscles control the soft palate?

A

Palatinus, palatopharyngeus, tensor veli palatini, and the levator veli palatini.

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22
Q

What is required for the proper positioning of the larynx?

A

the balance of rostral and caudal tension caused by the suspension of the petrous part of the temporal bone that is pulled rostrally and caudally during exercise

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23
Q

_____ ____ of the ___ _____ occurs when the epiglottis is trapped under the soft palate and is caused by palatal dysfunction.

A

dorsal displacement, soft palate

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24
Q

What is another name for palatal dysfunction? It is the most commonly diagnosed cause of upper airway obstruction in what population of horses?

A

palatal instability - race horses

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25
Q

How do you diagnose DDSP?

A

Dynamic endoscopy and resting endoscopy

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26
Q

*_________/_______ ____ in young horses results in inflammation of the pharyngeal branch of the vagus nerve which ultimately innervates the muscle governing SP tone.

A

Pharyngitis/lymphoid hyperplasia

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27
Q

Identify four etiologies for DDSP.

A
  1. Neuromuscular dysfunction of the intrinsic SP muscles
  2. Variatios in anatomic positioning of the laryngohyoid apparatus
  3. Role of the thyrohyoid muscles in laryngeal elevation
  4. Role of the distal hypoglossal nerve in maintaining naspharyngeal stability
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28
Q

Does DDSP cause more inspiratory or expiratory problems?

A

expiratory - during expiration, a portion of exhaled air exits ventral to the SP and into the oropharynx

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29
Q

What clinical signs are associated with DDSP?

A

Clinical signs: stridor during exercise, worse performance

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30
Q

How do you treat DDSP?

A

surgical treatment, laryngohyoid support device (Cornell Collar), or use of a tack

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31
Q

How does persistent DDSP differ from regular DDSP?

A

Persistent is a permanent soft palate displacement, often secondary to underlying pharyngeal or laryngeal disease. It’s most commonly seen after surgery to release epiglottic entrapment.

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32
Q

What procedure is used to treat primary PDDSP?

A

Laryngeal advancement procedure

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33
Q

What is the most common clinical sign of a cleft palate in foals?

A

nasal regurgitation of milk or feed material

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34
Q

What signs are indicative of aspiration pneumonia?

A

coughing and poor growth

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35
Q

When might you consider a surgical repair of a cleft palate?

A

When it is a less than 30% of the soft palate and can be used as a salvage procedure. Few horses do well with this.

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36
Q

What are palatal cysts? What age of horse do we typically see them in?

A

Palatal cysts are rare lesions of young horses that may present as abnormal respiratory noise and airway obstruction.

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37
Q

_____ and _____ of palatal cysts may result in disruption of the normal palate-epiglottic relationship.

A

size, location

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38
Q

Horses with palatal cysts are at an increased risk for what?

A

DDSP

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39
Q

What can cause palatal cysts?

A

obstruction of mucus-secreting glands within the SP or as a result to trauma

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40
Q

What are clinical signs of palatal cysts?

A

Common clinical signs include respiratory noise (at rest or exercise), coughing, exercise intolerance, nasal discharge, dysphagia, and signs of aspiration pneumonia.

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41
Q

While palatal neoplasia is rare in horses, what two neoplasms do we most often see?

A

Lymphosarcoma and squamas cell carcinoma

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42
Q

Where do pharyngeal cysts most often originate from?

A

The subepiglottic region.

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43
Q

What population of horses typically get diagnosed with pharyngeal cysts?

A

Usually diagnosed in young Thoroughbreds, Standardbreds, and Quarter Horses.

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44
Q

How do you treat pharyngeal cysts?

A

Surgical excision with complete removal of the cyst lining is necessary in most cases. Perhaps, formalin injections are a possible alternative.

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45
Q

Inflammation of the pharyngeal tissues is known as what?

A

Pharyngitis (pharyngeal lymphoid hyperplasia or follicular pharyngitis)

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46
Q

What are the clinical signs of pharyngitis?

A

pharyngeal pain, nasal discharge, regional lymphadenopathy, inspiratory respiratory noise, pharyngeal swelling, and cough

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47
Q

How do you diagnose pharyngitis?

A

endoscopy +/- pharyngeal radiographs

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48
Q

Describe the pathophysiology of pharyngitis.

A

In horses, the pharyngeal tonsil consists of discrete lymphoid follicles diffusely distributed in the dorsal and lateral walls of the pharynx.

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49
Q

In patients that have pharyngitis, what does the pharnx look like visually?

A

hyperemia, edema, and potential necrosis of the tonsilar tissues

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50
Q

True or false: Streptococcus equi subsp zooepidemicus, Bordetella bronchiseptica, Streptococcus equi subs. Equi, and Moraxella are commonly isolated from normal horses.

A

FALSE - Streptococcus equi ss. equi is not normal

51
Q

What is Nasopharyngeal Cicatrix Syndrome?

A

NCS is an inflammatory condition that is common in horses from Texas and the U.S. Gulf Coast states.

52
Q

What is inflamed in patients with NCS?

A

inflammation and scarring of the nasal passage, pharynx, larynx, arytenoid cartilages, and the proximal trachea

53
Q

What clinical signs are associated with NCS?

A

Abnormal respiratory noise, nasal discharge, exercise intolerance, coughing, respiratory distress, and abnormal vocalization.

54
Q

Do you often see NCS in horses under the age of 4?

A

No, it is typically a disease of older horses.

55
Q

What is NCS characterized by?

A

NCS is characterized by acute to active inflammation of the upper airway structures that progresses to severe fibrosis and stenosis of the airway or distortion of the affected structure.

56
Q

The _____ _____ are paired, air-filled diverticula of the eustachian tubes that communicate between the middle ear and pharynx.

A

guttural pouches

57
Q

Which compartment of the GPs is larger, medial or lateral?

A

medial - it is 3x larger

58
Q

What nerves and vessels can be found in the medial guttural pouch?

A

Medial pouch: CNN 9-12; cranial cervical ganglion, cervical sympathetic trunk, internal carotid artery.

59
Q

What nerves and vessels can be found in the lateral guttural pouch?

A

Lateral pouch: CNN 5, 7, 8; external carotid artery, maxillary artery.

60
Q

What are the three common diseases involving the guttural pouches?

A

GP tympant, GP empyema, and GP mycosis

61
Q

What breeds, age, and sex are more predisposed to GP tympany?

A

Arabians and German warmbloods, birth to 1.5 years old, and fillies

62
Q

What is guttural pouch tympany?

A

Unilateral or bilateral distension of the GP with pressurized air.

63
Q

What are the clinical signs of GP tympany?

A

Affected foals have non-painful, soft, fluctuant swelling in the retropharyngeal space. In mild cases, this may be the only abnormal clinical sign.
Variable signs of respiratory distress, extension of the head and neck, nasal discharge, signs of dysphagia.
GP distention leads to pharyngeal compression resulting in respiratory distress or dysphagia. Dysphagia can lead to aspiration pneumonia.

64
Q

How might you diagnose GP tympany?

A

Recognition of clinical signs, radiography, endoscopic examination.

65
Q

How do you treat GP tympany?

A

Decompression via catheterization or aspiration, surgery if it recurs several times. Most will resolve with catheters.

66
Q

How are GP infections introduced?

A

Directly through the pharyngeal opening or by lymphatic spread. Empyema is a secondary condition or manifestation of a more generalized ascending respiratory infection.

67
Q

What are the common etiologic causes of GP infections?

A

It is a common sequelae of Strep. equi ss equi, zooepidemicus is the second most common.

68
Q

What is the most common route for infectious agents to get into the GP?

A

Rupture and drainage of a retropharyngeal abscess into the pouches is likely the most common route.

69
Q

What are the clinical signs of GP empyema?

A

Common clinical signs are intermittent nasal discharge, retropharyngeal swelling, cough, fever, parotid swelling and pain, dysphagia, difficult breathing, and pneumonia. Nasal discharge may be unilateral or bilateral and is non-odorous, white and opaque.
Pharyngeal compression can lead to altered respiration and dysphagia.
Inspissation of the purulent material results in chondroid formation

70
Q

What are the most common hematologic findings of GP empyema?

A

Leukocytosis and hyperfibrinogenemia are common hematologic findings.

71
Q

How do you diagnose equine empyema?

A

Diagnostics to consider include endoscopy, radiography, and aspiration of exudate from the GP.

72
Q

What will radiographs show in patients that have GP empyema?

A

Radiographs of the pouches will reveal distinct GP fluid lines or radiodense masses (chondroids) within the pouches.

73
Q

True or false: Local GP therapy using diluted antiseptics (povidone-iodine, chlorhexidine) is highly recommended in the treatment of GP empyema.

A

FALSE

74
Q

How do you treat GP empyema?

A

Serial lavage with isotonic fluid and local antimicrobials (perform culture and sensitivity). Removal of chondroids by endoscopic snaring

75
Q

True or false: GP mycosis is a life-threatening disease that can lead to fatal hemorrhage in horses.

A

TRUE

76
Q

True or false: animals with GP mycosis typically are afebrile.

A

TRUE

77
Q

Why does GP mycosis cause epistaxis?

A

Epistaxis results from fungal erosion of the wall of the internal carotid artery in the roof of the medial compartment or the external carotid artery branches in the lateral compartment (maxillary artery 1/3 of cases).

78
Q

When do episodes of epistaxis typically occur?

A

Episodes of epistaxis typically occur at rest and vary from mild to severe, with several premonitory bleeds that generally culminate in a fatal episode of epistaxis.

79
Q

How often is epistaxis fatal?

A

in approximately 48% of horses

80
Q

Identify some differential diagnoses for epistaxis.

A

exercise induced pulmonary hemorrhage (EIPH), ethmoid hematoma, GP or pharyngeal neoplasia, Tracheobronchial foreign bodies, and GP mycosis

81
Q

How do you definitively diagnose GP mycosis?

A

endoscopy - make sure not to disrupt any blood clots

82
Q

Why do they think guttural pouch mycosis occurs?

A

They aren’t completely sure, but it is believed that the disease is initiated by some stress like inflammation, trauma, or vascular insult to the soft tissues where mycotic plaques are found.

83
Q

What fungal species may be the cause of guttural pouch mycosis?

A

Aspergillus species are most commonly associated with disease.

84
Q

What is the prognosis of GP mycosis without treatment?

A

poor

85
Q

What are the recommended treatments for GP mycosis?

A

Fungicidal and fungistatic drugs, topical enzymes, organic iodine compounds, antibiotics, corticosteroids, antifungals. Risk of fatal hemorrhage remains high. Surgery: best prognosis, occlude the internal carotid artery.

86
Q

____ ____ ____ is characterized by asynchrony and dysfunction of the arytenoid cartilages.

A

recurrent laryngeal neuropathy

87
Q

How do you diagnose RLN?

A

Resting endoscopy of the upper airway (without sedation) provides confirmation by evaluation of the arytenoid cartilage function.

88
Q

What is a grade 1 on the RNL grading system using resting endoscopy?

A

All arytenoid cartilage movement are synchronous and symmetrical, and full arytenoid abduction can be achieved and maintained

89
Q

What is a grade 2 on the RNL grading system using resting endoscopy?

A

Arytenoid cartilage movements are asynchronous at times, but full arytenoid abduction can be achieved and maintained

90
Q

What is a grade 3 on the RNL grading system using resting endoscopy?

A

Arytenoid cartilage movements are asynchronous or asymmetrical (or both). Full arytenoid cartilage abdution cannot be achieved and maintained

91
Q

What is a grade 4 on the RNL grading system using resting endoscopy?

A

Immobility of the arytenoid cartilage and ocal fold is complete (complete paralysis)

92
Q

What is a grade A on the RNL grading system using treatmill endoscopy?

A

Full abduction of the arytenoid cartilages during inspiration

93
Q

What is a grade B on the RNL grading system using treatmill endoscopy?

A

partial abduction of the left arytenoid cartilage (between full abduction and the resting position)

94
Q

What is a grade C on the RNL grading system using treatmill endoscopy?

A

Abduction less than resting position, inclding collapse into the contralateral half of the rims glottides during inspiration

95
Q

How does the left recurrent laryngeal nerve’s length contribute to its role in RLN?

A

High prevalence of chronic demyelinating peripheral neuropathy attributed to its length, and is characterized by severe myelin and axonal loss on the distal end of the nerve (RLN).

96
Q

What does RLN result in?

A

RLN results in progressive atrophy of the left dorsal cricoarytenoid muscle and associated loss of arytenoid cartilage abduction.

97
Q

What is the surgical gold standard of RLN repair?

A

Tie-back

98
Q

______ ______ is a progressive inflammatory condition of the arytenoid cartilages in adult horses, originating as an infectious condition.

A

arytenoid chondritis

99
Q

_____ _____ of the palatopharyngeal arch occurs when the PA displaces rostrally, overlying the apices of the arytenoid cartilages.

A

rostral displacement

100
Q

What are the clinical signs associated with rostral displacement of the palatopharyngeal arch?

A

CS include abnormal respiratory noise and poor athletic performance, and (due to the prevention of normal deglutition) potential signs of aspiration pneumonia (dysphagia, nasal discharge of food material, and persistent coughing.

101
Q

_____ _____ occurs when there is dorsal displacement of the aryepiglottic folds and subepiglottic mucosa over the epiglottis.

A

epiglottic entrapment (EE)

102
Q

What clinical signs are associated with epiglottic entrapment?

A

Coughing and nasal discharge are not uncommon reported clinical signs. Severe inflammation and ulceration of the entrapping tissue can exacerbate airway obstruction and noise production (rarely dysphagia).

103
Q

How is intermittent EE treated?

A

Intermittent is treated conservatively with topical and systemic anti-inflammatory therapy and exercise restriction.

104
Q

How is persistent EE treated?

A

Persistent is treated surgically using transoral or transnasal techniques. Currently axial division of the entrapping aryepiglottic folds and subepiglottic mucosa is the preferred technique because of reduced risk of excessive scarring (which leads to an increased risk of DDSP).

105
Q

The ____ ____ ___ completes the dorsal aspect of the tracheal lumen, attaching to the inner surface of the tracheal rings. The ____ muscle is contained within the ligament and allows expansion during times of increased respiratory effort.

A

dorsal tracheal ligament, trachealis

106
Q

The ______ _____ attaches the first tracheal ring to the cricoid cartilage of the larynx.

A

cricotracheal ligament

107
Q

What occurs in a case of Cricotracheal Ligament Prolapse?

A

CTL Prolapse may reduce the cross-sectional diameter of the trachea by 36-52%, resulting in abnormal respiratory noise during exercise and reduced exercise performance.

108
Q

How do you treat CTL Prolapse?

A

7 day course of systemic NSAID therapy is reported to be successful in <2yr old TB racehorses that had multiple dynamic endoscopic abnormalities at the time of CTL prolapse diagnosis.

109
Q

_____ ____ is a developmental disorder of the trachea most commonly seen in small ponies and miniature horses, and less frequently in larger ponies and donkeys.

A

tracheal collapse

110
Q

True or false: Horses with severe expiratory dyspnea due to pulmonary disease have marked increase in positive intrathoracic pressure during expiration that can lead to temporary tracheal collapse.

A

TRUE

111
Q

Describe the clinical signs of tracheal collapse.

A

dyspnea, stridor, possible tachycardia and hyperthermia, cough, EIPH may occur - signs worsen with age, humidity, and heat

112
Q

How do you treat tracheal collapse?

A

Initially, treatment is conservative by restricting exercise and providing a cool environment while ensuring any underlying pulmonary disease is addressed. Supplemental intranasal oxygen should be considered in dysgenic patients. Tracheostomy is NOT helpful in most cases. Systemic corticosteroid therapy may reduce tracheal edema or inflammation

113
Q

What is the more common cause of external tracheal trauma?

A

blunt force trauma

114
Q

How does tracheal rupture present?

A

Tracheal rupture often presents with cranioventral cervical swelling and pronounced subcutaneous emphysema.

115
Q

Where can emphysema due to tracheal rupture spread?

A

to the head, trunk, limbs, and mediastinum

116
Q

What other disease must me ruled out in cases of ruptured trachea?

A

ruptured esophagus

117
Q

What common sterilization agent for endotracheal tubes has been tied to tracheal tissue necrosis?

A

ethylene oxide - leads to intraluminal tracheal trauma

118
Q

If a horse has a intraluminal tracheal neoplasia, what is the common tumor?

A

benign small neoplasia

119
Q

What is the most common cause of extramural compression?

A

peritracheal lymphadenopathy

120
Q

What is the most commonly identified bacterial agent of peritracheal lymphadenopthy?

A

Streptococcus equi ss equi

121
Q

If a horse gets an inhaled foreign boddy, where will it end up?

A

it usually wedges in the carina or the mainstem bronchus

122
Q

What is the common presentation associated with tracheobronchial foreign bodies?

A

sudden onset of persistent coughing and often mainstem bronchus - can progress into a secondary infection

123
Q

What is the recommended treatment for tracheobronchial foreign bodies?

A

endoscopic retrieval

Equine Medicine (27 decks)

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