6. Examine the lower airway of the horse and summarise the findings.

Question 1

Strucutres/areas to examine the airways:

Answer 1

1. Nose & paranasal sinuses
2. Guttural pouches
3. Cough
4. Larynx
5. Trachea
6. Thorax

Question 2

Steps to examine the thorax:

Answer 2

1. inspection/Observation
2. Palpation
3. Auscultation
4. Percussion
5. Secondary diagnostic method

Question 3

Name secondary diagnostic methods for examination of thorax:

Answer 3

1. Endoscopy
2. Radiology
3. US
4. CT
5. Thoracocentesis
6. Tracheal/Bronchoalveolar lavage
7. Respiratory cytology

Question 4

Inspection/Observations:

Answer 4

1. Observe breathing pattern from both sides
2. Contribution of rib cage
3. Animals head position (feks: extended to promote air intake)
4. Nasal flaring
5. Respiratory rate
6. Rythm
7. Depth

Question 5

Steps of auscultation:

Answer 5

1. Examine both sides
2. Start cranially, behind thorax
3. Move 2-4 intercostal spaces caudally
4. Start dorsally in each ICS, move ventral by 5-10 cm

Question 6

What can increases inspiration sound indicate?

Answer 6

extrathoracic or large airway obstruction

Question 7

What can increases exspiration sound indicate?

Answer 7

partial collapse of intrathoracic airways promoted by increased
alveolar pressure generation – characteristic of lower airway obstructive diseases (e.g.
equine heaves/recurrent airway obstruction)

Question 8

Name abnormal sounds of thorax that is discontinuous:

Answer 8

1. Crackles
2. Pleural friction rubs

Question 9

Name abnormal sounds of thorax that is continuous:

Answer 9

Wheezing

Question 10

What can crackles indicate?

Answer 10

1. Inflammation causing excessive secretions -> obstructing the airways
2. Rupture of films or bubbles
3. Opening of bronchoconstricted zones in case of airway obstruction disease

Question 11

What can pleural friction rubs indicate?

Answer 11

sheering movements of pleural surfaces containing irregular inflamed, fibrinous or fibrous adhesions

Question 12

What can wheezing indicate?

Answer 12

1. Constricted airway walls
2. Secretions which narrows the airway lumen
   3.

Question 13

Why do we perform percussion of the thorax?

Answer 13

to isolate regions within pleural cavity or lung parenchyma where there is loss of air, due to
infiltration, effusion or space-occupying lesions

Question 14

Which equipment do we use for percussion?

Answer 14

Hammer and pleximeter

Question 15

Features of percussion sounds:

Answer 15

1. Intensity: strong/sharp or weak
2. Frequency: high or low
3. Tone: resonant or dull

Question 16

Normal findings of percussion of thorax:

Answer 16

Strong and sharp, low, resonant, (short)

Question 17

Normal lung borders:

Answer 17

1. Deltoid tuberosity = 7th ICS
2. Point of shoulder = 10th ICS
3. Ischiadic tuber = 14th ICS
4. Tuber coxae = 16th ICS

Question 18

What can decreased resonance indicate?

Answer 18

1. Accumulation of fluid
2. Consolidated lung
3. Enlarged heart
4. Large masses within the chest cavity (tumours)

Question 19

What can decreased resonance after a trauma indicate?

Answer 19

• hemothorax
• pulmonary contusion
• diaphragmatic hernia

Question 20

What can increased resonance indicate?

Answer 20

• pneumothorax
• hyper-inflation
• emphysema

Question 21

What can increased resonance after trauma indicate?

Answer 21

Most certainly pneumothorax

Question 22

What can we find and observe with endoscope?

Answer 22

1. Direct inspection of trachea, bronchi (not parnechyma)
2. Masses, oedema, constriction and secretion
3. Biopsies can be taken

Question 23

When is X-ray indicated?

Answer 23

1. abnormal auscultation
2. dyspnea
3. unexplained tachypnea,
4. presence of lower airway secretions
5. exercise intolerance
6. external trauma

Question 24

Placement of the cassettes in case of an X-ray of the thorax:

Answer 24

1. Leave air gap between patient and cassette
2. 4 LL views:
   - Dorsocaudal
   - Ventrocaudal
   - Dorsocranial
   - ventrocranial

Question 25

indication of Ultrasound of thorax:

Answer 25

Abnormal radiography that doesn't fully characterize the disease

Question 26

In which cases is ultrasound an optimal technique to investigate?

Answer 26

1. atelectasis (collapse) 2. diaphragmatic herniation 3. lung consolidation (air is replaced with fluid) 4. Pleural effusion (fluid btw pleura and the wall)

Question 27

What is thoracocentesis?

Answer 27

Sample of fluid, in case if pleural effusion, by sterile, percutaneous insertion of a cannula/needle or chest tube, since fibrin, mucopurulent exudate or clots can obstruct small needles

Question 28

Thoracentesis, what is the sample evaluated for:

Answer 28

1. color 2. viscosity 3. specific gravity (high SG indicating modified transudate or exudates) 4. protein 5. blood 6. total nucleated cell count 7. pH 8. lactate 9. cell differential.

Question 29

High indication of sepsis in the thoracentesis sample:

Answer 29

Low pH High lactate

Question 30

Indications for respiratory cytology:

Answer 30

1. Inflammation 2. Infection (bacteriology) 3. Neoplasia

Question 31

Common problems/disease of lower respiratory tract:

Answer 31

1. Tracheal collapse 2. Pneumothorax 3. Rib fracture 4. Diaphragmatic hernia 5. Pulmonary masses 6. Airway obstruction