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RUSVM LAM I > E2: Respiratory sounds: Cough, Stridor, RAO, IAD > Flashcards

E2: Respiratory sounds: Cough, Stridor, RAO, IAD Flashcards

1
Q

What are the 4 most common causes of aspiration in horses?

A

Stomach tube misplacement

Choke

Laryngeal hemiplasia

Dysphagia (Neonatal encephalopathy, Botulism, Guttural pouch disease, Strangles)

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2
Q

High intensity exercise results in decreased peripheral blood _______ function.

A

Neutophil

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3
Q

In a normal horse, which muscle/nerve (left/right) takes longer to respond when performing an electrolaryngeography?

A

Left

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4
Q

What is the first line intervention if you have a horse with an upper respiratory tract dysfunction resulting in dyspnea? What if the problem is in the lower respiratory tract?

A

Upper: Tracheostomy

Lower: Oxygen supplementation

(When in doubt, do tracheostomy and put O2 tube down trach-hole)

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5
Q

How long (approximately) does it take airway epithelium to heal?

A

About 7 weeks

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6
Q

What are the 2 protective mechanisms that function together in the airways?

A

Mucocilary escalator

Cough reflex

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7
Q

Which of these are anaerobic bacteria that can result infections involving coughing?

  • Stretococcus zooepidemicus*
  • Actinobacillus equuli*
  • Bacteroides fragilis*
  • Pseudomonas*
  • Rhodococcus equi*
  • Escherichia coli*
A

Bacteroides fragilis

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8
Q

_____________ is a constant compenent of cough.

A

Bronchoconstriction

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9
Q

Which virus is a major cause of respiratory disease and coughing in horses, usually affects younger (3 year old) horses, is associated with crowding and stress, and causes the destruction of the ciliated epithelium?

A

Equine influenza

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10
Q

What is the most common secondary organism that can cause coughing in horses?

A

Aspergillus

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11
Q

What cells produce the surfactant-like substance which aids in maintaining patency of the airway?

A

Clara cells

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12
Q

Which equine respiratory virus which causes coughing in horses, causes human meningitis?

A

Hendra virus

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13
Q

Which virus that causes coughing is common in foals with SCID?

A

Equine adenovirus

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14
Q

Which virus that causes coughing, has no age prediliction, and is usually subclinical, results in a long lasting immunity?

A

Equine viral arteritis

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15
Q

What causes decreased ability for oxygen to be released at the tissue site leading to hypoxia following smoke inhalation?

A

Carboxyhemoglobin

(Note: Diagnosed if >10% in blood)

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16
Q

Which of these causes stridor without distress ONLY at inspiration? (Also, what do these stand for?)

DDSP

RLN

EE

A

RLN (Recurrent Laryngeal Neuropathy)

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17
Q

What’s going on here?

A

DDSP

Cannot visulaize epiglottis in nasopharynx

Expiratory disturvance occurs because caudal border of soft palate billows and vibrates throughout expiration.

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18
Q

What’s going on here?

A

EE

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19
Q

How do ‘horse people’ descirbe the gurgling, rattling, snoring, fluttering noise associated with DDSP?

A

Choking down

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20
Q

What is the preferred surgery to correct DDSP?

A

Laryngeal tie-forward

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21
Q

T/F: Coughing indicates LRD.

A

False, lower or upper

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22
Q

If you have a dyspnic horse patient that is panicking and thus too dangerous for you to treat, what do you do?

A

Have everything for the procedure set up and let the horse collapse, then work fast

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23
Q

Which disorder causes of stridor due to obstruction occuring at high speed?

A

Epiglottic entrapment (EE)

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24
Q

Dysfunction of which nerve (specifically) and which muscle have been associated with DDSP?

A

Pharyngeal branch of Vagus nerve

Thyrohyoideus muscle

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25
Q

What part of the larynx is paralized/weakened and axially displaced in the face of high negative inspiratory pressure in a horse with LH?

A

Arytenoids

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26
Q

Is EE typically persistent or intermittent?

A

Persistent

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27
Q

Are most cases of DDSP persistent or intermittent?

A

Intermittent

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28
Q

What’s going on here?

A

EE

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29
Q

You run a CBC on a couhging patient you suspect has pneumonia. The results show neutrophilia and anemia. What do these results indicate?

A

Chronic infection/disease

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30
Q

Match these pathological issues with the corresponding lung sounds:
Pneumonia

Pleuropneumonia

Pleural Effusion

Sounds:

Ventral dull sound

Increased lung sounds, crackles, wheezes

Cardiac sound larger area than normal

A

Pneumonia: Increased lung sounds, crackles, wheezes

Pleuropneumonia: Ventral dull sound

Pleural effusion: Cardiac sound larger area than normal (due to improved sound conduction)

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31
Q

What tissues “entrap” the epiglottis in EE?

A

Aryepiglottic and subepiglottic tissues

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32
Q

What is the typical signalment for a horse with LH?

A

2-3 year old large, long necked racehorse

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33
Q

What is likely if you choose conservative treatment for EE?

A

Recurrence

34
Q

Which pathology is difficult to diagnoe but often assocaited with DDSP and EE?

A

Hypoplasitc epiglottis

35
Q

What is typically the cause of persistent DDSP?

A

Neurologic dysfunction/disease

36
Q

What is the “horse people” term for speed slowed dramatically during a race, especially during the last half of the race, associated for DDSP?

A

Quitting

37
Q

Which of the following causes of coughing are usually associated with fever?

RAO

Parasites

EHV

EIPH

Trauma

Equine influenza

Foreign body

Trauma

Neoplasia

Equine herpes

A

EHV

Equine influenza

Equine herpes

38
Q

Which surgical method is preferred to correct EE?

A

Transendoscopic laser correction (Nd:TYAG laser)

39
Q

What does it indicate if you notice small ulceration on the caudal free border of the soft palate endoscopically while evaluating a horse for DDSP?

A

Chronicity - occurs secondary to repeated treama of dislocation esp. when coughing

40
Q

What can you use to treat RAO?

A

Corticosteroids

Antibiotics

Bronchodilators

41
Q

What nerve is most related to the cough neural pathway?

A

Vagus nerve

42
Q

What iatrogenic cause for LH is thought to be common potential cause?

A

Perivascular jugular injections

43
Q

You run a CBC on a couhging patient you suspect has pneumonia. The results show hyperfibrinogenemia and neutropenia. What do these results indicate?

A

Acute disease

44
Q

What cause of stridor can be the result of guttural pouch disease?

A

LH

45
Q

What side is affected in ILH (idiopathic LH)?

A

Left

46
Q

What are you differentials for upper airway obstruction?

A

Strangles

Bilateral laryngeal hemiplasia/paralysis

Arytenoids chondirits

Acute viral respiratory disease

(Less likely: Guttrural pouch tympany, LSA)

47
Q

Describe the stidor heard with LH.

A

Inspiratory roar/whistle that gets worse the longer and harder the horse works

48
Q

What drugs used to treat RAO block the smooth muscle constricting effects of acetylcholine? What are the side effects?

A

Atropine, Ipratropium (Anti-cholinergics)

Side effects: mydriasis, ileus, tachycardia, dry airway secretions

49
Q

In bilateral cases of LH, consider the possibility of generalized severe inflammation of upper airway, bilateral guttural pouch disease, and neurologic disoders such as ____ toxicosis, equine protoxoal myelitis, oxidatize damage, etc.

A

Lead

50
Q

What is the diagnostic test for LH called that involved slapping the saddle area of the thorax resulting in an adduction flicker on the contralateral side called? Describe a normal test result.

A

“Slap” test/ Thoraco-laryngeal reflex

Response in both arytenoids should be symmetric

51
Q

T/F: Oral prednisone is used to treat RAO in horses.

A

False, prednISOLONE

52
Q

For how long does the epiglottis have to remain ventral relative to the soft palate during high speed treadmill endoscopy for a diagnosis of DDSP?

A

>8 sec

53
Q

What intermandibular width is undesirable because it may indicate a higher degree of RLN?

A

< 4 fingers (approx 7cm)

54
Q

Which respiratory disease is associated with coughing and abortions?

A

Equine viral arteritits

55
Q

What aspect of the pathophysiology of RAO results in delayed mucus clearance?

A

Destruction of epithelial cells

56
Q

What is/are the preferred surgery /surgeries for LH? At what grades is it indicated?

A

Tie-back/ Laryngoplasty in combination with ventriculochordectomy

Grade III B and C, Grade IV

57
Q

What can be combined with a low dust diet to treat RAO?

A

Polyunsaturated omega-3 fatty acids

58
Q

Which virus is equine multinodular pulmonary fibrosis associated with? What x-ray pattern is associated with it?

A

EHV-5 (Herpes)

Diffuse bronchointerstitial patterns with multiple coalescing circular nodules throughout lung field

59
Q

Which modality is most efficient for evaluating deeper lung parenchyma?

A

X-Ray

60
Q

Which functional airway obstruction causes a noise generated by air turbulance in inspiration and expiration, but mostly duirng expiration resulting in cheek puffing?

A

DDSP

61
Q

Match the following with either IAD or RAO:

Occasional cough

Regular-Frequent cough

Increased respiratory effort

No increased respiratory effort

>7yo horses

Any age

Improve spontaneously or with minor treatment

Lasts for weeks, improve with strict environmental control or treatment

Seasonal

A

IAD:

  • Occasional cough
  • No increased respiratory effort,
  • Any age
  • Improve spontaneously or with minor treatment

RAO:

  • Regular-frequent cough
  • Increased respiratory effort
  • >7yo horses
  • Lasts for weeks, improve with strict environmental control or treatment
  • Seasonal
62
Q

How can IAD be diagnosed?

A

BAL

Pulmonary function test

63
Q

You peform a BAL and note nonspectic inflammation as well as >5% mast cells, RAO or IAD?

A

IAD

64
Q

What are your differentials for lower airway disease?

A

RAO

R. equi pneumonia

Acute Viral Respiratory disease

Adult intersitital pneumonia

Severe smoke inhalation

(Less likely: Pneumothorax, ARDS, Diaphragmatic hernia)

65
Q

Which 2 non-invasive treatments for DDSP are also diagnostic?

A

Laryngohyoid stabilizer (LSH) TSD or Cornell collar

Tongue-tie

66
Q

Is bronchospasm associated with RAO or IAD?

A

RAO

67
Q

What is the test for LH called where you press on both sides of the larynx to try and elicit a respiratory noise?

A

Arytenoid depression test

68
Q

Decreasing environmental challanges, bronchodilators and anti-inflammatories are all indicated to treat RAO. Which one is vital for successful treatment?

A

Decreasing environmental challanges

69
Q

Which class of bronchodilators is preferred to treat RAO? Give an example of a drug.

A

B-2 adrenergic agonists

Albuterol (Dr.DePedro’s fav)

70
Q

How many tiers does the grade classification system for assesement of equine laryngeal respiratory function in unsedated horses examined at rest have? What if you are assessing a hourse during exercise?

A

4 (I-IV)

3 (A-C)

71
Q

T/F: Prednisone is the drug of choice for treating RAO if you can only use one drug.

A

FALSE

Not predniSONE but predniSOLONE! (or dex)

72
Q

T/F RAO is best treated with, in addition to environmental control, you administer inhaled steroids in conjuction with inhaled bronchodilators.

A

True

73
Q

What presenting complaint would indicate that the best treatment for LH is a ventriculochordectomy?

A

If the problem is the noise not exercise intolerance

74
Q

When performing an endoscopic analysis of a horse with RAO or IAD, the distal airways are edematous, inflammed, and easily collapse during _______.

A

Expiration

75
Q

What class of drugs used to treat RAO cause relaxation of smooth muscle by increasing the intracellular levels of cAMP? Which one is preferred and by which method of administration? Name another drug that is commonly used.

A

B2-adrenergic agonists

Albuterol (per prof)

Metered dose inhaler

Also commonly used: Clenbuterol (also has antiinflammatory effects)

76
Q

Which should be administered first when giving both steroids and bronchodilators via MDI?

A

Bronchodilators (improve glucocorticoid deposition)

77
Q

How would you describe the noise made by a horse with EE?

a. Expiratory
b. Inspiratory and Expiratory
c. Inspiratory
d. Inspiratory and mostly expiratory

A

B. Inspiratory and Expiratory

(In= tissue on epiglottis flutters, Out= air flow over and between the tissue and epiglottis)

78
Q

What features define a DDSP on endoscopy?

a. Inability to visualize epiglottis
b. Loss of scalloped edge
c. Loss of vasculature of epiglottis
d. Sides of pharynx merging into tissue covering the epiglottis

A

d. Sides of pharynx merging into tissue covering the epiglottis

(a-c can be both EE or DDSP)

79
Q

What head positioning is associated with noise caused by DDSP?

A

Collecting

Holding back

Overcheck

80
Q

What treatments can you recommend for DDSP?

a. Tie-Back
b. Tongue-tie
c. Sacculectomy
d. Laryngoplasty
e. Tie-forward
f. Cornell collar

A

b. Tongue-tie
e. Tie-forward (Surgical version of the collar; repositions larynx)
f. Cornell collar (aka LSH, Laryngohyoid stabilizer)

RUSVM LAM I (19 decks)

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