Equine Respiratory Surgery, Arytenoid Chondritis, Guttural Pouch Issues Flashcards Preview

RUSVM Large Animal Surgery > Equine Respiratory Surgery, Arytenoid Chondritis, Guttural Pouch Issues > Flashcards

Flashcards in Equine Respiratory Surgery, Arytenoid Chondritis, Guttural Pouch Issues Deck (79):
1

What is your diagnosis?

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Progressive ethmoid hematoma

  • Clinical signs:
    • Epistaxis (bilateral)
    • Seroanguineous nasal exudate
    • Stridor
  • Cause: nasogastric tubing

2

What is the suspected cause of ethmoid hematoma in equines?

nasal gastric tubing

3

Which of these radiographs shows a progressive ethmoid hematoma in this horse?

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The one that says "PEH" on it

The way I understand it, the letters "PEH" will not be present on the hematoma in normal radiographs

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4

What procedure is taking place here?

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Trephination

5

What is the main postoperative complication associated with surgical removal of ethmoid hematomas?

Hemorrhage

6

What is the composition of an ethmoid hematoma when viewed on histopathology?

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  • Outer surface: respiratory epithelium
  • Central: hemosiderin-filled macrophages

7

T/F: Chemical ablation with formalin is an acceptable treatment for ethmoid hematomas

True

  • Transendoscopic Chemical Ablation:
    • 4% formalin via biopsy channel of endoscope
    • Can be done on an outpatient basis 
    • Repeat in 2-3 weeks

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8

Definitive diagnosis of progressive ethmoid hematoma in horses is made by:

  • Endoscopic exam
  • History and PE
  • CT
  • Histopathologic exam

Histopathologic exam​

9

What is the prognosis for long term resolution of progressive ethmoid hematoma?

  • Grave no matter what treatment is performed
  • Good if treated with intralesional formalin
  • Guarded to poor no matter what treatment is performed
  • Good if treated with surgical excision and cryotherapy of the base

Guarded to poor no matter what treatment is performed​

10

In what breed have there been no reports of progressive ethmoid hematoma?

  • Warmblood
  • Arabian
  • Tennessee walking horse
  • Standardbred

Standardbred​

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11

What causes the color variations of the progressive ethmoid hematoma when viewed through a video endoscope?

Type and distribution of hemoglobin pigments​

12

What is the most common clinical sign observed in horses with progressive ethmoid hematoma?

Epistaxis

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13

Which survey radiographic view most consistently demonstrates the lesion associated with progressive ethmoid hematoma?

  • Dorsoventral
  • Oblique
  • Lateral
  • None of the above

Lateral

14

Formalin (10%) treatment for progressive ethmoid hematoma in the horse is administered via what route?

intralesional injection

15

To monitor for recurrence after treatment of a progressive ethmoid hematoma, repeat endoscopic exam should be performed at ________ intervals for ________.

  • 2 weeks; 2 years
  • 1 month; 1 year
  • 3-6 months; 5 years
  • 1 year; 10 years

To monitor for recurrence after treatment of a progressive ethmoid hematoma, repeat endoscopic exam should be performed at 3-6 month intervals for 5 years.

16

What is the cause of primary sinusitis?

upper respiratory tract infection (URTI)

17

What are the causes of secondary sinusitis?

  • Dental disease
  • Facial fractures
  • Cysts
  • Neoplasia

18

What are the clinical signs associated with sinusitis?

  • Nasal discharge: serosanguineous
  • Coughing
  • Facial deformity

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19

What is the surgical treatment for sinusitis?

Sinusotomy (trephination)

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20

Aftercare for sinusotomy involves:

  • Antibiotics + NSAIDs
  • Leave open and flush daily
  • Prognosis is good/excellent

21

What is this horse doing?

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Cribbing

  • Grasp object with incisors
  • Contract ventral neck muscles
  • Pull backward
  • Consequences:
    • Maybe colic
    • Abnormal wear of incisors
    • Weight loss

22

Identify this piece of equipment:

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Cribbing Strap

When the horse swallows, this puts pressure on the larynx

23

What is the Modified Forssel's procedure?

Surgical treatment for cribbing

  • Myectomy:
    • Removal of Sternothyrohyoideus and Omohyoideus mm.
  • Neurectomy:
    • Removal of ventral branch of spinal accessory nerve (XI)

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24

The cricoarytenoideus dorsalis muscle is innervated by the __________ nerve

recurrent laryngeal nerve

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25

Unilateral or bilateral paralysis of the cricoarytenoid muscle results in a condition known as:

Recurrent Laryngeal Hemiplegia ("Roaring")

Caused by progressive neurogenic atrophy (distal axonopathy) of the recurrent laryngeal nerve (branch of vagus nerve)

26

What is the most common cause of upper respiratory noise in the horse?

Recurrent Laryngeal Hemiplegia ("Roaring")

27

Horses with laryngeal hemiplegia (LH) typically present for:

Noise & Exercise Intolerance

28

What is the Slap Test?

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Evaluates recurrent laryngeal nerve and portions of spinal cord

  • Slap withers during endoscopy
  • Observe adduction of contralateral arytenoid cartilage
  • Pathway: spinal cervical cord  medulla decussation → recurrent laryngeal nerve

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29

What is the most common surgical treatment for recurrent laryngeal hemiplegia?

Laryngoplasty (Tie-back)

30

"Asynchronous abduction, but full abduction could be achieved" describes a Grade ___ laryngeal hemiplegia

Grade II

31

"Asymmetry at rest, some movement, but full abduction cannot be achieved" describes a Grade ___ laryngeal hemiplegia

Grade III

32

"Asymmetry at rest and no movement of the arytenoid cartilage" describes a Grade ___ laryngeal hemiplegia

Grade IV

33

What are some complications associated with laryngoplasty?

  • Prosthesis failure
  • Loss of abduction
  • Seroma
  • Cough
  • Dysphagia

34

What should be done if an animal is coughing following a tieback procedure?

Remove the sutures and start over again

35

Identify this instrument:

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Roaring Bur

36

What is arytenoid chondritis?

Inflammation and thickening of the arytenoid cartilage​

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37

What is a partial arytenoidectomy?

Removal of the arytenoid body and corniculate process

  • 50% of racehorses return to racing
  • Significantly improved upper airway flow dynamics
  • Coughing may be noted after surgery
  • Preferred treatment for arytenoid chondritis

38

___% of racehorses return to racing after a partial arytenoidectomy

50%

39

When the soft palate is dorsally displaced over the epiglottis, it is appropriately termed:

Dorsal Displacement of the Soft Palate (DDSP)

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40

This image shows a treatment option for what condition?

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Dorsal Displacement of the Soft Palate (DDSP)

The image shows a tongue tie

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41

What is a staphylectomy?

resection of the posterior part of the soft palate

May be used for surgical treatment of DDSP

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42

Identify this instrument:

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Bistoury

a surgical knife with a long, narrow, straight or curved blade

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43

What intrinsic laryngeal muscle provides arytenoid abduction by drawing the dorsomedial margins of the arytenoid cartilages together?

the arytenoideus transversus muscle

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44

Which intrinsic laryngeal muscle is not innervated by the recurrent laryngeal branch of the vagus nerve?

  • the cricoarytenoideus dorsalis
  • the arytenoideus transversus
  • the cricothyroideus
  • the thyroarytenoideus

the cricothyroideus​

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45

A remnant of the thyroglossal duct is thought to cause:

  • Dorsal epiglottic abscessation
  • Subepiglottic granulomas
  • Epiglottitis
  • Subepiglottic cysts

Subepiglottic cysts​

46

Alone, which recommended treatment for RLN does not improve upper airway noise or return the upper respiratory airflow mechanics to baseline values?

  • Laryngoplasty
  • Bilateral ventriculocordectomy
  • Unilateral laser vocal cordectomy
  • None of the above

Unilateral laser vocal cordectomy​

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47

Laryngoplasty failure can be corrected by:

  • Partial arytenoidectomy
  • Ventriculectomy
  • Bilateral ventriculocordectomy
  • Unilateral laser vocal cordectomy

Partial arytenoidectomy​

48

Which upper airway disturbance is thought to be caused by a developmental abnormality of the fourth branchial arch?

  • A subepiglottic cyst
  • Axial deviation of the aryepiglottic folds
  • Epiglottic retroversion
  • Rostral displacement of the palatopharyngeal arch

Rostral displacement of the palatopharyngeal arch​

49

Which nerve/muscle combination is used when performing a neuromuscular–pedicle graft to treat recurrent laryngeal neuropathy (RLN)?

  • Hypoglossal nerve/hyoepiglotticus muscle
  • First cervical nerve/omohyoideus muscle
  • External branch of the cranial laryngeal nerve/cricothyroideus muscle
  • External branch of the cranial laryngeal nerve/thyrohyoideus muscle

First cervical nerve/omohyoideus muscle​

The neuromuscular–pedicle graft technique entails creating a pedicle graft involving the first cervical nerve and the omohyoideus muscle and implanting the entire graft into the affected cricoarytenoideus dorsalis muscle.

50

Which of the following is not a complication of surgical correction of epiglottic entrapment?

  • Reentrapment
  • Dorsal displacement of the soft palate
  • Laceration of the epiglottis
  • Epiglottic retroversion

Epiglottic retroversion​

51

Which of the following disorders results in distortion of the corniculate process of the arytenoid cartilage, causing decreased arytenoid cartilage abduction, axial displacement of the arytenoid cartilage, and rostral displacement of the palatopharyngeal arch?

  • Axial deviation of the aryepiglottic folds
  • Rostral displacement of the palatopharyngeal arch
  • Arytenoid chondritis
  • Dorsal epiglottic abscessation

Arytenoid chondritis​

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52

In a resting horse, what fraction of the total resistance to airflow is in the upper airway?

2/3

53

Videoendoscopy with the patient at rest allows diagnosis of all the following upper respiratory disturbances except:

  • Arytenoid chondritis
  • Axial deviation of the aryepiglottic folds
  • Persistent dorsal displacement of the soft palate (DDSP)
  • Persistent epiglottic entrapment

Axial deviation of the aryepiglottic folds​

54

The intrinsic musculature of the pharynx includes all of the following except the:

  • Tensor veli palatini
  • Levator veli palatini
  • Palatopharyngeus
  • Hyoepiglotticus

Hyoepiglotticus​

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55

Which of the following extrinsic muscles of the pharynx is innervated by the pharyngeal branch of the vagus nerve?

  • Genioglossus
  • Thyrohyoideus
  • Sternohyoideus
  • Sternothyroideus

Thyrohyoideus​

56

Rostral pharyngeal collapse has been experimentally reproduced by transecting the tendon of the _________ muscle.

tensor veli palatini

57

Staphylectomy, epiglottic augmentation, rostral palatoplasty, and sternohyoideus/sternothyroideus myectomy are all treatments for:

  • Rostral pharyngeal collapse
  • Nasopharyngeal cicatrix
  • Dorsal pharyngeal collapse
  • DDSP

DDSP

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58

Dysfunction of the ________ muscle causes collapse of the pharyngeal roof during dorsal pharyngeal collapse

stylopharyngeus caudalis

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59

Which of the following is not an acceptable treatment for nasopharyngeal cicatrix?

  • Antiinflammatory medications
  • Transendoscopic laser transaction
  • Permanent tracheostomy
  • Partial arytenoidectomy

partial arytenoidectomy

60

Which upper respiratory disturbance may predispose a horse to DDSP as a result of inflammation of the pharyngeal branch of the vagus nerve?

  • Pharyngeal lymphoid hyperplasia
  • Elongated soft palate
  • Subepiglottic cyst
  • Epiglottic hypoplasia

Pharyngeal lymphoid hyperplasia​

61

What is the maximal length that should be removed from the soft palate during staphylectomy for correction of DDSP?

5 mm

62

What is the most likely diagnosis in this horse?

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Guttural pouch tympany

63

Which approach to the guttural pouch is illustrated below?

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Hyovertebrotomy

The problem with this approach is that there is no ventral drainage

64

Which approach to the guttural pouch is illustrated below?

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Viborg's Triangle

 

  • Borders:
    • Sternomandibular muscle
    • Linguofacial vein
    • Caudal border of vertical ramus of the mandible

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65

Which approach to the guttural pouch is illustrated below?

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Modified Whitehouse

66

What are the causes of guttural pouch empyema?

  • Upper respiratory infection
  • Abscessation of the retropharyngeal LN
  • Fracture of stylohyoid bone

67

Is guttural pouch empyema usually unilateral or bilateral?

Unilateral

68

What are the main clinical signs associated with guttural pouch mycosis?

Epistaxis and Dysphagia

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69

What structure in the guttural pouch is most commonly affected by mycosis?

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internal carotid artery

70

Which surgical approach to the guttural pouches does not provide ventral drainage?

  • Hyovertebrotomy
  • Whitehouse
  • Viborg's triangle
  • Modified Whitehouse

Hyovertebrotomy​

71

Which surgical approach is best suited for treat­ing guttural pouch mycosis?

  • A low hyovertebrotomy
  • Viborg's triangle
  • Whitehouse
  • Modified Whitehouse

Viborg's triangle​

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72

What is the most common complication of gut­tural pouch surgery?

  • Blindness
  • Dysphagia
  • Facial nerve paralysis
  • Abnormal respiratory noise

Blindness​

73

Mycotic lesions of the guttural pouch have a propensity for developing in the __________ artery

internal carotid

74

Which organisms are most commonly grown from diphtheritic plaque in cases of guttural pouch mycosis?

  • A fumigatus and Streptococcus equi
  • E. nidulans and Histoplasma capsulatum
  • E. nidulans and A. fumigatus
  • Candida albicans and Blastomyces dermatitis

E. nidulans and A. fumigatus

75

What is the most common presenting sign of guttural pouch mycosis?

  • Dysphagia
  • Bilateral epistaxis, especially after work
  • Facial nerve paralysis
  • Unilateral epistaxis at rest

Unilateral epistaxis at rest

76

Which ancillary procedure is most effective in diagnosing guttural pouch mycosis?

  • Endoscopy
  • Radiography
  • Ultrasonography
  • Fluoroscopy

Endoscopy​

77

What is the recommended therapy for guttural pouch mycosis?

  • Scraping the fungal plaque off the guttural pouch membrane
  • Irrigation with antifungal medication
  • Surgery
  • Systemic antifungal medication

Surgery​

78

Which artery is most likely to cause retrograde blood flow to mycotic lesions in the external carotid and maxillary arteries?

  • Linguofacial
  • Major palatine
  • Infraorbital
  • External ophthalmic

Major palatine​

79

Current surgical techniques for arterial occlusion in treating guttural pouch mycosis include:

  • Ligation
  • Balloon catheterization
  • Transarterial coil embolization
  • All of the above

All of the above​