Exam 1 Flashcards
(160 cards)
1
Q
What is the Most Likely Diagnosis?
A. Coagulopathy
B. Trauma
C. Ethmoid Hematoma
D. Guttural Pouch Mycosis
E. EIPH (Exercise Induced Pulmonary Hemmorhage)
A
Guttural Pouch Mycosis
*Guttural Pouch Mycosis- Usually Unilateral, Second Most common Clinical Sign is Dysphagia
*Not Coagulopathy- Horse would be having other Systemic Signs
Not EIPH- Lower Respiratory Tract Disease, would see Bilateral Bleeding and Associated with Exercise
2
Q
Fluid Type that is Akin to Giving Free Water as Glucose is Rapidly Metabolized by Cells
A
D5W
*5% Dextrose Solution
*When you put D5W in an Animal, it acts as an Hypotonic Solution as if putting Free Water in the Animal, because Glucose is Rapidly Metabolized by Cells
3
Q
Phase of Laminitis characterized by:
Post 72 Hours with Clinical Signs, and without Physical or Radiographical Evidence of Mechanical Disruption
Duration of Stage is Variabe- Days, Months, or Years (Typically 8-12 Weeks)
Hoof is Healing but still very Weakened and can still Structurally Fail
A
Subacute Phase
*Prolonged Clinical Signs Occur, but NO Mechanical Disruption
4
Q
A
Yes
*Lines are NOT Parallel (Dorsum of Hoof Wall and Dorsum of P3)- Based on that, we have Rotation
*The Degree of the Angle = Degree of Rotation
*If we are taking an Exam and we have a Radiograph like this, except there are NO lines, the Easiest thing to do is pick up Scratch Paper and you can tell whether or no the lines are Parallel
5
Q
A
Right Mainstem Bronchus
6
Q
Treatment for Guttural Pouch Mycosis
A
Surgical Therapy - Obliterate Vessel (More Common)
Antifungal Administration- Takes 4-6 Weeks of Daily Infusions
*Most commonly only Treat with Surgical Therapy- Lesion will Resolve on its own. If we Obliterate the Vessel we do NOT Recommend also treating with Antifungals
If there is no History or Potential for Epistaxis in the animal, it can be Treated with Antifungals
7
Q
When Administering Fluids Per Os, how many Liters/Hour are you able to Administer?
A
12-16 L/Hr
*Can Achieve 12-16 L/hr via Per Os Route
*We are Administering 6-8 Liters every 30 Minutes with this Route
8
Q
Which of the Following is the Most Significant Factor in Deciding your Diagnosis?
A. Signalment
B. Location of Epistaxis
C. Intermittent Nature
D. Spontaneous Occurence
E. Degree of Epistaxis
F. Time Line
G. Other Signs
A
Signalment
Time Line
*Signalment for Ethmoid Hematoma- 10-12 yo Thoroughbred Male Horse
Time Line for Ethmoid Hematoma- Epistaxis is typically Mild, Spontaneous, Intermittent, and Unilateral. Ethmoid Hematomas are Often Present for many Months to Years
*B,C,D,and E do not Distinguish between Guttural Pouch Mycosis and Ethmoid Hematoma
9
Q
Prognosis in Horses with Laminitis that are Exhibiting Mechanical Disruption and Sinking
A
Mechanical Disruption- Poor Prognosis
Sinking- Grave Progonsis
10
Q
Disadvantages of which Fluid Administration Route:
Fluids tend to Track down within Abdomen causing Space Occupying Type Lesion in Abdomen resulting in Abdominal Discomfort
Vigilant need for Monitoring
Vigilance Regarding Sepsis- Can Result in Widespread Peritonitis
A
Intra-Peritoneal
*Acts as a Space occupying Mass and Creates Discomfort in Horses
11
Q
Review Card
A
12
Q
Maximum Volume Injected during Intramuscular Injections in the Semitendinosus/Semimembranosus of a Horse
A
15-20cc Maximum
13
Q
If Horse presents with Chronic Sodium Disturbance with Clinical Signs, then ______correct to some Accepted Value (To the Limit of Compensation), then correct Slowely over Days to bring to Normal Value
A
Rapidly
*Chronic Changes Outside the Compensatory Range- Corrected Quickly to a Certain Range, and then Slowely back to Normal
14
Q
Disadvantages of which Fluid Administration Route:
Virtually No Clinical Indication for its Use due to Limitation on Volume
Basically no Place for these Fluids in Horses- Especially Adults
A
Subcutanous
15
Q
LPS Binds to LBP in Circulation and is shuttled to Target Cells, which are Pulmonary Intravascular Macrophages in the Lung. These Macrophages have _____ Receptors where the LBP will Bind. Then a Comformational Change will occur that will activate the _____ Receptor
A
CD 14- MD2
TLR-4 (Toll Like Receptor 4)
*Once the TLR-4 Receptor is Activated then Intracellular Signalling will occur and the production of Inflammatory Mediators- TNF alpha, IL6, IL1
16
Q
Typical Presenting Complaint in Horses with Laminitis
A
Lameness/Reluctance to Move
17
Q
Characteristics of which Route of Fluid Administration:
Could get Large Volumes at Fairly Rapid Rate
Easy Access without Need for any more Specific Equipment than Standard IV Administration
Alternative in Cases of Limited Venous Access
A
Intra-Peritoneal
18
Q
Diagnostic Technique used in Horses with EIPH, because it is a Lower Airway Disease
A
Transtracheal Washes
BAL
*Neither of these Techniques are used in Cases of Guttural Pouch Mycosis or Ethmoid Hematomas- Upper Airway Diseases
19
Q
A
Nares
Nasal Passage
Ethmoid
Nasopharynx
Guttural Pouch
Larynx
Trachea
*Horses don’t have a Pharynx
20
Q
Two Stages of Shock Associated with Endotoxemia
A
Hyperdynamic State- Initial Stage
Hypodynamic State- Second Stage
21
Q
A
Guttural Pouch
22
Q
When Administering Bicarbonate Supplementation, Traditionally ____ of the Deficit is given over an Hour, then the Horse is Revaluated if Continued need to Re-Administer
A
Half
*Typically we don’t Replace the Total Bicarbonate Volume That has been Lost- While you are Administering first Half of Bicarbonate you are also using other techniques to Re-establish Circulation. When Circulation is Normalized, they should Self Correct the remaining Bicarb Deficit_. If we administer too much Bicarbonate we can put the animal into a Metabolic Alkalosis_
23
Q
______ is used as a Preventive and Therapeutic to Neutralize Circulating Endotoxin
A
Endoserum
24
Q
What is the Location of the Lesion?
A. Medial Compartment of Left GP
B. Lateral Compartment of Left GP
C. Medial Compartment of Right GP
D. Lateral Compartment of Right GP
A
Medial Compartment of Right GP
25
When doing **Blood Gas Analysis,** In order to Calculate how the _Expected pH based on Change in PCO2_
(Measured CO2 - Normal CO2)
For every 10mmHg Increase in CO2, get ____ Decrease in pH
**0.05**
**\***Ex. If PCO2 is 80, Calculate what the pH in the Horse should be:
80 - 40 = 40
Expected pH : (40/10) x 0.05 = 0.2
_7.4 - 0.2 = 7.2_
\*A Horse with a PCO2 of 80, is expected to have a pH of 7.2
26
Most Likely **Acid Base Distrubance** that this Horse is Suffering From?
**Metabolic Acidosis**
**\***_Typical Acid-Base Disturbance in the Horse is Metabolic Acidosis_
27
**Training** Leads to all of the Following Muscle Changes EXCEPT?
A. More Type IIA Fibers
B. Volume of Mitochondria
C. Increase in Oxidative Enzymes
D. Increase in Glycogen Stores
E. More Type I Fibers
**E. More Type I Fibers**
**\***Training does NOT Result in more Type I fibers
28
_Bloodwork:_
Often changes in Sodium are Concomitant with Changes in Chloride. **How can you Explain the Disconnect between Sodium (Low) and Chloride (Normal) Values?**
**Metabolic Acidosis**
\*Sodium is Low and Chloride is in the Middle Range- In most Situations _Sodium and Chloride should be changing together. Often Changed in Sodium are Concomitant with Changes in Chloride._
_If Bicarb starts Reducing, to Maintain Electroneutrality, the System is going to Retain Chloride_
29
**Ethmoid Turbinate**
30
**Training** Improves Oxygen Delivery in all the Following ways EXCEPT?
A. Increase in Heart Mass
B. Increase in Lung Mass
C. Increase in Stroke Volume
D. Increase in Plasme Volume
E. Increase in Total RBC Volume
F. Increase Capillary Supply to the Muscles
**B. Increase in Lung Mass**
_**\***Training Results in Little/No Adaptations in the Lung_
31
True/False: Disease Process occuring in _Only One Foot_ on a Horse, it is Most Likely NOT **Laminitis**
**True**
_**\***Exception to this Rule: Horse that is significantly non-weight bearing on ONE Limb for an extended period of time. We worry about the Horse developing Laminitis in the Contralateral Limb (Weight Bearing Limb). Very specific scenario in which a horse may develop Laminitis in ONE Foot!_
_\*Laminits is a systemic Disease- should see manifestation in AT LEAST the TWO Front Feet, or possibly all four feet_
32
Treatment for **Ethmoid Hematoma**
**Laser Surgical Ablation**
**Intralesional/IV Formalin**- leads to Necrosis of Hematoma
_\*If Mass is extending into the Cribiform Plate, we do NOT want to Treat with Formalin_
33
Most Important Technique for Evaluation of Coffin Bone Position with Respect to the Hoof thus **_Mechanical Disruption_** and Severity/Prognosis of **Laminitis**
**Radiography**
**\***Prognosis Determination is Closely linked to Changes and Progession Observed on Radiographic Evaluation
\*Radiographs- we are looking for MECHANICAL DISRUPTION
34
**Which of the Following Catheter Choices is best to achieve the Deficit Replacement (45L in One Hour)?**
A. Two 14G Catheters
B. One 14G and one 12G Catheter
C. One 14G and one 10G Catheter
D. One 10G and one 12G Catheter
**One 14G and one 12G Catheter**
**\***Will Need to Place Two IV Catheters- None of the Catheters that we Routinely use will be able to Achieve the Volume that we need
_Why not use Two 14G Catheters? Each 14G Catheter cannot provide more than 13L/Hr. Max that we would be able to administer in one Hour is 26L/Hr_
_\*10G and 12G Catheter- More Thrombogenic. Two Larger Catheters with Higher Thrombogenicity. Using a 10G and 12G Increases Chances of creating Thrombosis in Jugular Veins_
35
**0.9% NaCl**
_**\***Endurance Horses have Metabolic Alkalosis. **In Endurance Horses, the Number One Fluid that we will end up giving is NaCl**_
_\*These Endurance Horses are Loosing a lot of Chloride- Sweat is High in Chloride_
36
When **Endotoxin** Enters Circulation, what Three things can Occur?
**1. May bind to Circulating LPS Antibodies present**
**2. Removed Directly by RES in Liver**
**3. May bind to Circulating LBP (LPS Binding Protein)-** Circulating Acute phase protein that we see in these animals
\*With very small amounts of Endotoxin and these three Mechanisms in Play, no Endotoxin will get into the Central Circulation to have any major effect
37
Characteristics of which **Fluid Aministration Route**:
_Most Common Method of Fluid Administration in Equine Patient_
_Easy Access_
_Unlimited Available Amount and Rate of Fluid Administration_
_Allows for Easy Change and Adjustment in Fluid Plan_
**Intravenous (IV)**
38
Major _Contraindication_ to Administering Fluids **Per Os**
**Presence of Gastric Distension, _Reflux_ and Ileus**
**\***Do NOT Administer Fluids Per Os if the Horse is Refluxing
39
Possible Pathophysiology for **Laminitis** characterized by:
_Displacement attributed to **Shear Forces**_
_Results in Movement of Hoof Wall up the Limb and Sole into the Ground_
_Damage/Disruption throughout Entire Foot- Release from Underlying Tissue and Lack of Support_
**Vertical Displacement (Sinking)**
\*_Poorer Prognosis_ than Rotational Displacement
\*P3 is being Driven Down in the Hoof- Sinking of the Hoof without Rotation
_\*Worse Case Scenario- Loss of Hoof_
40
**Flow Rate in L/hr** for a 14G, 12G and 10G Catheter
**14G = 13L/hr**
**12G = 27L/hr**
**10G = 36 L/hr**
41
Signalment associated with which Cause of **Epistaxis**?
_Incidence Related to INTENSITY of Exercise_
_40-100% of Racehorses have Evidence_
_80-100% Racing Thoroughbreds have Evidence_
**Exercise Induced Pulmonary Hemorrhage (EIPH)**
_\*Related to Intensity of Exercise rather than Duration_
42
Which Region of the Endotoxin is **Antigenic**?
**Polysaccharide O-Region**
**\***O Region is Highly Variable in Gram Negative Bacteria
43
Diagnoses based on this Hoof
**Rotational Displacement (Laminitis)**
**\***_Dorsum of P3 is no Longer Parallel with Dorsum of Hoof Wall_
\*Inflammation, Hemorrhage and Clots are Present
44
Three Non Invasive Techniques for Local (Hoof) Support in Horses with **Laminitis**
**Lily Pad-** Rubber Insert that Fits over Heel
## Footnote
**Pink Stryofoam Insulation**
**Roll Gauze Taped to Foot or Frog area**
45
Phase of Laminitis Characterized by:
_Mechanical Disruption/Collapse (Rotation or Sinking)_
_Occurs Irrespective of the Duration of the Process, can be as Fast as 24 Hours_
_Disruption involves Rotational Displacement and Vertical Displacement (Sinking)_
**Chronic Phase**
_**\***Clinical Signs with Mechanical Disruption_
46
True/False: Most common Fluid Replacement used in Equines is **LRS**
**True**
**\***Almost Always using LRS as Fluid Replacement, except in very specific Situations
47
Possible Pathophysiology for **Laminitis**, Characterized by:
_Gross Disconnect of Laminar Tissues_
_Major Forces Including: Vertical Load, Shear Forces, and Tensile Forces_
_**Vertical Load** playing Critical Role- Weight of Horse versus Size of Foot_
**Mechanical Disruption/Displacement**
\*Disconnection of Laminar Interdigitations- Loosing Support for P3 within the Hoof
_Mechanical Disruption- Gross Disconnect of Laminar Tissues_
48
Pattern of Recruitment of **Muscle Fibers** once Exercise Begins
49
In Horses under Stress, \_\_\_\_\_\_can give _Overestimated_ Impression of _Degree of Dehydration_
**Splenocontraction**
**_\*_**_In Equine Patients under stress, Splenocontraction leads to High PCV. If you use PCV to make a Determination on Degree of Dehydration, you will OVERESTIMATE Dehydration_
50
**Two Antimicrobials** that can be added to Systemic Circulation in Horses with Colonic Torsion, so that when you Un-Twist the Colon these Substances can Bind up Endotoxin and prevent severe **Endotoxemia**
**Endoserum** (Anti-Endotoxin Antibodies)
**Polymyxin B** (Sulfa Trimethoprim)
51
Where does the Highest amount of **Endotoxin** likely come from?
**GIT- Cecum and Colon**
\*_The GIT has the Highest Propensity for Developing Endotoxemia with Gastrointestinal Tract Disease- **Horses have Naturally Occuring Endotoxin in their Gut**_
\*Horses have tremendous amounts of endotoxin in their Intestinal Tract 24/7. Any time you have _Cecum or Colon Disease- Very high Risk for developing Endotoxemia_
52
**Shock Dose** Maximum in Horses
**60-_90_ mL/kg/hr**
53
Mostly Type ____ **Muscle Fibers** are Found within Equine _Forelimbs_
**Type I**
**\*Aerobic**
54
Disadvantages of which type of **Fluid Administration Route**:
_Technically More Difficult_
_Limited Rate of Administration by Size of Needle- Maximum Administered is 2L/Hour_
_Rate Sufficient in Foals, but Barely Compatible with Maintenance in Average Adult Horse_
**Intra-Osseous**
**\***_Classic Needles that you use for Intra-Osseous will acheive no more than 2L/Hour_
55
Diagnosis based on these **Endoscopy** Results:
_Visualization of **Plaque** on Internal Carotid Artery_
_Necrotic Tissue and Debris_
_Visualization of Blood from the Lesion/Pouch_
**Guttural Pouch Mycosis**
56
True/False: **Sinking**, is Definitively Diagnosed via Radiograph
**False**
**\***Sinking is NOT Diagnosed via Radiograph. Sinking is a Clinical Diagnoses
57
True/False: **Laminitis** Most commonly affects the Two Hind Feet of the Horse
**False**
**\***_Laminitis occurs in at least the Two FRONT Feet, or possibly all Four Feet._ Will never have the Two Hind Feet involved without having the Two Front Feet involved
_\*Always the Two Front Limbs due to Weight Distribution- Horses carry more weight in their front limbs than their hind limbs_
58
5-yr-old Thoroughbred Mare with _8 hr. History of Severe Colic_
**What is the Fluid Deficit in this Horse?**
A. 7% Dehydrated: 31.5L
B. 10% Dehydrated: 45L
C. 14% Dehydrated: 63L
**10% Dehydrated: 45L**
59
Which of the Following is NOT a limitation of the **Cardiovascular System** in an Exercising Horse?
A. 20-50% Increase in Stroke Volume with No Further Increase
B. Extreme Heart Rate leads to Reduces Ventriular Filling Time
C. Hypoxemia Ensues at 65% VO2 max due to Diffusion Limitation
D. All of the Above are Limitations in Exercising Horse
**D. All of the Above**
60
Maximum Volume Injected during **Intramuscular Injections** in the _Neck_ of a Horse
**10-15cc Maximum**
61
A Horse with **Chronic Hyponatremia** is _Acutely_ Corrected by Administering a High Sodium Fluid, which Causes the Neuronal Cell to Loose water into the Interstitial Space, which Results in Cell _____ and Neurologic Dysfunction
**Shrinkage**
**\***Horses with Chronic Hyponatremia/Hypernatremia should be Corrected Slowely (Over 1 Week)
62
Recommended during **Intravenous Injections** in Horses that the Needle be pointed towards the \_\_\_\_
**Heart**
**\***_Major Concern- Intra-Carotid Injections- Want to Minimize the Likely hood of Hiting the Carotid Artery rather than the Jugular Vein during Intravenous Injections- KNOW THIS_
_\*_If you use an 18 G 1 1/2 " Needle Pointed towards the heart you are least likely to hit the Carotid Artery without knowing it
63
**True**
_**\***Any Irritation anywhere within the Respiratory Tract is going to Elicit a Cough_
64
_**Review Card:** Energy System being used Through Duration of Exercise_
**As the Horse Begins Exercise**- **Phosphocreatine Pathway**: _Generates Tremendous Amount of ATP however only used in Initial Seconds of Exercise allowing Anaerobic pathway to "Come up to Speed"_
**Anaerobic Glycolysis**- _Peaks at 2 Minutes. Glucose Breakdown leading to Generation of Lactate and ATP. As Exercise Continues, the Anaerobic Glycolysis will Taper down as Aerobic Glycolysis is Gearing up_
**Aerobic Glycolysis and Fat Oxidation-** _Takes 35-40 Seconds to come to Maximal Function. Can be Sustained for Prolonged Periods_
_\*All of these Systems are Engaged from the Beginning of Exercise- Only the Percentage of which System we are Using changes during Exercise_
65
**Left**
**\***Notice the Wall that the Ethmoid is Coming off of
66
In Radiographs of the Hoof, some will Mark the Distal most Aspect of the Pastern (Coronary Band area) to Mark the Horizontal Displacement of the Coffin Bone, namely \_\_\_\_\_
**Sinking**
67
How much is the **Total Fluid Requirement** for this Mare in the First Day?
**68L**
\*Deficit: 0.05 x 400 = 20L
Maintenance: 60mL x 400 = 24,000mL = 24L
_MUST DO TWICE MAINTENANCE- Overhydration_
\*_For Horses with **Intestinal Impaction**, You need to use Overhydration to Increase Flow of Fluids to Intestinal Lumen_
68
3 Markers used for Radiographs when Evaluating **Laminitis**
**Dorsal Hoof Wall**- Determination of Rotation of P3
**Tip of Frog**- Determine Specific Location of P3. Important with Respect to Placement of _Heart Bar Shoes_
**Marker of Coronary Band**- Evaluate Distal Displacement in the Hoof (Sinking)
69
**Neither**
**\***Parallel Alignment of P3 and Dorsal Hoof Wall = No Rotation
No Indentation at Coronary Band = No Sinking
_\*Diagnoses for Sinking is Classically CLINICAL, and not Radiographic_
70
How will you Adminster **Per Os** Fluids to this Horse?
**Nasogastric Tube**
_**\***How much Fluids can we pump into the Horse at one time? **6-8 Liters Every 30 Mintues**_
_Gastric Capacity- 15 Liters_
_\*Don't want to put the full 15 Liters Capactiy of Fluid into the Stomach because extensive Distension of the GI Tract shuts down Motility_
71
Most Common **Acid-Base Disturbance** in Equine Patients that is Characterized by _Decreased HCO3 (Bicarb)_
**Metablolic Acidosis**
_**\***Leads to Hyperchloremic State_
_\*Even if we did not have a Blood Gas Analysis, we can Predict that the animal has a Metabolic Acidosis, based on a Disconnect between Sodium and Chlorid_e
72
Characteristics of Which **Fluid Aministration Route**?
_Access to Free Water and/or Electrolyte Solution_
_Least Expensive_
_Lease Invasive with Less Complications_
_**Especially Helpful in Large Intestinal Impactions**- Ex. Colic_
**Oral/Per Os**
73
Angiomatous Mass composed of Respiratory Epithelium and Fibous Tissue, which Progressively Enlarges as Variable Rates
**Progressive Ethmoid Hematoma**
**\***Grows Slowely- _May be Present for Many Months to Years_
_Ethmoid Hematoma- Invades Locally and Creates Deformations Locally_
\*Resembles a Tumor but is NOT Neoplastic
74
What is the _Top Differential Diagnosis_ in this Case?
**EIPH (Exercise Induced Pulmonary Hemorrhage)**
75
_Cantor and Gallop Stride Frequency_ and **Respiratory Rate** are Coupled at ____ Ratio, thus limiting Respiratory Rate to a Maximum of 130/min
**1:1**
_\*Important Limitation- At Moderate to High Speeds of Movement, they are Linked into 1:1 Foot Fall to Respiratory Rate ratio. They cannot unlink this_
_\*Maximum Achieve Respiratory Rate- 130 Breaths/min_
76
True/False: If you are Distending the Jugular for Administration of the Needle for **Intravenous Injection**, make sure to keep the Vein Distended throughout the entire Injection
**True**
_**\***Do NOT let go of the vein prior to injection_- The Needle could Push through the Vein and become Perivascular (Intravenous Drug being injected into Muscle). **_Intravascular Drugs Injected Perivascular can lead to Necrosis (Fenylbutazone) or Laryngeal Paralysis if the drug hits the Recurrent Laryngeal Nerves- KNOW THIS_**
77
**Which of the Following other Clinical Signs would you Expect to see in this Horse?**
A. Unilateral Epistaxis
B. Respiratory Noise
C. Exercise Intolerance
D. Bilateral Epistaxis
E. No other Clinical Signs
**Bilateral Epistaxis**
**Exercise Intolerance**
78
If you take **Hypertonic Saline** and Perfuse it Directly into First Pass Circulation into the Heart, it is a \_\_\_\_\_\_\_, Creating a Decrease in Heart Function
**Negative Ionotrope**
_\*If you take Hypertonic Saline and Perfuse it Directly into First Pass into the Heart, it is a Negative Ionotrope- Creating a Decrease in Heart Function \*\*KNOW THIS. However its Net Effect in the System, when administered into Vascular Circulation and its Diluted, it creates and Increase in Plasma Volume and all of those effects Supercede the Possible Negative Ionotropic Effect that is Specific to the Heart_
_\*You DO NOT want Hypertonic Saline to go straight to the Heart_
79
Number one Therapy, Most Notably in the _Developmental Stage_, for **Laminitis**
**Cryotherapy (Ice Baths**- Water and Ice)
\*Very Important to do this in the _Developmental Stage_- Avoid development of Laminitis
\*How long Does the Horse stay with Feet in Ice Water? Keep feet in Ice Water as long as the Horse is still Significantly ill from their Primary Disease and at risk for Developing Laminitis- _At LEAST 24 Hours, and Possibly upwards of 48 Hours_
80
Fungal Invasion of Tissue Resulting in Erosion of the Wall of the _Arterial Structures of Guttural Pouch_, most Notably the Internal Carotid Artery
**Guttural Pouch Mycosis**
**\***Plaque Like lesion in the Guttural Pouch
81
**What Solution should you use in Deficit Replacement in this Horse?**
A. 0.9% NaCl
B. 7.2% NaCl
C. D5W
D. LRS
E. 5% Sodium Bicarbonate
**LRS**
_\*Horse is Suffering from Metabolic Acidosis_
0.9% NaCl- Acidifying Solution. Don't want to use in a Horse with Metabolic Acidosis
_\*LRS behaves as an Alkalinizing Solution when put in the Horse_
D5W = Dextrose 5% in Water
82
**Chronic**
_**\***Determinant of **Chronic Stage = Mechanical Disruption**. Since Rotational Displacement (Mechanical Disruption) is Occuring in this Radiograph, it is considered Chronic_
83
With **Increased Intensity Exercise,** Energy is being Derived via Oxidation of Carbohydrates, most Notably \_\_\_\_\_\_
**Glycogen**
_**\***Further Increases in Intensity of Exercise cannot be met by Oxygen Supply, and Energy pathways change to Anaerobic_
_\*During High Intensity Exercise- Glycogen is the Major Substrate Generating ATP_
84
**True**
85
Clinical Signs associated with Which Cause of **Epistaxis:**
_Epistaxis is typically Mild, Spontaneous, Intermittent and Unilateral_
_Blood-Tinged Mucoid to Mucupurulent Discharge_
_Malodorous Discharge_
**Ethmoid Hematoma**
**\***Intermittent Recurrent Bleeds usually of a very small Volume
86
Which **Stage of Shock** is this Horse Displaying
**Hyperdynamic State**
\*The Horse is going to be _INJECTED- More Blood Flow to the Area_
\*Heart will be Racing and the Horse will be Shaking
**\***The Hyperdynamic State is Very short Lived. Usually will not see it Clinically
87
Possible Pathophysiology for **Laminitis** Characterized Below:
_Displacement Attributed to **Tensile Forces**_
_Forces Originating from the **Deep Digital Flexor (DDF)**_
_Lack of Sufficient Dorsal Hoof Dermal-Epidermal Interface allows for Displacement (Leverage of Dorsal Hoof Wall)_
**Rotational Displacement**
_**\***Deep Digital Flexor = Tensile Forces_
Rotational Displacement- Loss of Normal Alignment between the Dorsum of P3 and the Dorsum of the Hoof Wall- They should be Parallel. As soon as they loose the Parellelity, there is a Displacement of P3
_\*If Dorsal Laminae are not Attached, the Deep Digital Flexor is now only pulling P3, creating a Rotation_
88
Best Area of the Neck for Administration of **Intravenous Injections**
**Middle 3rd of the Neck**
**\***Try not to be Low on the Neck for IV Injections due to Proximity of the Carotid Artery and Jugular Vein. _As you Move up the Neck the Artery and Vein Separate_
89
Which Region of the **Endotoxin** is the culprit of the Clinical Significance and Signs/Problems we have with Endotoxemia
**Lipid A Region**
**\***The Lipid A component is not very Antigenic
90
**What is your Final Diagnosis?**
**Guttural Pouch Mycosis**
91
_Ozena_, a Foul Odor, is usually Associated with Which Cause of **Epistaxis**?
**Ethmoid Hematoma**
_**\***Malodorous Discharge is often Seen with Ethmoid Hematoma_
92
What is the **Degree of Dehydration**?
A. None
B. 5%
C. 8%
D. 11%
E. 15%
**8%**
**\***Animal is Somewhat Dehydrated, but Not Severe
\*Tacky Mucous Membranes, CRT = 2.5 (Prolonged CRT)
93
Recommended Needle Size for **Intravenous Injections** in Horses
**18 G 1 1/2 " Needle**
**\***Needle should be no LESS than 19 G 1 1/2 " Needle
_\*Always Seed the Needle to the hub in parallel with the Vessel_
94
The Gelding Defecates 2 Liters every 2 Hours. How many Liters of Fluid would this Horse be Recieving a Day?
**94L**
**\***Deficit (8% Dehydrated): 0.08 x 500 = 40L
\*Maintenance: 60mg/kg/day x 500 = 30L
Ongoing Losses: 2L x 12 = 24 L
_40L + 30L + 24 L = 94L/24 Hours_
_\*Of which First 40L Ideally given in First Hour_
95
Based on the **PCO2** in this Horse, what is the Expected **pH**?
**7.13**
94.6 - 40 = 55
(55/10) x 0.05 = 0.27
_Expected pH: 7.4 - 0.27 = 7.13_
\*Side Note- If the Patient had an Alkalosis, the 0.27 would be Added to 7.4 to predict the pH
96
**True**
97
**Medial**
**\***This is an Image of the Right Gutteral Pouch
_\*Lateral Compartment is Smaller than Medial Compartment. They are Divided by Stylohyoid Bone_
**_\*Large Vagus Nerves are Found in the Medial Pouch!_**
**Normally the Stylohyoid Bone is Bowing towards the Lateral Compartment**
98
Horse Presents with **_Profuse, Acute, Bilateral Epistaxis_**
**Trauma**
_**\***Nasogastric Intubation_
99
9-yr Old Standard Breed Mare
History: Colic (Mid Abdominal Pain for 12 Hours)
**How would you Administer these Fluids?**
A. SQ
B. IV
C. Per Os
D. Per Rectum
E. Intraperitoneal
F. Intra Cecal
**Per Os**
_Per Os- Especially Helpful in **Large Intestinal Impactions** - This Horse has Firm Ingesta in the Intestinal Tract_
\*We want to Liquify that Content/Firm Ingesta to allow the Horse to pass it
100
Most Common Surgical Treatment for **Guttural Pouch Mycosis**
**Transarterial Coils**
**\***Most Advocated Treatment for GPM
101
What is the Degree of Dehydration?
A. None
B. 5%
C. 8%
D. 11%
E. 15%
**None**
**\***If the Horse had been at least 5% Dehydrated there would have been Slightly Tacky Membranes
\*High Heart Rate- Normal in Foals/Fillys
102
Classic Gait seen in Horses with **Laminitis**
**Walking on Eggshells**
**\***Gingerly Walking and Picking up Limbs Quickly
103
**Epistaxis**
104
PEH = Progressive Ethmoid Hematoma
**Bilateral Lesion**
**Large Volume Bleeding**
**Unilateral Lesion Invading to Opposite Side**
**\***No Coagulation associated with Ethmoid Hematoma
105
True/False: Adult Horses and Foals with **Endotoxemia** should not be given "Cidal" Antimicrobials because they will Severely Increase the Endotoxemia
**False**
**\***Foals with Endotoxemia should not be given "Cidal" Antimicrobials because they can worsen the Endotoxemia
_\*In Adult Horses there is NO Evidence that giving "Cidal" Antimicrobials have any significant impact on the severity of Endotoxemia_
106
**False**
_Unilateral Nasal Discharge- Only Upper Airway_
107
Signalment for which **Epistaxis Disease:**
_Most Often Older than 8 Years (10-12) of Age_
_Thoroughbred, Warmbloods_
_Male Stallions_
**Ethmoid Hematoma**
108
Treatment for Horses with **EIPH**
**Lasix (Furosemide)-** Most widely Used and Recommended
\*Lasix- Decreases Pulmonary Capillary Pressure during Exercise
109
Two Circumstances in Horses where we will use the **Overhydration** Fluid Technique
**Liquefaction of Respiratory Secretions**
**Intestinal Impactions**
**\***Respiratory Disease- Overhydrate in order to Loosen up the Junk that is caught in their Airways
110
The Target Cell for the Activation of **Endotoxemia** originates from the Pulmonary Intravascular \_\_\_\_\_
**Macrophage**
**\***In Horses, the Lung has the Greatest Amount of Intravascular Macrophages. Pulmonary Intravascular Macrophage- Target Cell for Endotoxemia
111
**Distal Trachea**
112
Classic Stance for Horses with **Laminitis** in Its _Two Front Feet_
**Front Feet are Somewhat out Forward**
**\***Preferential Loading on the Heel Region of Hoof
_\*Common in Horses with Laminitis in the Front Limbs- Classically sitting on their Heels_
113
The **Polysaccharide Region** of Endotoxin is \_\_\_\_\_\_, While the **Lipid A Region** is \_\_\_\_\_\_
**Hydrophilic**- Polysaccharide
**Hydrophobic**- Lipid A
\*_Lipid A Region (Hydrophobic) in a circulation that is water based- Makes Micelles. If you have a lot of Endotoxin in circulation, the unbound Endotoxin will find eachother and make Micelles_
114
**No**
\*Nasopharynx is Lumpy/Bumpy- Inflammation of Nasalpharnyx
Larynx- Missing Visualization of Epiglottis due to Inflammation
115
**Energy System** used in Initial Seconds of Exercise that Generates a _Tremendous amount of ATP_ however is only Sustained for a few Seconds
**Phosphocreatine Pathway (PCr)**
116
**Left**
117
**On Left of Image**
**Branch off to Lower Lung Directly after Bifurcation**
**\***In Image you can see Accessory Bronchi (White Oval), which Branches Off on the Right Side of the Trachea _after Bifurcation of Trachea_
118
Review Card
\*_Horses with Stress and Endotoxemia will have a Total WBC Count within Normal Limits with a Lymphopenia_
119
In Horses with **Laminitis**, Pain is Evaluated by Hoof Testers. Pain is usually detected at the \_\_\_\_
**Toe**
**\***Hoof Testers- Identify Pain within the Foot
_\*Laminitis- Responsive and Painful at the Toe_
120
Phase of **Laminitis** characterized by:
_First Identifiable Clinical Signs_
This Phase ends after the Development of Either:
_Passing of 72 Hours without Physical or Radiographic Evidence of Mechanical Disruption_
_or_
_Development of Mechanical Digital Collapse_
**Acute Phase**
_**\***Clinical Signs Occur, but NO Mechanical Disruption_
_Clinical Signs Seen- Weight Shifting, Heat in their Feet, Increased Digital Pulses, Abnormal Gait/Stance, Positive on the Toe with Hoof Testers_
121
Cationic Polypeptide **Antibiotic** that exerts its effect by Binding with Lipid A, thus preventing its interaction with Inflammatory Cells that is used to _Neutralize Circulating Endotoxin_
**Polymixin B**
122
_Early on_ in **Shock,** there will be an overwhelming ____ State. As Shock Progresses, there is a tendency towards an overwhelming _____ State
**Vasoconstrictive-** Hyperdynamic
**Vasodilatory-** Hypodynamic
123
Horses with **Laminitis** will have Increased Digital \_\_\_\_\_
**Pulses**
_**\***Strong, Bounding Digital Pulses_
\*Digital Pulses are Not Detectable in Normal Horses
124
Treatment for **Rotational Displacement** leading to _Laminitis_
**Cut Deep Digital Flexor**
**\***Stops the Rotation from Perpetuating
125
**Distal Nasopharynx**
126
During **Low Intensity Exercise**, the Horse is Exercising Largely \_\_\_\_\_, while the Vast majority of Energy is being Derived by _Beta Oxidation of Free Fatty Acids_
**Aerobically**
_**\***During Low Intensity Exercise- Fats are major Substrate Generating ATP_
127
**Opening to Guttural Pouch**
**\***R = Right Side
\*In this Image we are in the middle of the Nasopharynx
128
True/False: If Bleeding from an **Ethmoid Hematoma** is High Volume, the Bleeding can be Bilateral
**True**
_**\***Ethmoid Hematoma can lead to Bilateral Bleeding in 15-20% of Cases due to presence of 2 Lesions, Extension of One Lesion into the Other Side, or Due to High Volume of Bleeding_
129
In Horses, _____ Increases Oxygen Carrying Capacity by Increasing Circulating Red Cell Volume (PCV)
**Splenocontraction**
130
Epistaxis Resulting from Disruption of Pulmonary Capillaries as a Consequence of High Cardiac Output required during Intense Exercise
**EIPH**
131
The _____ the Diameter of the Catheter, the more **Thrombogenic**
**Larger**
**\***Ex. 10G Catheter is MORE Likely to Cause Thrombosis than a 14G Catheter
132
Horses with **Laminitis** have Swelling, Inflammation (Heat) and Edema of the \_\_\_\_\_\_
**Coronary Band**
133
Classic Stance in Horses with **Laminitis** in _All Four Hoofs_
**Inverted Tripod**
**\***Trying to Gain _Equal Weight Distribution_
134
While Performing Radiographs of the Hoof, we Mark the Dorsal Surface of the Hoof Wall (Coin, Metal Strip of Wire, ect.) to Evaluate \_\_\_\_\_\_
**Rotation**
135
The Gelding Defecates 2 Liters every 2 Hours. If you have Fulfilled the Deficit upon Intial Treatment, what is the Remainder of the Volume of Fluids he needs to Receive that First Day?
A. 24L
B. 30L
C. 40L
D. 54L
E. 70L
F. 94L
**54L**
**\***Maintenance: 60 ml/kg/day
60ml/kg x 500kg = 30L
\*Ongoing Losses: Diarrhea
2L x 12 = 24L
_30L + 24L = 54L_
**Fluid Therapy = D + O + M**
Deficits have already been given in this Patient
136
5-yr-old Thoroughbred Mare with 8 hr. History of Severe Colic
**How would you Administer These Fluids in this Horse?**
**IV**
**\***Animal is Refluxing- Cannot give Fluids Per Os
137
In a Horse with **Acute Hypernatremia/Hyponatremia,** you correct this as ____ as Possible using D5W
**As FAST as Possible**
_**\*Acute Hypernatremia- Give D5W**, because it is equivalent to Free Water and will Dilute Sodium_
_\*In Horses with Acute Hypernatremia/Hyponatremia, we want to get the Horse back to Normal as FAST as possible_
138
A Goal of Treatment for **Endotoxemia** involves Inhibition of Synthesis and Effects of Endotoxin-Induced Mediators. The Most Accepted/used Modality is via the Administration of NSAIDs, notably \_\_\_\_\_\_\_\_
**Flunixin Meglumine**
_**\***#1 Drug of choice used in these Patients. Used in all cases where the Horse is believed to be Endotoxemic_
**\***Substantial Evidence that Flunixin reduces the Effects of the Endotoxin and the Mediators Produced
139
Phase of **Laminitis** characterized by:
_Prior to the Development of Clinical Signs of Laminitis_
**Developmental**
_**\***No Clinical Signs_
140
Clinical Signs associated with which Cause of **Epistaxis:**
_Poor Performance- Quitting_
_Epistaxis (1-10% of Cases)_
_Coughing_
_Increased Swallowing Efforts while Racing_
_Gurgling/Choking_
**Exercise Induced Pulmonary Hemorrhage**
_\*Many Cases may have No Clinical Signs_
_\*EIPH is the Number One Cause of Epistaxis in the Exercising Horse, but the vast majority of EIPH horses are not Bleeding through their Nares. Most Horses are only Bleeding in their Trachea_
141
Review Card
142
Which **Stage of Shock** is this Horse Displaying
**Hypodynamic State**
**\***Congested- Circulation is Stagnating- Blue Color
_\*Hypothermic- Caused by Peripheral Vasoconstriction. In Peripheral Limbs there is Vasoconstriction leading to Cold Extremeties. Although Overall, the Horse is experiencing Net Vasodilation in the Hypodynamic State_
143
**Guttural Pouch Mycosis** Predisposition for Location on Internal Carotid Artery is though to be Related to High ____ at these Locations
**Oxygen Tension**
144
Adjustable Shoe that Provides Support for Horses with **Laminitis**
**Adjustable Heart Bar**
145
Horses with _____ will have _Increases in Pulses Equally of the Lateral and Medial Palmar Digital Arteries of at least the Two Front Limbs or all Four Limbs_
**Laminitis**
**\***If you have an Increase in the Medial and Lateral Palmar Digital Arteries in One Foot- NOT likely Laminitis
146
In Horses with **EIPH** that are a _Grade 1 or Grade 2_ you would not expect to see \_\_\_\_\_\_
**Exercise Intolerance**
147
4 yr old Standardbred Racing Mare with Mild Bilateral Epistaxis. You perform and Endoscopy. What is your Diagnosis?
**EIPH**
**\***_Pool of Blood in the Trachea_
_What Grade would you Classify this Horse? Grade 3_
148
**Categorize this Disease**
A. LRT Infectious
B. LRT Non-Infectious
C. URT Infectious
D. URT Non-Infectious
**URT Non-Infectious**
**\***Not Lower Respiratory because there is Unilateral Discharge
_Unilateral Discharge- Upper Respiratory ONLY_
_Non Infectious- No Fever, Non Purulent Discharge_
149
The Disconnect in a **Rotational Displacement,** is the ____ Laminae
**Dorsal**
_**\***If Dorsal Laminae are not Attached, the Deep Digital Flexor is now only pulling P3, creating a Rotation_
\*If you want to Stop the Rotation what would you do? Cut Deep Digital Flexor (DDF)
150
Name Two _Anti Inflammatory and Analgesic Drugs_ that are an Essential Component to the Treatment of **Laminitis**
**_Antiinflammatories- Flunixin and Fenylbutazone_**
**_Analgesics- Fenylbutazone (Systemic NSAID)_**
\*Analgesics- Very Important. Need to Control the Pain in their Feet
151
Evaluation of Coronary Band for \_\_\_\_\_
**Sinking**
**\***See if you can get your Thumbnail under the Coronary Band = Sinking
152
5-yr-old Thoroughbred Mare with 8 hr. History of Severe Colic
## Footnote
**Horse Refluxes 20 Liters Twice and then 1.5 Liters every Two Hours for 12 Hours. If Deficit is Replaced in First Hour, How much Volume Remains to be Administered that First Day?**
**76L**
Fluids = D + M + O
_\*Deficit has Already Been Administered_
Maintenance: 60mL x 450 = 27L
Ongoing Losses: (20L x 2) + (1.5L x 6) = 49L
_27 + 49 = 76L_
153
**7.2**
80 - 40 = 40
Expected pH : (40/10) x 0.05 = 0.2
_7.4 - 0.2 = 7.2_
154
Goal of Intervention during the Developmental Stage of **Laminitis**
**Prevent Development**
_Ex. Icing the Feet- Icebath_
**\***Rather than Treat and Affected Patient
155
Disadvantages of which Route of **Fluid Administration**?
_Danger of Compromise to Vein- Ex. Thrombosis_
_Introduction of Organisms- Sepsis_
_Requires Sterility of Both Placement and Fluids used_
_Expensive_
_Requires Monitoring, Frequent Evalutions of Fluids, Catheters and Catheter Changes_
**Intravenous**
156
Due to Proximity of Structures, Occasionally _Horners Syndrome, Laryngeal Hemiplegia_ and other Neuropathies can be seen with which Cause of **Epistaxis**?
**Guttural Pouch Mycosis**
_**\***Some horses with Guttural Pouch Mycosis my Present Solely with Neuro Signs Alone_
157
9-yr Old Standard Breed Mare
History: Colic (Mid Abdominal Pain for 12 Hours)
**What is the Degree of Dehydration?**
**5%**
**\***Tacky Membranes, but other Parameters are not abnormal
158
True/False: Insulin Resistance with **Hyperinsulinemia** is a Key Determinant in Susceptibility to **Laminitis** in Horses and Ponies
**True**
**\***Insulin Resistance Horses and Ponies are MORE LIKELY to develop Laminitis
159
True/False: This is what we expect to see on the CBC of a Horse with **Endotoxemia**
**True**
**\***Normal Total WBC Count should be: 6,000-12,000
Normal Segmented Neutrophils- 4,000-10,000
Normal Bands Neutrophils- 0-100
Normal Lymphocytes- 1000-6,000
\*This Horse has a Significant Lymphopenia. Total WBC Count and Segmented Neutrophils are on the Low Edge of Normal. _Stress and Viral Disease are the two major causes of Lymphopenia in Horses_. _Lymphopenia Caused by Stress would also show a Neutrophilia. What we are seeing here is a CBC in a horse that has Concurrent Stress and Endotoxemia. Stress Increases Neutrophils while Endotoxemia Decreases them, leading to a Neutrophil Count within Normal Limits_
160
**LPS Binding Protein** that is an acute phase protein which acts as a Shuttle Protein bringing LPS from aggregates to responding cells
**LBP**
**\***Shuttle Protein- _the Big Issues that we see with respect to Endotoxemia, have to do with LPS bound to LBP going to that target cell in the Lung_
_\*_If you can reduce the LPS being shuttled to the target cell then you hopefully will reduce the negative effects associated with Endotoxemia
