Exam 2 Flashcards
(186 cards)
1
Q
Classify the Colic
A
Non-Strangulating Small Intestine
2
Q
Gold Standard for Diagnosis of Equine Infectious Anemia
A
Coggins Test (AGID)
*AGID = Agar Gel Immunodiffusion Test
Coggins Test- Gold Standard and Only officially Accepted Test
3
Q
What is the Common Heart Rate in a Horse with a Non-Strangulating Colic (Simple Obstruction)?
What is the Common Heart Rate in a Horse with Strangulation Colic?
A
Simple Obstruction = 40-70 BPM
Strangulating Colic = 50-90 BPM (Very Elevated)
*Heart Rate is Elevated to Reflect Anxiety/Stress Level of Animal, Degree of Pain, and Degree of Cardiovascular Compromise
*NORMAL Resting Heart Rate in Adult Horse = 28-44 BPM
4
Q
Treatment for Laryngeal Hemiplegia in a Horse with Exercise Intolerance and Inspiratory “Roar”
A
Laryngoplasty- “Tie Back”
*If the Horse ONLY shows Inspiratory Roar without Exercise Intolerance, what is the Treatment? Ventriculectomy/Ventriculocordectomy. Vast majority of the noise is associated with the vocal Fold. These Procedures are Performed as the only Procedure in those in which noise is the issue
5
Q
Signalment for which Valvular Disease in Horses:
Age: Commonly Less than 4 Years of Age
More Common in Males
Common Valves Affected: MITRAL and AORTIC
Multiple Sites can be affected in a Single Animal
A
Vegetative Endocarditis
*Most Frequently affecting the MITRAL VALVE
6
Q
In Suspected Cases of Equine Infectious Anemia that we consider to be Infected LESS than 45 Days ago, what other Diagnostic Tests should be Run in addition to Coggins Test
A
ELISA
*ELISA: More Specific and Sensitive. Can Detect Pior to Development of a Positive AGID
7
Q
Pathophysiology associated with which Classification of Pericarditis:
Accumulation of Fluid within the Pericardial Sac
Acute/Rapid Accumulation of Fluid can Result in Sudden Cardiac Tamponade and Cardiovascular Collapse
Severity of Clinical Signs directly Related to the Amount of Fluid present and the Rate of Accumulation
Decreased Diastolic Filling
A
Effusive
*Effusive Pericarditis- As the Heart is filling, the Fluid that is Surrounding the Heart is going to exert a Higher and Higher Pressure against the Ventricular Walls as they are trying to Expand
*Slow Increase in Pressure and the Heart is Fighting to Fill against the Higher Pressure
8
Q
Most Commonly used Beta2 Adrenergic Agonist used in Horses described Below:
Short-Acting, Rapid Onset within 5 Minutes
Duration of Effective Dilation is 1-3 Hours
Pure R-Isomer is Preferred
A
Albuterol (Torpex)
9
Q
Two Bronchodilator Agents used in Therapy for Horses with Cough:
A
B2 Adrenergic Agonists
Anticholinesterases
10
Q
Clinical Signs seen with Which Viral Respiratory Disease:
Cough
Abortions
Neurologic Syndrome
Diarrhea
A
Equine Herpes Virus
*If you have a Facility where you are seeing Abortions and Viral Respiratory Disease, top Differentials should be EVA and EHV
Respiratory and Neuro Disease = Equine Herpes Virus
11
Q
Bronchodilator used to Treat Cough in Horses Described Below:
Rapid to Immediate Relief
Rapid Local Effect with Minimal Side Effects
Most commonly used in the Horse is Albuterol
A
Beta 2 Adrenergic Agonists
*Most Commonly used Bronchodilator used in Cases of Recurrent Airway Obstruction
*Beta 2 Adrenergic Agonists used with Steroids- Most Common Combination used in Recurrent Airway Obstruction (RAO)
12
Q
Classify this Colic
A
Strangulating Small Intestine
13
Q
Nasogastrically Intubate this Horse to Find:
18 Liters of Malodorous Fluid
pH = 7.6
Physical Exam Findings:
Heart Rate: 106 BPM
Respiratory Rate = 48/min
Temperature = 99.2 F
Mucous Membranes Congested with CRT = 3.5 Seconds
Thoracic Auscultation: Within Normal Limits
GIT Auscultation
Negative in All Four Quadrants (Silent Abdomen)
What is the Next Step?
A
Perform a Trans-Rectal Palpation
14
Q
Pathogenesis of which Lower Airway Disease in Horses:
Small Airways Collapse during Expiration due to High Pleural Pressure Resulting in EXPIRATORY Difficulty
A
Recurrent Airway Obstruction (Heaves)
*Because its Terminal Airway Disease, the Component of the Difficulty is primarily EXPIRATORY
*The Greatest Resistance on Expiration is in the Small Airways
15
Q
Review Card: Strangulating versus Non Strangulating
*Strangulating = Gut Wall Compromise
A
16
Q
Three Pathophysiologies leading to Epiglottis Entrapment in Horses
A
Aryepiglottic and Subepiglottic Tissue Envelopes the Epiglottis
Redundant Loose Tissue
Hypoplastic Epiglottis
*Epiglottic Entrapment can be Concurrent with DDSP- many of these conditions are related to eachother or can occur at the same time
17
Q
Idiopathic Laryngeal Hemiplegia is a Term only used for ____ Sided Laryngeal Hemiplegias that can be Partial or Complete
A
Left
*Idiopathic Laryngeal Hemiplega- Damage to the Left Recurrent Laryngeal Nerve
*Majority of Hemiplegias which are Left-Sided are Idiopathic
Laryngeal Hemiplegias can be Right Sided Only or Bilateral. If it is a Right Laryngeal Hemiplegia, it is NOT considered Idiopathic
18
Q
Most common Cause of Anemia in Horses is that Associated with Depression of RBC Production (Inadequate Production), More Particularly Anemia of _____ Disease
A
Chronic
*What Etiology should be at the Top of your List for Decreased RBC Production resulting in Anemia? Anemia of Chronic/Inflammatory Disease!!!- Number one Cause of Anemia in the Horse
*Anemia of Chronic Disease- Decreased Production as a Result of Iron Sequestration
19
Q
Pathophysiology of which Muscle Disease in Horses:
Voltage Gated Sodium Channels of Skeletal Muscle have Increased Sodium Permeability
Results in Potassium (K) Efflux = Hyperkalemia
Resting Potential of Sodium Channels are Closer to Firing
A
Hyperkalemic Periodic Paralysis (HYPP)
*Sodium (Na) Channels Resting Potential Closer to Firing (Normal = 70mV, HYPP = 55mV)
*Clinical Signs are associated with Episodic Hyperkalemia
20
Q
A 5-yr-old Warmblood Mare is Presented with a History of Exercise Intolerance and Intermittent Stridor for the last 3 weeks manifested only when used for Jumping. An Inspiratory and Expiratory Noise is Heard
What is the Diagnosis?
A
Epiglottic Entrapment
21
Q
Four Pathophysiologies leading to Dorsal Displacement of the Soft Palate (DDSP)
A
Excessive Negative Intrapharyngeal Pressures- In the Face of very Negative Pressures, the Soft Palate gets Sucked into the Airway. If there is any other concurrent Upper or Lower Airway disease, it can Predispose the animal to DDSP
Excessive Poll Flexion- Poll: Area Immediately behind the Ears
Epiglottic Shortening (Hypoplastic Epiglottis)
Caudal Retraction of Larynx
22
Q
Upper Respiratory Disease with Nasal Discharge Described Below:
Highly Contagious Disease
Causative Agent: Streptococcus Equi Var Equi
ALWAYS PATHOGENIC
Mainly in Younger Horses: YEARLINGS
A
Strangles
23
Q
Treatment for Babesiosis/Piroplasmosis
A
In Endemic Area- Suppress Clinical Signs WITHOUT eliminating organism from the Body. DO NOT Clear Organisms. Only Treat to Alleviate Clinical Signs. You want to Leave these Animals with a Low Level Infection in order for the Horse to have Continued Immunity
In Non-Endemic Area- Completely Eradicate Organism. Clear and Repeat Serology for Reversion of Negative Status
*For Importation to the US from Positive Countries, Horse needs to be Seronegative!
24
Q
Two Abnormal Variations that can be Felt during Transrectal Palpation
A
Loops of Sausage- Small Intestine or Small Colon
Large Balloon like Structures- Cecum or Large Colon
*How to Differentiate Small Intestine from Small Colon- Small Colon has a Band that can be Palpated
How to Differentiate Cecum from Large Colon- Cecum should be Limited to the Right side of the Horse (Fixed to the Right Side)
25
**F. Right Ventral Colon, Sternal Flexure, Large Ventral Colon**
**\***Ventral Colon is the Beginning of the Large Colon- When food comes out of the Cecum it "Drops to the Floor" into the Right Ventral Colon
26
**_Classify this Colic_**
**Rectal Palpation:**
_Multiple Loops Tightly Distended "Sausages"/Tubular Structures_
_No Bands_
**Nasogastrically Intubate this Horse to Find:**
_18 Liters of Malodorous Fluid_
_pH = 7.6_
**Physical Exam Findings:**
_Heart Rate: 106 BPM_
_Respiratory Rate = 48/min_
_Temperature = 99.2 F_
_Mucous Membranes Congested with CRT = 3.5 Seconds_
**GI Auscultation:**
_Negative in All Four Quadrants (Silent Abdomen)_
**Strangulating Small Intestine**
27
Only **Intraerythrocytic Parasitic Disease** that affects Horses. They Appear as Pyriform Bodies in Groups of 2-4 organisms within RBC's
**Piroplasmosis/Babesiosis**
28
Clinical Signs of which Airway Disease:
_20-27% show No Clinial Signs_
**_COUGH_**
**Inflammatory Airway Disease (IAD)**
**\***20-27% Present with No Exercise Intolerance or Overt Signs and were diagnosed via Endoscopy and Cytologic Findings
_\*85% of Horses with a Cough have Inflammatory Airway Disease. If you take 100 Young Racehorses who are Coughing, 85% have IAD. **Inflammatory Airway Disease is the Major Differential for a Cough in a Young High Performance Animal (Racehorses)**_
_\*Cough is an Insensitive Indicator of IAD- If you take 100 Horses with IAD, only 30-40% of them will have a Cough_
29
Type _____ **Inflammatory Airway Disease (IAD)** is Described Below on BAL:
## Footnote
**_\> 2% of Cells in BAL are MAST CELLS_**
**_Responds BEST to Mast Cell Stabilizers- Cromolyn Sodium_**
**Type 2 IAD**
**\***Some Cases you may see up to 25-30% of Cells being Mast Cells
_\***Cromolyn Sodium**- Can be Given by Nebulization (10-15 Puffs BID or TID)_
30
**Review Card: Bands in Large Colon**
_**Pelvic Flexure Band = Mesenteric Band** (Clinically we say there are No bands in the Pelvic Flexure because the Mesenteric Band is NOT Identifiable on Rectal Palpation_
_Clinically- Identify the Pelvic Flexure during Rectal Palpation by virtue of the Fact that is a Component of the Large Intestinal Tract and has No bands_
_**Small Colon- Antimesenteric Band and Mesenteric Band**. From Clinical Perspective only One band since you can only Palpate the Antimesenteric Band_
31
Etiology of which **Muscle Disease** Described Below:
_Familial Disease of **Autosomal Dominant Inheritance**_
**_Point Mutation Resulting in Phenylalanine/Leucine Substitution in Key location of Alpha Subunit_**
_Voltage Gated Sodium Channel of Skeletal Muscle Affected_
**Hyperkalemic Periodic Paralysis (HYPP)**
_**\***AKA Impressive Disease_
32
Significant Structures to assess in the _____ Quadrant
**Left Dorsal**
**\***Left Dorsal Quadrant- Spleen, Caudal 1/3rd of the Kidney, and Nephrosplenic Ligament
\*MEMORIZE THIS PICTURE
33
**Muscle Enzyme** Described Below:
_**Muscle Specific Enzyme**- Predominantly in Skeletal and Cardiac Muscle_
**_Reflects Degree of Muscle Damage_**
_**Increases Rapidly after Insult** (Peaks within 6-8 Hours)_
_Short Half Life- Decreases Rapidly (Return to Normal within 3 Days)_
**CK (Creatinine Kinase)**
_**\***Reflects Degree of Muscle Damage- The Higher the CK, the more Muscle Damage Present_
_\*Signficant Increases Involve Levels in the Tens and Hundreds of Thousands- Severe Muscle Damage_
34
_Major Presenting Complain_t for Horses with **Recurrent Airway Obstruction (RAO)**
**Seasonal Episodic Distress at REST**
_**\***RAO = Seaosonal Episodic Distress in a Febrile Horse at Rest_
_\*These Horses are Classically DISTRESSED so we often see an Anxious Horse with Incredible Nasal Flares- Obvious Difficulty Breathing AT REST_
35
Review: Therapy for **Recurrent Airway Obstruction**
36
Treatment for Horses with **Strangles**
**Consider Goal of Client**- Do we just consider this a Childhood Disease and allow Yearling to develop disease then Recover?
**If Not Depressed and Eating OK with NO Complications- Best to Let Disease Run its Course**
**Strict Isolation of Affected Animals**- Typically 6 Months to 1 Year
**In ALL COMPLICATED (**Retropharyngeal LN Enlargment/Purpura**) Horses- PENICILLIN**
_**\***Penicillin is ONLY Recommended in Complicated Course of Disease_
37
Mainstay of Therapy In Horses with an Underlying _Immune Mediated Pathophysiology_ of **Recurrent Airway Obstruction (RAO)**
**Maximized Corticosteroids**
**Minimized Bronchodilators**
_**\***In Most cases of Recurrent Airway Obstruction (RAO) we will Likely be Treating with BOTH Corticosteroids and Bronchodilators. However, if the Underlying Cause is Mainly **Inflammation, we will Maximize the Amount of Steroids Given.** If the Underlying Cause is **Bronchoconstriction, we will Maximize the Amount of Bronchodilators** Given_
38
In Horses with **Colic**, _Reflux_ of Large Volumes typically Indicative of \_\_\_\_\_\_Involvement
**Small Intestinal**
_**\***ALL SMALL INTESTINAL OBSTRUCTIONS tend to result in some degree of Refluxing in the Horse_
39
Clinical Signs of which Condition on Horses:
**_Exercise Intolerance_**
**_INSPIRATORY NOISE- "Roar"_**
_Possible EIPH_
**Idiopathic Laryngeal Hemiplegia**
_**\***What Clinical Signs do these horses show at rest? NONE_
40
Treatment for **Effusive and Constrictive Pericarditis**
**Effusive- Drainage/ Pericardiocentesis**
**Constrictive- Pericardectomy**
**\***_Effusive- Need to Drain Fluid because the Fluid is Exerting Pressure._ Placement of Intrapericardial Catheter
_Constrictive- Need to Remove a piece of Pericardium to Release the Pressure of the bag around the Heart_
41
Both Effusive and Constrictive **Pericarditis** are _____ Problems
**Preload**
_**\***The Failure is Associated with a PRELOAD Problem in Horses with Both Effusive and Constrictive Pericarditis_
_\*The Preload will be Reduced, thus the Cardiac Output is Reduced_
42
_Anti-Inflammatory drug_ used to Treat **Coughing** in Horses Described Below:
**_Inhibit Mast Cell Degranulation_**
_Used Preventively to Stop Further Mast Cell Degranulation_
_**Preventative:** Only Effective for Mast Cells that have Not Degranulated, they have No Effect on already Released Mediators_
**Mast Cell Stabilizers** (Sodium Cromoglycate, Nedocromil Sodium)
\*Really Helpful as a Preventative, because it is ONLY helpful if Mast Cells have not yet Degranulated
**_\*Mainly used in Cases of Inflammatory Airway Disease (IAD)_**
_\*NOT used in Standard Therapy for Horse with RAO (Recurrent Airway Obstruction)- Mast Cell Stabilizers are Not effective Treatment for an Episode of Airway Obstruction_
43
**Purpura Hemorrhagica** is an Aseptic Vasculitis occuring in Mature Horses. Which Two Airway Diseases lead to Purpura Hemorrhagica and what are their Clinical Manifestations?
**_Strangles_- Localized Purpura of the Upper Airway leading to Pharyngeal Collapse (Nasopharynx Collapse)**
**_Equine Influenza Virus_- Edema of Distal Limbs which is Hot/Painful**
44
Pathophysiology of which Disease leading to **Anemia** in Horses:
_**Infects Macrophages**- Integrates into the Host Genome_
**_INDIRECT DESTRUCTION- NOT Infection of RBCs_**
_Immune Mediated Hemolysis_
_Thrombocytopenia Common_
**Equine Infectious Anemia**
45
Five Prognostic Factors that are associated with a Poor Prognosis in Horses with **Pleuropneumonia**
**Systemic Fibrinogen Value \> 1000** = Poor Prognosis
**Isolated Organism: Worse if E. Coli**
**Amount of Fibrin in Chest-** The More Fibrin, the Harder the Treatment
**Foul Odor to Pleural Fluid or Breath-** Presence of Anaerobes
**Gas Bubbles on Ultrasound-** Presence of Anaerobes
_\*Presence of Anaerobes WORSENS the Prognosis_
46
**What is the Degree of Colic Manifested by this Horse?**
**Severe**
_**\*Multiple Facial Abrasions!!!**_
_\*Never had a Previous Episode- One of the main Risk Factors for development of a Colic is having a Previous Episode of Colic_
47
Treatment for **Rhodoccocus Equi**
**Antimicrobials- ERYTHROMYCIN Estolate, Rifampin**
**Anti-Inflammatories- Flunixin Meglumine**
**Antiulcer Medication**- Controversial
**Supportive Treatment- Oxygen, Fluid Therapy**
\*Antimicrobials - Must be Lipophilic (Lipid Soluble) to penetrate Abscesses
48
General Clinical Signs for _______ **Colic:**
**Non- Strangulating**
**Reflux:**
_None: Non-Strangulating Large Intestinal Lesion_
_Minimal: Non-Strangulating Small Intestinal Lesion_
49
Which **Muscle Disease** is Described below:
_Reports of Heavily Muscled Quaterhorse Foals with upper Airway Stridor and Spasm or Paralysis of Laryngeal Muscles_
**Hyperkalemic Periodic Paralysis**
_**\***Common to see Bilateral Laryngeal Hemiplegia_
50
Complications associated with which **Upper Respiratory Tract** Disease of Horses:
**_Dyspnea/Distress_**
_Can Result in **Guttural Pouch Empyema-** Extension of Ruptured Lymph Node into Guttural Pouch_
**_PURPURA HEMORRHAGICA_**
_Brain Abscessation_
_Immune Mediated Myopathy_
**Strangles**
_\*Purpura Hemorrahgica- Main Underlying Cause Associated with Purpura: Strep Equi Infections_
_\*Not Many Horses with Strangles, will develop Brain Abscesses- Very small percentage of Animals develop this Complication. HOWEVER if you look at Brain Abscessation in Horses, the Number one Organism causing Brain Abscessation in Horses is Strep. Equi. Strep Equi is the MAJOR cause of Brain Abscesses_
51
Airway Disease Leading to **Chronic Cough** in Horses Described Below:
_Clinical Signs- Severe Cough (Same as RAO)_
_Risk Factor: **Housing with Donkeys or on Pasture where Donkeys were Previously Kept**_
**Lungworm (Dictyocaulus Arnfeldi)**
**\***Clinical Disease is Indistinguishable from COPD (RAO)
_\*On TTW or BAL- Increased Eosinophils and Occasionally Larvae or Parasites_
52
_A 5-yr-old Warmblood Mare is Presented with a History of Exercise Intolerance and Intermittent Stridor for the last 3 weeks manifested only when used for Jumping. An Inspiratory and Expiratory Noise is Heard_
## Footnote
**How would you Treat this Horse?**
**Laser Tissue Resection**
**\***Complete Epiglottic Entrapment- Must be Treated Surgically
53
Clinical Signs of which Equine Condition:
_Exercise Intolerance_
_Inspiratory and Expiratory Noise_
_Chronic Cough Especially when Eating_
_May be Asymptomatic and not show Clinical Signs_
**Epiglottic Entrapment**
**\***How do Epiglottic Entrapment Horses look at Rest? NORMAL
How does a DDSP Horse Look at Rest? NORMAL
_\*Noise is only Generated when the turbulance in the Airway is High Enough to create Factors Favorable to produce a Noise. We Do NOT Expect Noise at Rest_
_\*You will NOT see CHEEK PUFFING with Epiglottic Entrapment_
54
Airway Disease characterized by _Dyspnea WITH Distress_ leading to **Chronic Cough** Described Below:
_Chronic, Progressive Disease Occuring Rarely in Adult Horses_
**_Clinical Signs are Indistinguishable from RAO, However Horses are Unresponsive to Conventional Therapy for RAO_**
**_Following the use of Repeated IV injections of "EquImmune"_**
_Thoracic Radiographs- Interstitial to **Reticulonodular Pattern**_
_Lung Biopsy- Confirms Diagnosis_
**Adult Interstitial Pneumonia**
_**\***There is Nothing we can do to Treat this!- Therapy is Largely Unsuccessful_
55
Treatment for a Horse with **Recurrent Airway Obstruction** with a _Secondary Bacterial Infection_
**Antibiotics- Penicillin/Trimethoprim Sulfa**
**\***What organisms do we predict are going to be involved in this case Scenario? We have a Pretty good Idea of what Organims we're thinking are responsible for the Pneumonia in this Secondary Bacterial Infection- _STREPTOCCOCUS_
_#1 Organism in the Equine Patient leading to Generic Pneumonia and Bacterial Pneumonia secondary to Viral Respiratory Disease or Reccurent Airway Obstruction is STREPZOOEPIDEMICUS_
56
Intracellular Facultative Aerobic, _Gram Positive, Pleiomorphic, Coccobacillus Organism_ that Results in Subacute to Chronic Bronchopneumonia and Pulmonary Abscessation in Foals
**Rhodococcus Equi**
57
General Clinical Signs for _______ **Colic:**
**Strangulating**
**\***Severe Unrelenting Pain is often Present
**Reflux:**
_Mild- Strangulating Large Intestinal Lesion_
_Severe- Strangulating Small Intestinal Lesion_
58
Technique that is Anecdotally Effective for Treatment of **Rhodococcus Equi,** but is mainly used in _Prevention_ of R. Equi in Foals
**R. Equi Hyperimmune Serum**
59
Pathophysiology associated with which Classification of **Pericarditis:**
_Initial Diastolic Filling is Unimpaired but when Critical Volume is reached expansion is Restricted and Filling Ceases Abruptly, Resulting in General Decrease in Preload and thus Cardiac Output_
_Sudden Cessation in Late Diastolic Filling with a Sudden Increase in Ventricular and Atrial Pressures_
**Constrictive**
_**\***Constrictive Pericarditis- In the Initial Phases of Filling, it will look like a Normal Heart, Until the walls of the Ventricle get to the Edges of the Pericardium. When the Ventricles exert Pressure on the Pericardium the Pressure will Skyrocket because the Pericardium is unable to Expand_
60
_You are Presented with a 6-yr-old Holsteiner Jumper Mare for the generation of a Noise in the show Ring_
## Footnote
**What is your Diagnosis?**
**Idiopathic Laryngeal Hemiplegia**
**\***_Left Laryngeal Hemiplegia_
61
**Physiologic Arrhythmia** Most typically Heard in the Horse
**Mobitz Type I Second Degree AV Block (Wenkenbach)**
62
_Upper Respiratory Tract_ Disease with **Nasal Discharge** Described Below:
**_Recurrent Unilateral Purulent Nasal Discharge_**
_Nasal Discharge Worsens when Head is Lowered_
**_Waxes and Wanes with Antimicrobial and Anti-Inflammatory use_**
_Dysphagia- Difficulty Breathing_
_Concretions of Desiccated Pus- **Chondroids**_
**Guttural Pouch Empyema**
_\*Two Airways Diseases where Nasal Discharge Worsens when the Horse Lowers its Head- Gutteral Pouch Empyema and Sinus Disease_
_\*Horse Presents with Purulent Nasal Discharge- Administer Antimicrobials and the Nasal Discharge Stops. Once you stop the Antimicrobials , a few days later the Purulent Nasal Discharge Returns (Waxes and Wanes). **Will not be able to Treat completely until you FLUSH the Guttural Pouch**_
63
_A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance_
## Footnote
**What is the Most Likely Diagnosis?**
**DDSP**
64
Four Patterns seen on Thoracic Radiograph that are very Supportive of a Diagnosis of **Rhodococcus Equi**
**Abscessation Pattern**
**Miliary Pattern**
**Broncho-Pneumonia Pattern**
**Intersitial Pattern**
_**\***Multiple Abscesses Pattern- Most Indicative of R. Equi_
_\*Pulmonary Abscessation and Miliary Pattern very Indicative of R. Equi and typically they are not seen with general Foal Pneumonia_
65
True/False: This Depicts a **Normal GIT Auscultation**
**True**
**\***_Impossible for there to be Motility on the Right Side of the Large Colon and not on the Left Side_
_\*Unless Total Absence of Motility in all Four Quadrants (Silent Abdomen), NO Conclusive Statement can be made of a Single Silent Quadrant_
66
Treatment for **Purpura Hemorrhagica**
**Corticosteroids (At least 7 Days)**
**Topical Therapy: Hydrotherapy (15-20min. Per Day), Bandages Sweat Wraps**
_**\***Possibly put on Antimicrobials- If the Horse has a Strep. Equi or Strep. Zooepidemicus Infection they will be put on Antibiotics_
67
In Horses with **Anemia of Chronic Disease,** the PCV is NEVER less than \_\_\_\_\_
**18-19%**
68
Three Typical _Complications_ associated with **Mitral Insufficiency**
**HEART FAILURE**
**Rupture of the Chordae Tendinae-** _Loud Honking Murmur_
**Rupture of Pulmonary Artery-** _Sudden Death_
69
In a Horse with **Strangulation Colic**, describe the Sequence of Changes that will be seen on Abdominal Fluid via _Abdominocentesis_
**Within 1 Hour: Increase in Protein**
**Within 3-4 Hours: Increase in RBC**
**Within 6 Hours: Increase in WBC**
_**\***Expectation: Strangulating Lesions will commonly present with Increased Protein, RBC, and WBC all to the same Degree at the same Time_
70
Common Placement for **Electrocardiography Leads** in Equine Patients
**Positive Lead- Left Thorax**
**Negative Lead- Right Jugular Furrow**
**Ground Lead- Any Point Remote from the Heart**
**\***_Most commonly used Lead is the Bipolar Lead: Base-Apex_
71
What Drug is used in the Treatment of **Babesiosis/Piroplasmosis**
**Imindocarb Dipropionate**
_\*Adverse Effects- Imidocarb Causes Cholinesterase Inhibition and can result in Diarrhea and Colic_
**_\*DEADLY in Donkeys_**
72
In Horses being Treated for **Atrial Fibrillation**, ______ is Highly Protein Bound and therefore can Displace Digoxin leading to an Increased Incidence of _Digoxin Toxicity_
**Quinidine**
73
Two _Anti-Inflammatory Agents_ used in Therapy for Horses with **Cough:**
**Mast Cell Stabilizers-** Inflammatory Airway Disease (IAD)
**Corticosteroids-** Recurrent Airway Disease (RAO)
74
History and Clinical Presentation for which **Lower Airway Disease:**
_Middle Aged or Older Afebrile Horse with Recurrent Seasonal Episodes of Expiratory Dyspnea/Distress_
**Recurrent Airway Obstruction (Heaves)**
_Afebrile = No Fever_
75
Two Causative Agents for **Babesiosis/Piroplasmosis**
**Babesia Caballi**
**Theleria Equi**
76
**_Classify this Colic_**
## Footnote
_**Nasogastric Intubation**- Little/No Reflux_
_**Severely Distended Abdomen**- Obvious External Flank Distension_
**Strangulating Large Colon**
**\***Explain why Strangulating Cecal Disease would be Incorrect- With Cecum Distension you may have Distended the Right Flank but there is No way you would have distended the abdomen as a Whole
77
For which **Airway Disease** will we see this on BAL?
**Recurrent Airway Obstruction**
78
Mainstay of Therapy In Horses with an Underlying _Bronchoconstriction_ Pathophysiology of **Recurrent Airway Obstruction (RAO)**
**Maximized Bronchodilators**
**Minimized Corticosteroids**
**\***_Ex. B2 Adrenergic Agonists and Anticholinesterases_
79
True/False: We can _Completely Eradicate_ **Theleria Equi (T. Equi)** with Treatment for Babesiosis
**False**
_**\***Cannot Completely Eradicate Theleria Equi from the Horses Body when Treating for Babesiosis_
80
How do we Check for Reflux in a Horse with **Colic**?
**Nasogastric Tube**
_**\***Horses cannot Vomit, if you do not place a Nasogastric Tube the Horse is at risk of Rupturing its Stomach (Fatal)_
_\*Usually in Horses with any Significant Colic, we are putting and Leaving a Nasogastric Tube in the Horse. **Should be First Procedure attempted when Evaluating a Horse with Colic**_
81
Horse with **Atrial Fibrillation**, That Resolves on its own/Only Occurs during Racing. You have done a _Physical Exam, which Shows signs of Cardiovascular Compromise_. You then assess the Heart Rate and the Heart Rate is Greater than 60 bpm. You continue an evaluation and Perform and Echocardiogram. The Echocardiogram is Abnormal. _With a Heart Rate \> 60 bpm and an Abnormal Echocardiogram. What is the Treatment in this Animal?_
**First Dixogin**
**Followed by Quinidine**
_**\***If HR \> 60 AND Underlying Heart Disease- Treat for Heart Disease with Digoxin. Conversion of these Cases with Quinidine is Highly Unlikely and would be very Case Dependent_
82
**_Classify the Colic_**
**Strangulating Small Intestine**
83
Complication of **Strangles** described Below:
**_Thoracic/Abdominal Abscesses_**
_Systemic Manifestation of Strangles_
_**Metastasis to Lymph Nodes throughout the Body**- Typically Involves the Abdomen_
**Bastard Strangles**
84
Technique used in Treatment of **DDSP** Described below:
_Commonly uses Nylon Stalkings (Pantyhose)_
_**Prevents Caudal Retraction of the Larynx**- Increases the contact Surface of the Palate and Epiglottis_
**Tongue Tie**
_**\***If you are tying the Tongue Forward then you are Conterbalancing the Caudal Retraction of the Larynx_
85
Describe Typical Horse Behavoir in _Mild, Moderate, and Severe_ Pain due to **Colic**
**Mild**
_Playing in Water, Looking at Flanks_
_Pawing Occasionally_
**Moderate**
_Kicking Abdomen with Hind Limbs_
_Frequent and Purposeful Pawing_
_Getting Up and Down_
**Severe**
_Rolling and Thrashing_
_Up and Down Constantly_
86
Typical Abdominocentesis Findings for _____ **Colic:**
_Increase In Total Protein, WBC, and RBC at the Same Time to the Same Degree_
**Strangulating**
87
In a Horse with **Non Strangulation Colic**, describe the Sequence of Changes that will be seen on Abdominal Fluid via _Abdominocentesis_
**First: Increase in Protein**
**Second: Increase in WBC**
**Third: Increase in RBC**
**\***This is the Presentation Expected in a _Non-Strangulating Lesion_
88
If a Horse is Manifesting **Second Degree AV Block**, what can you do in order to determine if the Block is Purely _Physiologic_?
**Jog the Horse**
_**\***Second Degree AV Blocks are a Manifestation of High Vagal Tone. Generally Physiologic thus resolves with Increased Sympathetic Tone- JOGGING Horse_
89
True/False: **Hyperkalemic Periodic Paralysis** is commonly seen in _Exercising Horses_
**False**
_**\*HYPP is Atypical to see with Exercise-** Tends only to occur when the Horse is at Rest_
90
Which **Upper Respiratory Tract Infection** can cause _Retropharyngeal Abscesses_ in Horses?
**Strangles**
_**\***Infection of Retropharyngeal Lymph Nodes- Can lead to Respiratory Distress and Rutpure of Lymph Nodes into Guttural Pouch (Guttural Pouch Empyema)_
_In Order to see the Retropharyngeal Lymph Nodes affected you will most likely have to do a Radiograph_
91
Diagnosis Based on these ECG's
**Multifocal Ventricular Tachycardia**
_4 Or More Ventricular Premature Contractions (VPC's) are Diagnostic for Ventricular Tachycardia_
**\***We don't Necessarily treat the VPC's per say. We treat the Underlying Condition- Toxemia, Electrolyte Abnormality ect.
92
Diagnosis based on this Endoscopic View
**Pharyngitis**
_**\***Pharyngitis- Lumps and Bumps all over (Inflammation)_
\*This is the type of Airway that we may see Associated with DDSP- Caused by Upper Airway Disease (Pharyngitis)
93
Pathogenesis of which **Lower Airway Disease** in Horses:
_Immune Mediated Disease_
_**Allergic Disease**- **Inhalation of Molds, Notably Faenia Rectivirgula aerosoloized from Hay and Bedding**_
_Inhalation of Endotoxins_
_Hereditary Predisposition_
**Recurrent Airway Obstruction**
94
Clinical Signs seen with which **Viral Respiratory Disease**:
**_Acute COUGH_**
**_Purpura Hemorrhagica_**_- Immune Mediated Vasculitis_
_Myalgia- Pain in Muscles_
_Arthralgia- Pain in Joints_
**_Myocarditis- Arrhythmias_**
**Equine Influenza (Flu)**
_**\***Horses with Equine Influenza have MORE COUGHING than in Horses with Herpes or EVA_
_\*Example- If you enter a Barn Facility and there a several Horses Coughing at the same time (Lots of Coughing), Equine Influenza (Flu) should be at the top of your list_
_\*Possible for some Flu Horses to Manifest Arrhythmias_
_Purpura Hemorrhagica in cases of Equine Influenza can also lead to Edema_
95
Two most Common Organisms leading to **General Pneumonia** (Lower Respiratory Tract Disease) in Horses
**Streptococcus Zooepidemicus**
**Actinobacillus Equuli**
_**\***Strep. Zooepidemicus- Treated with Penicillin_
_Strep Zooepidemicus and Actinobacillus Equuli- Treated with Penicillin and Trimethoprim Sulfa (TMS)_
_\*Anti-inflammatory used for Treatment- Flunixin Meglumine_
96
Pathophysiology of which **Lower Respiratory Disease** in Horses:
**_Diseaes of YOUNG Horses- Mean Age 2-4 Months_**
_Soil Organism_
_Opportunistic- **Role of Immunosuppression**_
**_Certain Strains are Pathogenic- Carry Plasmid which allows it to Escape Destruction after Phagocytosis_**
**Rhodococcus Equi**
_\*Adults and Foals greater than 6 Months of age DO NOT get this Disease- Seem to be Protected_
_\*Disease Causing Strain carries a PLASMID, which makes it more Resistant to Destruction_
_\*Although the Foal Manifests Disease at several Months of Age, they Acquire the Disease within the First Week of Life_
97
Horses with **Hyperkalemic Periodic Paralysis** are Identified according to their genome as _NN = Normal_, _HN = Carriers (Heterozygote)_, which are affected but to a lesser extent than the _Homozygotes_, denoted as \_\_\_\_\_
**HH**
_**\***Both HH and HN Horses are Affected_
**_\*HH (Homozygote)- Expected to Start Episodes at a Younger age, usually will have more Severe Episodes and are more likely to have Episodes that are associated with Clinical signs such as Acute Respiratory Distress_**
**_HN (Heterozygote)- Show Clinical Signs after 1 year of age and are NOT likely to have acute distress type Episodes_**
98
**Severe Pain**
_**\***Facial and Head Abrasions- When horses begin getting Abrasions it is because they are very violently Thrashing. Just by virtue of these Injuries you know they are very severly painful_
99
Which Causes of **Anemia** cause an _Intravascular Hemolysis versus an Extravascular Hemolysis_
**Extravascular Hemolysis- Equine Infectious Anemia, Babesia Caballi**
**Intravascular Hemolysis- Babesia Equi (aka Theleria Equi)**
_**\***Intravascular Hemolysis more Typical of Theleria Equi Infection but RARELY in Babesia Caballi Infections_
100
Mechanisms for **Anemia** in which Disease:
_Immune-Mediated Hemolysis- **INDIRECT HEMOLYSIS**_
_Decreased Intravascular Erythrocyte Survival Time_
_Decreased Bone Marrow Erythrocyte Production_
**Equine Infectious Anemia**
_**\***The Infection is NOT Infecting the Red Blood Cells. The Anemia is associated with Immune-Mediated Hemolysis. INDIRECT Mechanism of Action_
101
**Review Card**
102
Diagnosis based on this Lung
**Rhodococcus Equi**
_\*Significant Infiltration of Abscesses within the Lung Fields_
103
_A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance_
## Footnote
**What is the Diagnosis?**
**DDSP**
104
Important Structures found in the _Left Dorsal Quadrant_ on **Transrectal Palpation**
**Spleen**
**Caudal 1/3rd of Kidney**
**Nephrosplenic Ligament**
105
Breed Predisposition in Horses with **Hyperkalemic Periodic Paralysis (HYPP)**
**Heavily Muscled Quarter Horses**
_\*WITH Large Muscle Masses- Heavily MUSCLED Quaterhorses_
106
**4**
_**\*"**Four on the Floor"_
_\*One of these Bands is not Palpable: Mesenteric Band is in between the Two components of the Colon. You cannot feel the Mesenteric Band of the Ventral Colon_
107
_A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance_
## Footnote
**Which of the Following is NOT a Recommended Treatment for this Horse?**
**Tie-Back**
_**\***Diagnosis: DDSP- Tie Back has no place in the Treatment in this Horse. Tie Back is a Treatment option for Horses with Idiopathic Laryngeal Hemiplegia_
108
Horse is in **Dorsal Recumbancy**. Which Two Pathologies are Most Likely?
**"Cast" in Stall** (Stuck in Stall)
**Gastric Ulcers (Most Common)!**
**\***Horses with Gastric Ulcers will adopt this position because it makes them more comfortable- _Dorsal Recumbancy or Dog Sitting Position_
109
True/False: As you are Moving Further Down (Aborally) the Gastrointestinal Tract, you should have Less and Less Expectation for Reflux
**True**
_**\***If the Obstruction is anywhere past the Large Colon, you don't have an expectation for Reflux in those cases_
**_\*HOWEVER, as you are moving through the Small Intestine (Aborally) the Reflux Volume is Expected to Increase. As you go more distally in the Small Intestine you have an expectation for Greater and Greater amounts of Reflux_**
110
In Order to Prevent Foals from Developing **Rhodoccocus Equi**, we Treat Foals _within First Week of Life_ with \_\_\_\_\_\_
**R. Equi Hyperimmune Serum**
**\***Has been shown to greatly reduce the number of foals Effected or the Severity of the Disease
111
During **Transrectal Palpation**, _Fixed Structure_ attached to the _Right Dorsal Abdominal Wall_ by a very short Mesentery
**Cecum**
112
Clinical Signs for which **Lower Respiratory Disease** in Horses:
**_Significant Dyspnea: marked Crackles, Wheezes and Cough_**
_Fever, Anorexia and Depression_
_**Mesenteric Lymphnode Involvment**- Diarrhea and Abdominal Abscessation_
_\*\*\***Polysynovitis- Effusion of Multiple Joints**_
_**Osteomyelitis** and Septic Physitis- Vertebrae and Long Bones_
**Rhodococcus Equi**
_\*Normal Presenting Complaint- Foal seemed Fine until the last day or so, when the Foal developed obvious Respiratory Disease_
_\*Rhodococcus Equi is a very Particular Type of Pneumonia in the Foal_
113
**Gut Wall Compromise**
114
Surgical Treatment of **Dorsal Displacement of Soft Palate**
**Laryngeal Tie-Forward**
**\***_Most Recent of Surgeries with Good Success_
115
_Coggins Test_, used for Diagnosis of **Equine Infectious Anemia**, can take up to ___ days to Produce Detectable Levels of Antibody
**45**
_**\***If Suspected Disease and Coggins is Negative (_
116
**Which of the Following best Represents Expected Reflux?**
A. Large Volume, Acidic
B. Large Volume, Alkaline
C. Small Volume, Acidic
D. Small Volume, Alkaline
**B. Large Volume, Alkaline** (Strangulating Small Intestine)
_\*2-4 Liters = Small Volume (Gastric, Large Intestine)_
_10-13 Liters = Large Volume (Small Intestine)_
_\*At What point do we consider Reflux Significant? Greater than 2 Liters. If you are getting Reflux less than 2 Liters it is not Considered Clinically Significant_
117
**B. Prophylactic Antibiotics for Close Contact**
118
When Placing a _Nasogastric Tube_ in a Horse with **Colic**, we always ____ the Tube with Water, which Creates the Siphoning Action, as Fluid Rarely Exits the Tube Spontaneously
**Prime**
_**\***Always Prime the Tube. If not Primed the Fluid will not Run out the Tube_
119
#1 Organism in the Equine Patient leading to _**Generic Pneumonia** and **Bacterial Pneumonia secondary to Viral Respiratory Disease or Reccurent Airway Obstruction (RAO)**_ is \_\_\_\_\_\_\_
**Strep Zooepidemicus**
_Treatment for Strep Zooepidemicus- Penicilin Alone (Generally 5-7 Days)_
_Treatment for Strep Zooepidemicus and Actinobacillus- Pencillin and Trimethoprim Sulfa (TMS)_
**_\*Strep Zooepidemicus and Actiobacillus are the Number One Organisms that we will see affecting the Respiratory Tract of the Horse_**
120
What does the **pH of the Reflux** tell us about the Location of Obstruction?
**pH**
**pH 6-7 : Typically Gastric**
**pH \> 7 : Reflux from the SMALL INTESTINE**
121
**_Classify this Colic_**
_**Nasogastric Reflux-** None_
_**Rectal**- Very Firm Slightly Indentable Structure in Left Ventral Quadrant. Filled Structure coming across Pelvic Inlet_
**Non-Strangulating Large Intestine**
122
**Muscle Enzyme** Described Below:
_Not Muscle Specific_
_**Tends to Increase More Slowly** (Peak in 12-24 Hours)_
**_Longer Half Life- Remains Elevated Longer (Can take 2 weeks to retrun to Normal Levels)_**
**AST**
123
Treatment for **Hyperkalemic Periodic Paralysis (HYPP)**
**Breeding Managment-** want to Eliminate Disease from Gene Pool
**During Hyperkalemic Episode- Administer IV Calcium Gluconate and Dextrose Drip**
**Managment Changes- Dietary: Avoid High Potassium Feeds _(Most Notably Alfalfa),_** Exercise Regularly, Avoid Fasting
_**\***Dextrose Drip- Enhances Intracellular Movement of Potassium_
124
Treatment for Horses with **Valvular Endocarditis**
**Antimicrobials (IV Penicillin and Gentamycin)- Minimum of 4-6 Weeks** (Risk of Relapse High if Discontinued too Early)
**Antiinflammatories- Flunixin Meglumine and ASPIRIN (QOD)**
_**\***Mainstay of Therapy is Antimicrobial Treatment- IV Protocol with Penicillin and Gentamycin_
_\*Very Important to use ASPIRIN- Decreases Platelet Aggregation and Minimizes the Growth of the Lesion. Aspirin is Given Once Every Other Day (QOD)_
125
Disease also known as "Swamp Fever" that is a **REPORTABLE Disease** in Horses
**Equine Infectious Anemia**
126
Diagnosis based on this Endoscopy
**Left Laryngeal Hemiplegia**
**\***Whats on the Right of your image, is on the Left of your Horse
_On Exam- Find anything with a straight edge and line it up with your image. Bisect the larynx going from the top of the larynx where the two aryetnoids join, straight down. You will Notice that one space is smaller than the other- tells you which side is effected (smaller space)_
127
Term used to Describe **"Noisy Breathing"**
**Stridor**
_\*Audible Noise during Breathing_
**\***Respiratory Noise may or may not be associated with Respiratory Distress
128
_Non Invasive Treatments_ for **Dorsal Displacement of Soft Palate (DDSP)**
**TSD**- **Throat Support Device** (Cornell DDSP Collar): Holds Larynx in Place such that Displacement does not occur. _Positions Larynx Rostral and Dorsally_
**Tongue Tie**
**Change Poll Flexion-** If Horses are "Checked" or "Collected", tell Owners to do it less and see if that Resolves the Problem
**Treat Other Respiratory Conditions**
_\*Before you Decide on Treatment, you need to make sure there are no Other Lower or Upper Respiratory Diseases. If you find Respiratory Disease, then Treat it prior to Treating DDSP_
129
Etiology of **Anemia** caused by _Increased Red Cell Destruction_ Described Below:
_Clinical Signs: **Hemolytic Anemia**, Fever, Icterus_
_Clinically Recovered Horses Become Infected **Asymptomatic Carriers** where Stress may Precipitate Relapse_
_Soure of Infection: Primarily **Tick Vectors (Dermacentor Nitans)**_
**Babesiosis/Piroplasmosis**
130
Most Common **Pathologic Arrhythmia** of the Horse
**Atrial Fibrillation**
\*Irregularly Irregular"
_\*#1 Pathologic Arrhythmia in Horses_
131
Three Recommendations for Horses that Test Positive for **Equine Infectious Anemia** on Coggins Test
**Euthanasia (Most Recommended)**
**Donate to Apporved Research Facility**
**Permanent Quarantine-** Isolate for LIFE
_\*If the Horse is Transferred of the Facility they must be Tattoed with an "A" on their Neck or Shoulder- Identifying them as an EIA Positive Animal_
132
Clinical Signs of which **Lower Respiratory Disease** of Horses:
_Fever (Febrile)_
_Respiratory Disease- Nasal Discharge_
_Anorexia/Weight Loss_
**_Pectoral Edema_**
**Pleuropneumonia**
_**\***Horse Following Long Distance Transport- Horse gets off and seems normal but within 24-48 Hours is ADR (Ain't Doing Right), Two Major Differentials: Pleuropneumonia, or GI Disease_
133
Diagnosis based on this Endoscopic View
**Dorsally Displaced Soft Palate**
**\***We do not see the edge of the Epiglottis, the Scalloped Edges or the Vasculature
_Ask yourself this question on every one of these- If you follow the wall down to the floor is it one continuous Structure that is Obliterating your view of the Epiglottis? If Yes, then it must be DDSP_
134
Predominant Cell Type found on BAL or TTW of Horse with **Recurrent Airway Obstruction**
**Neutrophils (\> 20% of Total Cell Count)**
135
Normal Look for **Electrocardiography (ECG)** in an Equine Patient
**Notched (Biphasic) P Wave**
**Negative QRS** (Interventricular Septum Depolarization)
**Large T Wave**
136
Clinical Signs of which **Lower Airway Disease** in Horses:
**_Seasonal and Episodic Dyspnea-_** _Mostly_ _Fall and Winter when Housed in a Barn_
**_CHRONIC COUGH_**
**_Flared Nostrils_**
_Typically Afebrile (No Fever)_
**_Heave Line-_** _Hypertrophy of External Abdominal Oblique_
**Recurrent Airway Obstruction**
_**\*Seasonal- Housing in a Barn:** Clinical Signs are Typically Associated with Confinement Housing, Feeding Hay, Bedding with Straw and Storage of Forages over Stalls_
_Classic RAO horse will have Dyspnea in Fall and Winter when it is Housed within a Barn_
137
**Aortic Insufficiency** is typically an ______ Finding in Older Horses leading to _Pathologic Murmur_
**Incidental**
138
Clinical Signs associated with which **Pathological Murmur:**
_Mild: Exercise Intolerance_
**_Signs of Congestive Heart Failure- Sudden Death, Jugular Vein Distension, Respiratory Distress, Subcutaneous Edema_**
**_Spontaneous Rupture of Chordea Tendinae- Very Loud Honking Murmur_**
**_The Most Likely Valvular Dysfunction that will Lead to Heart Failure in Equine Patient!!_**
_Dependent on Severity of Valvular Dysfunction and Horses Function (Competing, Riding, Back yard Horse)_
**Mitral Insufficiency**
_**\***Most Likely Valvular Dysfunction that will lead to Heart Failure in Horses!!!!- Mitral Insufficiency_
_\*Severe Damage of Valves can Result in Spontaneous Rupture of Chordae Tendinae_
139
Very Specific _Genetically Based Diseases_ that predispose to **Exertional Myopathy/Rhabdomyolysis**
**Polysaccharide Storage Myopathy (PSSM)**- _Quater Horses, Draft Horses_
**Recurrent Exertional Rhabdomyolysis (RER)**- _Thoroughbreds_
_\*Underlying Genetic Defects that predisposes to the Development of Exertional Myopathies_
140
**Review Card: Reflux Expectations**
_Gastric Lesions: Small Volume, Acidic pH (6-7)_
_Small Intestinal Lesions: Large Volume, Alkaline pH ( \> 7)_
**Examples:**
## Footnote
**Horse with a Large Colon Impaction. Nasal Gastric Tube placed which results in a Small Volume of Reflux of a 6.8 pH Fluid.** How do we Reconcile this Reflux in view of the Lesion? _Large Colon comes right behind the Stomach as it curves. As the Large Colon gets Distended it will compress the stomach in the Pyloric Area and Therefore create a Gastric Outflow Obstruction. Results in Small Volumes of Reflux that is compatible with Fluid coming from the Stomach_
**Strangulating Obstruction in the Mid Small Colon. The horse presents to you with Colic. You Place a NG Tube and get a Large Volume of Alkaline Reflux.** How do we Reconcile that Reflux with that Location of Lesion? _Bad lesions that have been there for a While the Horse may develop a Global/Generalized Ileus. Now the Ileus is affecting the Small intestine leading to the Fluid accumulation_
141
Diagnosis based on this Endoscopic View
**Inflammatory Airway Disease**
_\*Mucopurulent Exudate (Mucous Trail) in Tracheobronchial Tree_
142
Three Head Positions associated with **Dorsal Displacement of Soft Palate (DDSP)**
**Collecting-** Pulling Horse in
**Holding Back**
**Checked** (Standardbred Horses)
**\***Client will say: "He makes a Noise when I Collect him for the Jump"
\*Check: Strap that hooks the Poll of the Head to the Withers. Prevents the Horse from Extending its head and Neck
143
Clinical Signs seen with Which **Viral Respiratory Disease:**
_Cough_
**_Abortions_**
_Bleeding Problems_
**_Periorbital Edema!!_**
**_Edema_**
**Equine Viral Arteritis (EVA)**
_**\***EVA Horses will very Likely have EDEMA_
_\*Respiratory Disease in a Horse and you Notice Periorbital Edema = Equine Viral Arteritis_
144
Recommended Protocoal in DISTRESSED Horses with **Severe Recurrent Airway Obstruction**
**Inhalant Bronchodilator**
**Systemic (Injectable) Steroids**
_**\***Inhalant Bronchodiltors with Injectable Steroids- Only used Protocol in Horses with Severe Recurrent Airway Obstruction (RAO)_
145
Horse with **Atrial Fibrillation,** That Resolves on its own/Only Occurs during Racing. You have done a Physical Exam, which is Normal. You then assess the Heart Rate and the Heart Rate is Less than 60 bpm. You continue an evaluation and Perform and Echocardiogram. The Echocardiogram is Normal. _With a Heart Rate_
**Quinidine**
_**\***Administer Quinidine to Correct its Arrhythmia. In a Horse with a Heart Rate_
_If HR_
146
Diagnoses based on this ECG
**Atrial Fibrillation**
_**\***Irregular Baseline associated with a irregular Contractions through the Atria- F Waves_
_\*Baseline Fibrillation waves are called "F Waves" . F Waves can be Described as Coarse (Large) or Fine (Small)_
147
Clinical Signs associated with which Condition in the Horse:
_**Exercise Intolerance**: Due to Functional Obstruction (Temporary Suffication) at High Speed_
_Speed Slowed Dramatically during Racing- **Quitting**_
_**Noise Generated by air turbulence** in Inspiration and **EXPIRATION**_
_Choking Noise- Loud Gurgling or Fluttering Noise_
_Coughing when Eating_
**_Puffing of Cheeks_**
**Intermittent Dorsally Displaced Soft Palate**
\*_Mostly Expiration Component_
_\*Do we see a Noise at Rest in these Animals? NO!- You see nothing in these Horses at Rest_
_Puffing of Cheeks- Horses are Obligate Nasal Breathers so they should never have air going into or coming out of mouth- Soft Palate must not be in correct position_
148
_A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance_
**Which of the Following is Removed from your Differential List?**
A. Epiglottic Entrapment
B. Laryngeal Hemiplegia
C. DDSP
D. Idiopathic Laryngeal Hemiplegia
**Epiglottic Entrapment**
_**\***Epiglottic Entrapment- Not Dynamic. Disease will also be Present at Rest_
\*Nothing Abnormal about Endoscopy except some Pharyngitis
149
**Genetic Rhabdomyolysis** Described Below:
_Autosomal Dominant- **Glycogen Synthase 1 Gene Point Mutation**_
_Increased Clearance of Glucose in Circulation_
**_Accumulation of Glycogen and Abnormal Polysaccharides in Muscle Cells_**
_Predisposition- **Quaterhorses and Drafts**_
**Polysaccharide Storage Myopathy (PSSM)**
150
_Risk Factors_ associated with which **Lower Respiratory Disease** in Horses:
**_1. LONG DISTANCE TRAVEL (\> 2 Hours)_**
_2. Exposure to Viral Respiratory Disease Pathogens_
**_3. Eating while Trailering especially with Head Tied_**
**Pleuropneumonia**
_\*Reduced Pulmonary Defenses with Greater than 2 Hours of Transport. Results in Decreased Mucociliary Function and Decreased Phagocytic Ability of Macrophages_
_\*Eating while Trailering- Chronic Aspiration of Feed Material leading to Abscessation. Pleuropneumonia occurs when these Abscesses Rupture_
151
What is Pictured Below in this case of **Guttural Pouch Empyema**
**Chondroids**
_**\***Desiccated, Inspissated Pus_
152
Diagnosis based on this Endoscopic View
**Epiglottic Entrapment**
**\***Normal Epiglottis should have "tongue like" appearance with scalloped edges coming to a point
_In this View, we do not see any vasculature or Scalloped Edges_
153
**_Classify the Colic_**
**Strangulating Small Intestine**
_\*KNOW the Normal Values for TP, WBC, and RBC_
154
**Anemia of Chronic Disease**, the _Most common Cause of Anemia in the Horse_, Primarily Results in _____ from Circulation into Storage Forms which become Unavailable for Erythropoiesis
**Iron Sequestration**
_**\***Functional Iron Deficiency- Not Technically Deficient in Iron. The Animal has all the Iron it needs, its just not easily accessable_
_\*Iron is Taken out of the Readily Available Pool and put into the Storage Pool- Leading to Functional Iron Deficiency_
155
Which of the Following is False about **Equine Infectious Anemia:**
A. REPORTABLE
B. Negative Coggins Required for all Interstate or International Travel
C. Regulations Governing Foal and Young Horse Testing are Variable
D. Horses that are Found to be Positive: Euthanasia is Recommended
**All of the Above are True**
156
Two Treatments for **Epiglottic Entrapment**
**Conservative- Can Correct Spontaneously through Stall Rested 1 week and local/topical Anti-Inflammatory Administration**
**Surgery- Transendoscopic Laser Correction (Preferred Method)**
_**\***Difference between DDSP and Epiglottic Entrapment- DDSP is Intermittent, while Epiglottic Entrapment is Continuous (It doesn't come and go)_
157
Clinical Signs of which **Pathologic Arrhythmia** in Horses:
_**Exercise Intolerance: Quitting at the 3/4 Post**, Racing Poorly_
_Dependent on Underlying Cause: EIPH, Myopathy, Collapse, CHF_
**Atrial Fibrillation**
_\*Common Presenting Complaint: Quitting at 3/4 Post_
158
What Segments can be Palpated Normally on **Transrectal Palpation**?
**Base of Cecum**
**Inguinal Rings**
**Bladder/Reproductive Segments**
**Pelvic Flexure**
**Spleen, Nephrosplenic Ligament**
**Caudal 1/3 of Left Kidney**
**Small Colon with Fecal Balls**
_\*Cannot Palpate Small Intestine unless Abnormal (Distended)_
_\*Do not Feel all Bands of each Banded Structure as you cannot easily palpate entire Circumfrence of GIT Segment_
159
Type _____ **Inflammatory Airway Disease (IAD)** is Described Below on BAL:
## Footnote
**_Eosinophilic Inflammation: \> 3% of Total Cell Count in BAL_**
**_Respond Best to Corticosteroids_**
**Type 3 IAD**
_**\***Eosinophils- Underlying Cause most likely Parasitic_
_\*Corticosteroids- Helpful Especially if Eosinophilic Inflammation_
160
Treatment for **Recurrent Airway Obstruction** when _NO Clinical Signs are seen_
**Preventative Therapy: keep OUTSIDE at all times**
**Soak Hay**
_**\***In Horses with "Summer Pasture associated RAO" caused by Molds Growing on Pastures, respond best to Stall Confinement. So In order to Treat these Horses you would keep them Indoors and Cut Feed_
161
Two possible Causes of _Respiratory DISTRESS (Dyspnea)_ in Horses with **Strangles**
**Retropharyngeal Lymph Node Enlargement**
**Purpura of the Upper Airway (Pharyngeal Collapse)**
\*Retropharygneal Lymph Nodes are sitting on the Ventrum of the Guttural Pouch. If these Lymph Nodes Enlarge, they are going to End up Enlarging into the Nasalpharynx- _Retropharyngeal Lymph Node Enlargement Results in Edema and Compression of Upper Airway (Nasopharynx)_
**_In Horses with Retropharyngeal Lymph Node Enlargment, they Either Manifest as Respiratory Distress or Guttural Pouch Empyema._** Infection of Retropharyngeal Lymph Nodes_- Can lead to Respiratory Distress and Rutpure of Lymph Nodes into Guttural Pouch = Guttural Pouch Empyema_
_Purpura Hemorrhagica- Immune Mediated Vasculitis. These Horses can Develop a Purpura that is Limited to the Upper Airway leading to Pharyngeal Collapse_
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Signalment and History associated with which **Valvular Dysfunction:**
_Age- Most Common in **OLDER Horses**_
_Often Incidental FInding on Clinical Exam- Usually Asymptomatic_
**_Diastolic Mumur_**
**Aortic Insufficiency**
_**\***Aortic Insufficiency is Classically and Incidental Finding seen in an Older Horse_
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Treatment for **Guttural Pouch Empyema**
**Antimicrobials- usually Penicillin**
**Repeated Guttural Pouch Flushing with Endoscopic Reevaluation- with Saline or LRS**
**Surgery- Necessary if Chondroids**
**\***_Without Direct Treatment of Pouch- Usually results in Relapse. Must Flush Guttural Pouch_
_\*Retention Catheter- Used for Daily/Repeated Flushing_
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Type _____ **Inflammatory Airway Disease (IAD)** is Described Below on BAL:
## Footnote
**_5-20% Neutrophils_**
**_Respond BEST to Alpha-Interferon_**
**Type 1 IAD**
_**\***Normally you should have Less than 5% Neutrophils in a BAL_
_\*Type I Inflammatory Airway Disease- These are the Cases where the Horses are More likely to Present with a Cough. Cough is More Associated with Type 1 IAD, than with the Other Types_
_Alpha Interferon- Antiviral Immunomodulator- Given Orally as 5 Day Therapy_
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Treatment for _Long Term Managment_ of **Exertional Myopathies/Rhabdomyolysis**
**Dietary Managment:**
_Low Carbohydrate Diet, **HIGH FAT Diet (RICE BRAN)**_
_\*This Amount of Fat is 2.5-3 times the Typical Horses Diet_
\*3-6 Months of New Diet necessary for Adequate control of Muscle Injury
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Etiology of which Airway Disease leading to **Cough:**
_Irritants of the Airway combine to Result in the Initiation, Exacerbation and or Propagation of Airway Inflammation_
**Inflammatory Airway Disease (IAD)**
_**\***Hypersensitivity of the Airway_
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**Belgians** (Draft)**, Ponies and Percherons** (Draft)
**_\*Drafts and Ponies- Less Pain Sensitive/Expressive_**
_\*In General some consider Arabians more Pain Sensitive/Expressive_
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Horse with **Atrial Fibrillation**, That Resolves on its own/Only Occurs during Racing. You have done a Physical Exam, which is Normal. You then assess the Heart Rate and the Heart Rate is Greater than 60 bpm. You continue an evaluation and Perform and Echocardiogram. The Echocardiogram is Normal. _With a Heart Rate \> 60 bpm and a Normal Echocardiogram. What is the Treatment in this Animal?_
**Administer Digoxin First**
**Then Quinidine**
_**\***Quinidine is Tachyarrythmogenic: You must Slow Heart Rate Down first with Digoxin prior to Administering Quinidine, or else the Horse will be at Risk of Developing Life Threatening Arrhythmias_
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Number One Complication in **Rhabdomyolysis/Exertional Myopathy** Horse
**Acute Renal Failure**
170
Most Important _Diagnostic Technique_ used for **Inflammatory Airway Disease (IAD)**
**BAL (Bronchoalveolar Lavage)**
**\***_Reveals the Specific Cell Type and Cell Counts- Helps Determine the Appropriate Therapy_
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Injections given to Horses that Results in Significant **Non-Regenerative Anemia**
**Erythropoeitin Injections**
_**\***Leads to Development of Antibodies with Cross React with Horses own Erythropoietin thus leading to Life-Threatening Anemias_
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**What is the Likely Diagnosis for the Noise Heard in this Mare?**
**Epiglottic Entrapment**
**\***Main Differentials should be: Epiglottic Entrapment and DDSP
_\*Based on the Noise we should be Eliminating Laryngeal Hemiplegia- Would have Inspiratory Noise ONLY_
_\*Since it Stated there was an Inspiratory and Expiratory Noise, without saying the Expiratory Phase was more Prominent, it leaves us more to assume it is Epiglottic Entrapment_
_While the Stridor is Intermittent, that does not mean the Disease is Intermittent_
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**Genetic Rhabdomyolysis** Described Below:
**_Inherited Disorder in 5% Thoroughbreds_**
_Common Age: 2-4 Years Old_
_**Young Fillies with Nervous Temperaments** Particularly Prone_
**_Heritable Stress- Related Defect in Intracellular Calcium Regulation!!!!_**
**Recurrent Exertional Rhabdomyolysis (RER)**
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Clinical Signs of which **Upper Respiratory Disease** in Horses:
_Acute Onset_
_Fever/Lethargy/Cough_
**_Nasal Discharge- Yellow/Green and Purulent_**
**_Swelling and Draining of Submandibular Lymph Nodes_**
**_Infection of Retropharyngeal Lymph Nodes-_** _Respiratory Distress_
_Usually **Young Horses**- Considered "Childhood" Disease_
**Strangles**
_High Morbidity Rate (100%)_
_Low Mortality Rate (2%)_
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Recommendations for _Permanent Quarantine_ in a Horse Positive for **Equine Infectious Anemia (EIA)**
**Barn- _Double Screening_, Insect (Vector) Control**
**Kept a _Minimum of 200 yards (Meters)_ from Closest Horse**
**Disinfect all Instruments used on Affected Horses**
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Review of Treatment for **Atrial Fibrillation** based on Heart Rate:
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Two Agents that Cause **Guttural Pouch Empyema**
**Steptococcus Equi Var Zooepidemicus** (Most Common)
**Streptococcus Equi Var Equi** (Very Infectious)
_**\***Strep. Zooepidemicus is part of the Normal Flora of the Equine Skin and Respiratory Tract- Opportunistic Organism. Becomes Pathogenic in the face of Compromise_
_Strep. Equi- Causative Agent of Strangles_
**_\*Guttural Pouch Empyema is often a Sequelae to Streptococcus Equi Infections- STRANGLES_**
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_A 3-yr-old Throughoubred Gelding is Presented with a History of Exercise Intolerance noted in the Last Two Races. The Horse is Noted to make a Respiratory Noise at the Time of the Intolerance_
## Footnote
**What is your Diagnosis?**
**Epiglottic Entrapment**
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Which Grade of **Laryngeal Hemiplegia** requires a _Treadmill_ for its complete Evaluation?
**Grade III**
**\***If you take Two Grade III Horses and put them on a Treadmill, the Degree of Abduction can be completely Different. Use a Treadmill to Evaluate Degree of Incomplete Abduction
180
Treatment for **Viral Respiratory Diseases (EHV, EVA, and Equine Influenza)**
**Do Not Treat!!**
**Rest- General Rule: 1 Week of Rest for Every day Horse is Febrile** (Ex. Febrile 3 Days = 3 weeks of Rest)
**Decrease Respiratory Stress and Challenge**- Improve Ventilation and Decrease Dust Inhalation
**NSAIDs- Only Indicated if Temperature is VERY Elevated (104-104.5): Flunixin Meglumine**
**Antibiotics-** _ONLY if Secondary Bacterial Infection_
181
Review Card: **Comparison of Anemia of Chronic Disease (AKA Functional Iron Deficiency) versus True Iron Deficiency**
_**\***True Iron Deficiency-_ Total Body Reduction in Iron
_Anemia of Chronic Disease (Functional Iron Deficiency)-_ Not Technically Deficient in Iron. The Animal has all the Iron it needs, its just not easily accessable
**True Iron Deficiency:**
_Decreases in Marrow Stores and Serum Iron_
_Increased Total Iron Binding Capacity (TIBC) = Capacity to Bind more Iron_ (Body wants to Pull in more Iron)
**Anemia of Chronic Disease:**
_Decreased Total Iron Binding Capacity (TIBC)_
_Increased Serum Ferritin and Marrow Iron Stores- Iron Sequestration_
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Typical Abdominocentesis Findings for _____ **Colic:**
**Non Strangulating**
**\***Should basically have No Changes with Non Strangulating Lesions. However, if it has been going on for a while or Worsening: _First you would have Increase in Protein, then an Increase in WBC, then Increase in RBC_
183
True/False: We can _Completely Eradicate_ **Babesia Caballi** with Treatment for Babesiosis
**True**
_**\***We can Completely Eradicate the Babesia Caballi Organism_
**_\*You can Completely Clear Babesia Caballi, but You CANNOT Completely Clear Theleria Equi_**
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What would you expect to hear on Auscultation of a Horse with **Pleuropneumonia**
**Absence of Lung Sounds Ventrally**
**Clear Lung Sounds Audible Dorsally**
**Louder Cardiac Auscultation that Radiates**
185
What will you hear on Auscultation in a Horse with **Recurrent Airway Obstruction**
**Early Mild Cases: End-Expiratory Wheeze**
**Severe Cases: Expiratory Wheezes**
_**\***Expiratory Wheezes- High Pitched Musical Sounds associated with Narrow Airways_
_\*Where are we Hearing these Abnormal Sounds on Expiration? Throughout the Entire Lung field because RAO is a Diffuse Disease_
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_You are Presented with a 6-yr-old Holsteiner Jumper Mare for the generation of a Noise in the show Ring_
## Footnote
**How would you treat this Horse?**
**Ventriculochordectomy**
\*Idiopathic Laryngeal Hemiplegia
_\*The Problem the Horse is being Presented for is the NOISE. This Horse is NOT being presented for an exercise Intolerance_
