resp

Question 1

physical exam

Answer 1

• Airflow at nostrils: Symmetry?
• Sinus percussion (fluid will have dull sound)
• Submandibular lymph nodes
• Spontaneous or inducible cough?
• Tracheal and lung auscultation
• Rectal temperature

Question 2

physical exam nasal 1ts part

Answer 2

• Distance examination
• Posture
• Breathing rate & pattern
• Nostril flare (horse)
• Nasal discharge
• Unilateral vs. bilateral
• Characteristics of nasal discharge
• Colour
• Consistency
• Blood

Question 3

respiratory definitions

Answer 3

• Tachypnea:
• Increase in respiratory rate
• Hyperpnea
• Increase in respiratory rate and depth of respiration
• Dyspnea
• Shortness of breath (subjective)
• Respiratory distress
• Inappropriate degree and effort to breathing (dyspnea)

Question 4

clinical manifestations of dyspnea

Answer 4

• Tachypnea
• Extended head & neck position
• Mouth breathing (not horses)
• Nostril flaring (not cattle)
• Increased effort
• Abdominal effort
• Abducted elbows
• Stridor
• Anxious expression
• Cyanosis with severe
  distress
• Anorexia

Question 5

causes of tachypnea / dyspnea

Answer 5

• Dyspnea physiologic after strenuous exercise;
  pathologic at rest or following minimal exercise
• Tachypnea can be physiologic (exercise, heat);
  pathologic at rest
• Need for additional O2
• Compensation for metabolic acidosis
• Heat stroke
• CNS disease
• Weakness of respiratory muscles/ motor nerves

Question 6

need for additional Oxygen

Answer 6

• Decreased O2 in environment:
• High altitude
  -Fire or toxic fumes
• Disorders interrupting O2 transfer:
• Respiratory tract disease (ventilation/perfusion
  mismatch)
• Cardiovascular disease (bypassing lungs)
• Decreased O2 carrying capacity of the blood:
• Anemia (less hemoglobin)
• Abnormal hemoglobin

Question 7

trachea and lung sounds normal vs abnormal

Answer 7

-listen to lungs both sides, four quadrants and trachea

• Normal:
• Air movement through conducting airways
• Broncho-vesicular sounds
• Abnormal:
• Increased intensity/harshness (compare to trachea)
• Crackles (fluid, pleuropneomia)
• Wheezes (heaves)
• Absence of sounds

Question 8

dyspnea Intrathoracic airway obstruction

Answer 8

• Lower airway
• Dynamic airway collapse during expiration
• Expiratory distress

Question 9

dyspnea Extrathoracic airway obstruction

Answer 9

• Upper airway
• Dynamic airway collapse during inspiration (e.g. laryngeal hemiplegia)
• Inspiratory distress

Question 10

dyspnea fixed airway obstruction

Answer 10

• Intraluminal mass
• Bronchoconstriction
• Inspiratory and expiratory distress – severity
  depending on anatomic site

Question 11

dyspnea restrictive disease

Answer 11

• Pleural effusion
• Inhibition of lung expansion
• Inspiratory distress

Question 12

Purpose of rebreathing examination

Answer 12

• Rebreathe expired air
• Deeper breaths
• Clinical findings to observe:
• Respiratory rate
• Respiratory pattern
• Respiratory effort
• Coughing
• Lung sounds
• Recovery

Question 13

diagnostic imaging

Answer 13

• Radiographs:
• Head/sinuses (teeth)
• Guttural pouches (horse)
• Lungs
• CT:
• Head only in horses
• Ultrasound:
• Lungs (abscesses can show rhodococcus equi in foals)

Question 14

airway endoscopy

Answer 14

• Upper airway:
• Middle meatus: ethmoids (horse)
• Ventral meatus
• Guttural pouches (horse)
• Larynx
• Pharynx
  -mucus, tracheal muscle score
• Lower airway:
• Trachea
• Lungs

Question 15

Airway sampling

Answer 15

• Nasopharyngeal & guttural pouch swabs/washes
• Tracheal wash:
• Trans tracheal
• Endoscope guided
• Bronchoalveolar lavage (BAL)

Question 16

airway sample analysis

Answer 16

• Nasopharyngeal & guttural pouch swabs/washes
• PCR (influenza, EHV 1&4, strangles)
• Tracheal Wash (TW):
• Cytology
• Bacterial culture & sensitivity testing
• Bronchoalveolar Lavage (BAL):
• Cytology
• Bacterial culture & sensitivity testing (small animal)

Question 17

BAL cytology interpretation

Answer 17

• Interpret findings together with clinical signs!**
• Normal cytology horse
• ≤ 1% eosinophils
• ≤ 2% mast cells
• ≤ 5 % neutrophils (up to 10% may be normal)
• Mild to moderate equine asthma (IAD):
• Different “phenotypes”
• Eosinophilic inflammation (< 5 years old)
• Mast cell inflammation (usually younger)
• Neutrophilic inflammation (> 7 years old

Question 18

sinus disorders

Answer 18

-sinusitis:
primary: bacterial or viral
secondary: dental disease, cyst, neoplasia, foreign body, trauma

Question 19

upper airway disease diagnosis

Answer 19

-history:
-upper resp tract infections
-trouble eating, weight loss,
(could also be dental disease)
- nasal discharge
-sinus percussion
-submandibular lymph nodes
-radiography (CT) will see fluid line

Question 20

guttural pouch diseases

Answer 20

• Need to know anatomy to understand clinical
  findings, reach diagnosis & make treatment plan
• Empyema
• Mycosis

Question 21

neural anatomy with upper resp disease and gutteral

Answer 21

Medial compartment in contact with:
* Internal carotid artery
* Cranial cervical ganglion
* Cranial nerves IX, X, XI, XII
* Sympathetic nerves
* Recurrent laryngeal nerve

Question 22

anatomy and nerves with the stylohyoid bones large animals

Answer 22

• Stylohyoid bone ends in the temporohyoid joint
• Facial (VII) and vestibulocochlear (VIII) nerves
  located close to that joint
• Openings of the pouches located in dorsolateral
  aspect of the pharynx

Question 23

clinical signs of guttural pouch diseases

Answer 23

• Damage to cranial nerve IX or X:
• Nasopharyngeal dysfunction, dysphagia
• Damage to recurrent laryngeal nerve:
• Unilateral laryngeal hemiplegia
• Involvement of sympathetic nerve fibers:
• Horner’s syndrome (miosis, ptosis of the upper eye
  lid, protrusion of the 3rd eye lid, sweating of cranial neck & base of ear)

Question 24

Pathogenesis of pneumonia

Answer 24

• Secondary to viral respiratory infection:
• Stress/immunosuppression
• Transport (shipping fever)
• May be preceded by upper respiratory symptoms
• Aspiration pneumonia:
• Esophageal obstruction (choke)
• Dysphagia

Question 25

history which could point so pneumonia

Answer 25

-recent clinical symptoms of resp disease * Unvaccinated/not up-to-date * Travel or other recent stressors * Choke or dysphagia (aspiration pneumonia, guttral pouch disease, incorrect bottle feeding) * Strenuous exercise * Recent surgery (general anesthesia)

Question 26

clinical findings of pneumonia

Answer 26

* Fever * Coughing * Nasal discharge (bilateral) * Tachypnea * Increased respiratory effort * Abnormal lung auscultation

Question 27

diagnosis of pnuemonia

Answer 27

- History & clinical signs * Complete blood count * (Trans) tracheal wash * Cytology * Bacterial culture *& sensitivity (large animal) * BAL (small animal, cattle) * Diagnostic imaging * Lung radiographs * Ultrasound

Question 28

equine asthma pathogenesis

Answer 28

* Non-septic lower airway inflammation * Multifactorial * Airway hyperresponsiveness** to airborne antigens -environmental (pollen, dust, hay) * Different phenotypes * Genetic predisposition * (Previous viral infection) * Airway microbiota -hear wheezes on ascultatoin due to narrowing of airways** * Excessive mucus secretion + bronchoconstriction * Chronic: airway remodeling

Question 29

Mild to moderate equine asthma

Answer 29

* Usually younger – but any age * Poor performance: Differentials: upper airway obstructions, cardiovascular, musculoskeletal * Chronic cough (> 3 weeks), occasional/intermittent * NO increased respiratory effort at rest * Prognosis: good

Question 30

Severe equine asthma – “heaves"

Answer 30

* Horses usually older than 7 years * Frequent coughing * Exercise intolerance * Increased respiratory effort at rest * ”Heaves line” * Life-long management * Long-term: * hypoxic vasoconstriction * arterial remodeling and thickening * pulmonary hypertension-> cor pulmonale

Question 31

asthma diagnostics

Answer 31

-rebreathing exam -trans tracheal wash- culture + cytology to tule out bacterial pneumonia -BRONCOALVEOLAR LAVAGE BAL -endoscopic tracheal mucus grading -case based: bloodwork, ultrasound, rads, pulmonary function test

Question 32

BAL cytology

Answer 32

* Normal * ≤ 1% eosinophils * ≤ 2% mast cells * ≤ 5 % neutrophils (up to 10% may be normal) * mildly increased in IAD * severely increased in RAO

Question 33

management of equine asthma

Answer 33

-inhalent therapy * Antigen avoidance** * Do not store hay above horses * Remove horses from barn when sweeping * Water-down dusty arenas * Low-dust feed and bedding -taylor to individual case

Question 34

Exercise induced pulmonary hemorrhage AKA “Bleeders”

Answer 34

* Racehorses * Performance at maximum capacity * Hemorrhage within airways in pulmonary vessels * Diagnosis: endoscopy +/- BAL * Grading system 0-4

Question 35

Exercise induced pulmonary hemorrhage AKA “Bleeders” pathogenesis

Answer 35

* Increased capillary pressure * Caudo-dorsal lung most affected * Micro- to macroscopic hemorrhage

Question 36

diagnosis of bleeders

Answer 36

* Upper airway endoscopy: * Scoring of tracheal blood * Immediately following exercise * Lung radiographs: * Increased interstitial opacity in dorsal caudal lung * BAL: * RBC * Hemosiderophages * Timing of diagnostics vs exercise important*