Respiratory- Exam 2 Flashcards by Caitlyn Crawford

What is the pulmonary alveolar pressure?

25-30

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What is the order of respiratory structures?

Nares- nasal passage - ethmoid- nasopharynx- guttural pouch- larynx- trachea

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What is the difference in O2 tension at rest vs. intense exercise?

At rest: 100 mmHg

Exercise: 65-70 mmHg

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What allows us to assess lung auscultation based on increasing ventilation

Rebreathing- use a bag over horses head

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What makes a horse an obligate nasal breather?

Completely distinct oro/nasopharynx

Horses don’t have a pharynx

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How much fluid is held in the guttural pouch?

300 mL

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Which is the larger bronchus?

Right mainstem bronchus

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What dx test is run if you’re looking for pulmonary dz?

Rads

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What dx test is run if you’re looking for thoracic dz?

U/S

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When do we use transtracheal wash opposed to bronchoalveolar lavage?

TTW: INFECTIOUS dz of FOCAL origin- can do a sterile culture
BAL: NON-INFECTIOUS DIFFUSE dz

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Why can’t you culture a sample obtained from a BAL?

Not sterile and will not get a good evaluation of the culture

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What part of the lungs is respiratory tract disease (pneumonia) found?

Cranioventral lung lobes

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Where is the transtracheal wash performed?

Junction of middle and distal lower 1/3 of neck, above bifurcation of sternohyoideus m.

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What are all the possible dx techniques used to evaluate respiratory dz?

BAL
TTW
Thoracocentesis
Lung aspirate
Lung biopsy(rare)

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A 2 yr old standardbred gelding presents for a  cough and nasal discharge. PE reveals fever,  purulent nasal discharge, mild tachypnea, and  tachycardia, and normal thoracic auscultation.  Which of the following best categorizes the disease  in this horse?
A. NonWinfectious URT disease 
B. Infectious LRT disease 
C. Infectious URT disease 
D. NonWinfectious LRT disease

C- Infectious URT disease

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What in this case indicates it is infectious? 
A. Tachycardia 
B. Tachypnea 
C. Presence of nasal discharge 
D. The appearance of the nasal 
discharge 
E. Age of the horse 
F. Fever 
G. Presence of cough

D & F

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What in this case indicates it is NOT LRT  disease? 
A. Presence of a cough 
B. The appearance of the nasal 
discharge 
C. Fever 
D. Presence of nasal discharge 
E. Tachycardia 
F. Tachypnea 
G. Thoracic auscultation

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Bilateral nasal discharge can be associated to upper or lower respiratory Dz?
A. True
B. False

TRUE
From a uni to a bilateral perspective – the anatomic structure is the end of the nasal septum – rostral to this is uni; caudal is bilateral. UPPER RESP TRACT is ANYTHING in the conducting airway

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Cough is associated with upper and lower respiratory Dz?
A. True
B. False

TRUE
BOTH! Think – if you have a scratchy throat, do you cough? YES; also cough with pneumonia. Generic finding – not sensitive for upper or lower

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Unilateral nasal discharge is associated with upper and lower respiratory Dz?
A. True
B. False

FALSE

Yes – the separation is at the caudal aspect of the nasal septum ! only components of URT

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A horse can manifest a neutrophilic leukocytosis and hyperfibrinogenemia with either URT or LRT Dz?
A. True
B. False

TRUE

Yes – this indicates an infectious inflammatory disease – this is the nature of dz not location!

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CASE STUDY: 4WyrWold  thoroughbred mare that  first presented for mild  spontaneous  intermittent unilateral  epistaxis which first  occurred 3 weeks ago –  she has developed  dysphagia within the  last 2 days. No other  abnormalities have been  noted at this time or  previous to the  development of this. 
Categorize disease 
A. LRT infectious 
B. LRT non-infectious 
C. URT infectious 
D. URT non-infectious

D
you did your classification on appearance of case – it ended up being infectious – BUT – this didn’t look infectious before.

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CASE STUDY: 4 yr old  thoroughbred mare that  first presented for mild  spontaneous  intermittent unilateral  epistaxis which first  occurred 3 weeks ago –  she has developed  dysphagia within the  last 2 days. No other  abnormalities have been  noted at this time or  previous to the  development of this. 
 What is the likely diagnosis 
A. Coagulopathy 
B. Trauma 
C. Ethmoid hematoma 
D. Guttural pouch mycosis 
E. EIPH

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CASE STUDY: 4 yr old  thoroughbred mare that  first presented for mild  spontaneous  intermittent unilateral  epistaxis which first  occurred 3 weeks ago –  she has developed  dysphagia within the  last 2 days. No other  abnormalities have been  noted at this time or  previous to the  development of this. 
Which of the following is  most significant in deciding  your Dx? 
A. Signalment 
B. Location of 
epistaxis 
C. Intermittent 
nature 
D. Spontaneous 
occurrence 
E. Degree of 
epistaxis 
F. Time line 
G. Presence of  dysphagia

G- presence of dysphagia

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``` What is the most common CS in a guttural pouch mycosis (GPM)? A. Laryngeal hemiplegia B. Mucopurulent nasal discharge C. Ozena D. Epistaxis E. Dysphagia ```

Where are the ethmoids and guttural pouches located in reference to the nasal septum?

Ethmoids=rostral | Guttural pouches= caudal

T/F: Both ethmoids and guttural pouches can cause bilateral bleeding

TRUE Volume of blood determines whether bilateral or unilateral

What is the common signalment for hematomas?

Old, male warmblood

What runs through the medial vs. lateral guttural pouch?

Medial: internal carotid a. Lateral: maxillary a.

15 yr old Thouroughbred gelding 1 yr history of spontaneous unilateral right nasal epistaxis. Occasional blood from L. Episodes infrequent. • One month prior to presentation, epistaxis from R occurred more frequently Q: Categorize the disease A. LRT infectious B. LRT nonWinfectious C. URT infectious D. URT nonPinfectious

``` 15 yr old Thouroughbred gelding 1 yr history of spontaneous unilateral right nasal epistaxis. Occasional blood from L. Episodes infrequent. • One month prior to presentation, epistaxis from R occurred more frequently What is the likely diagnosis? A. Coagulopathy B. Trauma C. Ethmoid hematoma D. Guttural pouch mycosis E. EPIH ```

``` What is the most significant factor in deciding your Dx? A. Signalment B. Location of epistaxis C. Intermittent nature D. Spontaneous occurrence E. Degree of epistaxis F. Time line ```

A & F It took a year – if this was guttural pouch, it is highly unlikely they would be lasting for a year!! There are cases – rare – that show you the timeline of this disease. Past 4W5 months we are more likely NOT having a GPM. Signalment is helpful in focusing you.

Q: What might be the cause of bilateral bleeding in a PEH (Progressive Ethmoid Hematoma) case? A. Associated coagulopathy B. Bilateral lesion C. Large bleeding volume D. Unilateral lesion invading to opposite side

B, C, D

If you are suspecting respiratory dz but don't see any specific lesions upon endoscopy- what is the next dx test you will perform?

Rads

T/F: If there is active bleeding at time of scoping- difficult to evaluate

FALSE | You want them to be actively bleeding to better evaluate issue

T/F: You must scope when there is an active bleed to determine the cause, but for GPM you should still see a lesion even with no bleeding

TRUE

What is the #1 cause of bleeding in exercise horse and epistaxis in a horse?

Bleeding in exercise horse: EIPH | Epistaxis: trauma

What are your treatment options for ethmoid hematoma?

Intralesional formalin | Laser ablation

``` A 10 yr old quarter horse mare is presented for bilateral mild spontaneous intermittent epistaxis. She has an inspiratory and expiratory noise which has developed within the last month despite the problem being present for several months. No other abnormalities have been noted in this horse at any time Q: What is the likely diagnosis? A. Coagulopathy B. Trauma C. Ethmoid hematoma D. Gutteral pouch mycosis E. EIPH ```

What is intralesional formalin?

Create a necrosis and dessicate the lesion

What is laser ablation?

the best technique used to treat ethmoid hematoma

What needs to be done prior to laser ablation surgery and why?

Crossmatch prior and expect the horse needing a transfusion You are expecting the horse to bleed a significant amount Most preferred surgical option

What vessels need to be ligated prior to guttural pouch surgery?

Internal carotid artery External carotid artery Maxillary artery

What is a complication of guttural pouch mycosis sx?

Blindness

What are the four surgical options for guttural pouch mycosis?

Balloon tipped catheter placement Detachable self-sealing latex balloon Transarterial coil placement Transarterial nitinol intravascular plug

What are the arterial systems of the guttural pouch connected through?

Circle of Willis

T/F: It is essential to close off the retrograde and antegrade aspect of the carotid artery during guttural pouch sx?

TRUE

What is the common age of guttural pouch mycosis patients?

Younger horses

What is the presenting complaint of guttural pouch mycosis?

Mild frank, unilateral epistaxis

What is the #2 CS of guttural pouch mycosis?

Dysphagia

What is the deciding factor of treating guttural pouch mycosis medically vs. surgically?

Medically- no history of epistaxis | Surgically- history of bleeding

What is the typical speed exercise induced pulmonary hemorrhage is seen?

> 14 m/s

What are CS of EIPH?

Epistaxis Exercise intolerance None-acute collapse

What is seen in a grade 0-4 EIPH horse?

0: no evidence of hemorrhage 1: flecks of blood/single short stream of blood extending less than a quarter of the tracheal length 2: One continuous stream of blood extending at least 1/2 the length of trachea or multiple streams of blood covering less than one third of tracheal surface 3: Multiple streams of blood covering more than one third of tracheal surface 4: abundant blood in trachea completely covering tracheal surface and pooling at thoracic inlet

What is the typical dx method for EIPH

Endoscope- direct observation of blood in tracheobronchial tree

T/F: Incidence of EIPH is related to duration of exercise and not intensity

FALSE | Related to intensity

What are the three components of the capillary rupture theory for EIPH?

Disruption of pulmonary capillaries as a consequence of high CO required during intense exercise Stress failure of the vessel wall- tensile strength has been exceeded Elevated pulmonary vascular system pressures

What are two other theories besides the capillary rupture theory for EIPH?

Lower airway inflammation theory | Concussive lung injury theory

What is the concussive lung injury theory?

Impact or hoof on ground force transmitted as a wave to the scapula --> force transmitted to chest wall --> force travels as a wave through lung to caudodorsal area and then caudal tip of lung results in microscopic shearing

What are some classical CS of EIPH?

Poor performance- "quitting" Epistaxis- small percent of cases Coughing

What is the rad pattern of EIPH?

increased interstitial pattern in the caudo-dorsal lung fields

What is a tx commonly given for EIPH?

Furosemide

T/F: Giving furosemide pre-race is most commonly used and recommended?

TRUE

When performing a TTW what cells are you looking for?

Hemosiderophages

What is another tx for EIPH besides lasix?

FLAIR nasal strip | Conjugated estrogens- aminocaproic acid and premarin

Laryngeal hemiplegia will have what kind of noises?

STRIDOR- inspiratory noises

Respiratory- Exam 2 Flashcards

(66 cards)