Test 2 - Cough

Question 1

The _______ is compromised of continuous waves of ciliary motion that start at the level of the bronchioles.

Answer 1

Mucociliary Escalator

Question 2

The ______ removes secretions from the tracheobronchial tree proximal to the level of the segmented bronchi.

Answer 2

Cough Reflex

Question 3

TRUE/FALSE:

Sneezing is an important and normal respiratory defense mechanism.
It is a sudden, forceful noisy expulsion of air through the glottis to clear particles & other material from the tracheobronchial tree and glottis.

Answer 3

FALSE

We’re on the cough lecture…

Question 4

The mucociliary escalator works at the level of the _______ while the cough reflex works at the level of the _________.

Answer 4

The mucociliary escalator works at the level of the bronchioles while the cough reflex works at the level of the tracheobronchial tree (proximal to the level of the segmented bronchi)

Question 5

_________________ is a constant component of cough.

Answer 5

Bronchoconstriction is a constant component of cough.

Question 6

List the nerves involved in the cough as an involuntary reflex.

Answer 6

Vagus n.

Glosopharyngeal

Trigeminal

Phrenic

Question 7

TRUE/FALSE.

Things such as sloughing of the airway epithelium, intra/extramural pressure (ie tumor/fibrosis), and increased epithelial permeability (pulmonary edema) can stimulate cough.

Answer 7

TRUE

Question 8

_______ & ______ are part of the mucucilliary clearance mechanism.

Answer 8

Pseudostratified ciliated columnar epithelium & Clara cells are part of the mucucilliary clearance mechanism.

Question 9

___________ are located in terminal and respiratory bronchioles. Source of surfactant-like substance which aids in maintaining patency of airway. Metabolize airborne toxins.

Answer 9

Clara Cells are located in terminal and respiratory bronchioles. Source of surfactant-like substance which aids in maintaining patency of airway. Metabolize airborne toxins.

Question 10

How long does airway epitheliuam take to heal?

Answer 10

about 7 weeks

Question 11

Nasal discharge with a foul smell is indicative of a(n) _______ infection.

Answer 11

Anaerobic

Question 12

Fill in the cause of these lungs sounds:

• ________: ↑ lung sounds, crackles and wheezes
• ________: ventral dull sound
• ________: cardiac sound larger than normal b/c improves sound conduction

Answer 12

• Pneumonia: ↑ lung sounds, crackles and wheezes
• Pleuropneumonia: ventral dull sound
• Pleural effusion: cardiac sound larger than normal b/c improves sound conduction

Question 13

____________ is a symptom of peracute presentation of respiratory disease and has signs similar to colic.

Answer 13

Pleurodynia is a symptom of peracute presentation of respiratory disease and has signs similar to colic.

Question 14

TRUE/FALSE:

Infectious causes of coughing present with no fever.

Answer 14

FALSE

Infectious - Fever always with horses.

Question 15

________ is a major cause of respiratory disease in horses.
What are some other features about this disease?

Answer 15

Equine Influenza is a major cause of respiratory disease in horses.

• Aerosolized respiratory secretions, >35 ft
• Young - 3 y/o
• Crowding, transport & stress
• Destroy ciliated epithelium

Question 16

A young horse about 2 y/o presents with conjunctivitis, lymphadenopathy, edema,
vasculitis, and polysynovitis. What is yur most likely diagnosis?

Answer 16

EHV-1 or 4

Question 17

Identify the right EHV virus to the signs listed.

_______: respiratory & reproduction signs
______: respiratory & neurologic signs
_____: EMPF

Answer 17

EHV4: respiratory & reproduction signs
EHV1: respiratory & neurologic signs
EHV5: EMPF

Question 18

______ causes respiratory disease, abortions, and foal pneumonia through close contact transmission. It has a long lasting immunity (both natural and vaccines).

What is the typical age of the horse affected by this disease?

Answer 18

Equine Viral Arteritis causes respiratory disease, abortions, and foal pneumonia through close contact transmission. It has a long lasting immunity (both natural and vaccines).

NOT AGE RELATED

Question 19

________ is associated with immunocompromised Arabian foals (SCID)

Answer 19

Equine Adenovirus associated with immunocompromised Arabian foals (SCID)

Question 20

_______ infectious are usually clinically inapparent but may present with pharyngitis, mild bronchitis, nasal discharge.

Answer 20

Equine Rhinovirus infectious are usually clinically inapparent but may present with pharyngitis, mild bronchitis, nasal discharge.

Question 21

________ is a commensal aerobic bacteria associated respiratory infections.

Answer 21

Streptococcus zooepidemicus is a commensal aerobic bacteria associated respiratory infections.

Question 22

List the parastes associated with lung disease.

Answer 22

• Lung worms: Dictocaulus arnfieldi
• Roundworms: parascaris equorum.

Question 23

_____ is the most common pathogen associated secondary fungal pneumonia.

Answer 23

Aspergillus is the most common pathogen associated secondary fungal pneumonia.

Question 24

____________ is a major contributor for bacterial pneumonia and pleuropneumonia

Answer 24

Physiologic stress is a major contributor for bacterial pneumonia and pleuropneumonia

Question 25

How do transportaiton and exercise contribute to the development of cough?

Answer 25

* Transportation: Head elevated & secure (compromise mucocilliary clearance mechanism), dehydration (↓ secretions) * Exercise: high intensity exercise results in ↓ peripheral blood neutrophil function, oxidative burst of pulmonary alveolar macrophages, EIPH

Question 26

What kind of synthetic surfaces are associated with aspiration?

Answer 26

Synthetic surface → fibers, sand, rubber, coated with wax

Question 27

Stomach tube, choke, LH, dysphagia (neonatal encephalopathy, botulism, guttural pouch disease, strangles) are all causes of \_\_\_\_\_\_\_.

Answer 27

Aspiration.

Question 28

What are the affects of carboxyhemoglobin?

Answer 28

Carboxyhemoglobin: ↓ ability for O2 to be released at the tissue site leading to hypoxia

Question 29

What are the results of smoke inhalation? How can it be diagnosed?

Answer 29

Carboxyhemoglobin (diagnosis \>10%) Severe bronchoconstriction Pseudomembranous cast

Question 30

What are the factors related to the development of cough during anesthesia?

Answer 30

* Transtracheal Intubation: excessive cuff pressure → tracheal necrosis * Dorsal recumbency * Anesthetics cause depression of the respiratory defense mechanism

Question 31

What are the primary lung tumrs in the horse?

Answer 31

granular cell tumor, pulmonary chondrosarcoma

Question 32

A horse presents thin, with a dull attitude, tachypneic with increased respiratory effort. The presenting complaints are **Occasional Dry Cough, Exercise intolerance and Acute Respiratory Distress.** Initial Lab work shows: **↑ WBC count, ↑ fibrinogen, anemia, lymphopenia.** Radiographs show **a diffuse bronchointerstitial pattern with multiple coalescing circular nodules throughout the lung field.** What is the most likely diagnosis?

Answer 32

Equine Multinodular Pulmonary Fibrosis, most comomnly associated with EHV-5 Virus

Question 33

What are the proposed treatments for Equine Multinodular Pulmonary Fibrosis?

Answer 33

corticosteroids NSAIDs antibiotics, antivirals (acyclovir,valacyclovir), bronchodilators, O2 supplementation, antifibrotic agents -colchicine immune modulators (IFN-y)

Question 34

What are the differentials for foal pneumonia in each of the following age groups? 1 Months 1-6 months

Answer 34

_• \<1 month_: in utero or perinatally lung infection, meconium aspiration, aspiration pneumonia, iatrogenic, surfactant inactivation, EVA, EHV-1, EHV-4. • Adenovirus-combined immunodeficiency in Arabian foals _• 1-6 mos:_ S. zooepidemicus, R. equi, Respiratory viruses are often the 1° agents.

Question 35

What are the clinical findings asociated with foal pneumonia (Chem/CBC/Blood Gas)

Answer 35

* CBC: Abnormal, nonspecific, reflects chronicity & severity of inflammatory process * Acute: hyperfibrinogenemia & neutropenia * Chronic: neutrophilia, anemia of chronic disease * Hyperbilirubinemia: anorexia * Azotemia: pre-renal or renal Arterial blood gas: hypoxemia, hypercapnia, respiratory acidosis.

Question 36

What does U/S assess vs. Radiographs in foal pneumonia?

Answer 36

• U/S → pleura irregularities, limited deeper pulmonary parenchymal • Rads: more efficient evaluating deeper parenchyma, evaluate the amount of lung consolidation, evaluates long term progression

Question 37

What are complications of a TTW?

Answer 37

• Complications: cellulitis & chondritis

Question 38

TRUE/FALSE When treating foal pneumonia, chronic pneumonias rarely require fluid therapy.

Answer 38

TRUE. Fluid therapy should be used in the event of acute/hypovolemic patients.

Question 39

You perform a TTW in a foal with pneumonia and submit samples for cytology. Match the infectious agent with the appropriate treatment: Agents: * S. Zooepidemicus * Rhodococcus Equi * Bacteroides fragilis (anaerobe) _Treatments_ (note: some may not be used, some may be combined) * Clarithromycin * TMS * Aminoglycosides * Rifampin * Penicillin * Metronidazole * Ceftiofur *

Answer 39

* Penicillin: most common pathogen S. zooepidemicus * Ceftiofur: convenient in foals * Combination of TMS or aminoglycoside * Clarithromycin and Rifampin: Rhodococcus qui * Metronidazole: anaerobes (Bacteroides fragilis)

Question 40

What is the benefit of using aerosolized anti-microbials? Which are commonly used?

Answer 40

* Reach 12 times higher concentration than iV administration with lower toxicity * Gentamicin & ceftiofur

Question 41

You treat your foal with an anti-microbial for its foal pneumonia. What else can you use?

Answer 41

* Anti-inflammatory: * NSAIDs: phenylbutazone, flunixin meglumine * Corticosteroids: if unresponsive to antimicrobial and anti-inflammatory therapy * Bronchodilators: albuterol, clenbuterol * Palatable feed: green grass → monitor body weight * Stall rest * Immune modulators: IFN-y * Antivirals: acyclovir, valacyclovir

Question 42

TRUE/FALSE When treating foal pneumonia, steroids should only be used if they are unresponsive to antimicrobial and anti-inflammatory therapy.

Answer 42

TRUE

Question 43

TRUE/FALSE Abscessation, necrotic tissue and pleuropneumonia are all potential compllications of foal pneumonia.

Answer 43

TRUE