EqMed F, Resp III

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HLW
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217385
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EqMed F, Resp III
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2013-05-02 21:39:01
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EqMed Resp III
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EqMed F, Resp III
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  1. what are clinical signs seen with EIPH?
    • epistaxis NOT common
    • blood in trachea 45 minutes post race + hx of poor performance
  2. Horses with what grades of EIPH are 4 times more likely to win races?
    grade 0 and 1 (compared to 2-4)
  3. what is seen on grade 2, 3, and 4 of EIPH?
    • 2: single stream of blood in trachea
    • 3: 1/3 trachea has blood
    • 4: >90% covered in blood
  4. what is tx for EIPH?
    • no known tx - try to decr. inspiratory obstructions
    • some try furosemide or FLAIR nasal strips
  5. what is medical term for Heaves and what is it? what age horse is affected?
    • recurrent airway obstruction - lower airway obstruction dt mucous plugs, fibrosis, bronchospasm, chronic changes in alveolar wall
    • older horse problem (>12)
  6. what are clinical signs seen with heaves?
    • coughing in 12+ yr old and bilateral nasal discharge
    • incr. respiratory rate, flared nostrils
    • normal appetite, no fever
    • "heave line" = muscle hypertrophy from forced expiration
  7. what is heard upon thoracic auscultation of heave horse?
    • may be normal
    • prolonged recovery and wheezes/crackles with rebreathing bag
  8. what will thoracic rads show with heaves? endoscopy?
    • bronchointerstitial pattern
    • tracheal mucus (even in absence of nasal discharge)
  9. what is seen on BAL of horse with heaves?
    • *neutrophilia* >10-15% neutrophils
    • mucus
  10. what does atropine challenge show with heaves patient?
    • dilation of constricted airways - so see improved breathing effort for about 30 minutes
    • (buscopan works too since both are parasympatholytics)
  11. atropine is a helpful diagnostic tool for heaves, but why is it not used as treatment for this condition?
    unwanted side effects from regular use - ileus, dry airways, tachycardia
  12. what is the single most effective treatment for horses with heaves?
    • environmental change - keep *outside in fresh air*
    • prevent exposure to Ag that cause inflammation
  13. what is the lungworm in horses? who is the carrier?
    • dictocaulus arnfieldi
    • asymptomatic carrier = donkey/mule
  14. what happens in horse after ingesting L3 lungworm larvae?
    L3 penetrates GIT wall - becomes L4 in lymph node - carried to lung/burrow into alveoli - mature, lay eggs in bronchi - cough/swallow - pass eggs or L1 in feces
  15. how long is prepatent period for lungworm? what pathology is caused in respiratory tract?
    • 5-6 weeks
    • excess mucus, cough, pulmonary edema,
    • crackles/wheezes, 2nd bacterial infection
  16. what is seen on tracheal aspirate with lungworm? how is this treated?
    • eosinophils and larvae
    • ivermectin or moxidectin
  17. what type of pneumonia do adults get? who is most common victim?
    • pleuropneumonia (NOT in foals)
    • training/show horses traveling long distance (shipping fever) or those exposed to viruses, strenuous exercise, or general anesthesia
  18. how does viral infection lead to pleuropneumonia?
    • decr. mucociliary clearance, damaged epithelium
    • decr. surfactant levels w/destroyed type II alveolar cells - anaerobic environment
  19. how does exercise lead to pleuropneumonia?
    dirt and debris breathed in deeper with exertion
  20. how does post GA lead to pleuropneumonia?
    • ET tube can introduce bacteria
    • GA compromises mucocilliary clearance
    • compression/atelectasis of lungs
    • improves local bacterial growth
  21. what is #1 reason long transports lead to pleuropneumonia?
    traveling with head tied up - can't clear
  22. what are clinical signs of young horse with pneumonia?
    • fever, lethargy, inappetant, wt loss
    • cough, resp. distress
    • pleurodynia (pain may resemble colic)
    • +/-ventral/peripheral edema
    • laminitis
    • *sick horse*
  23. what etiology may be indicated if nasal discharge is foul smelling or there is halitosis?
    anaerobic presence
  24. what will CBC show in pneumonia case?
    • neutropenia or philia - with left shift
    • anemia of chronic inflammation
    • hyperfibrinogen
  25. 20 year old horse with no recent history of shipping presented with classic signs of pneumonia. He is not responding as expected to the treatment plan. What are 4 things on your differential list you should reconsider?
    • neoplasia
    • EHV-5
    • fungal pneumonia
    • granulomatous lung disease
    • esophagus ruptured in thorax
  26. What is expected neutrophil count and specific gravity of thoracic fluid in pneumonia patient?
    • nucleated cells >10,000 w/neutrophils >70%
    • SG: >3 g/dL
  27. what antibiotics are good choices for pneumonia?
    long term beta-lactam + aminoglycoside +/- metronidazole for anaerobes
  28. what is prognosis for pneumonia patient?
    • guarded even with aggressive therapy
    • can remain chronically ill, only 50% return to race

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