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93 Cards in this Set

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Which of the following are NOT true regarding strangles?
a) caused by a respiratory commensal
b) Only causes dz in horses, donkeys, and mules
c) can often be primary in origin
d) Can survive up to 7 wks in the environment
a) caused by a respiratory commensal (NO - it is not a normal inhabitant)
d) Can survive up to 7 wks in the environment (NO - short environmental survival but protected in moist discharges)
Which of the following are NOT true regarding S. equi equi?
a) Adherence is prevented by neutralizing antibodies
b) M protein prevents phagocytosis
c) HA capsule prevents phagocytosis
d) replicates within neutrophils
d) replicates within neutrophils (NO - it replicates extracellularly leading to neutrophil accumulation and abscess formation)
What are the 2 prime features of S. equi equi pathogenicity?
M protein
HA capsule
What is bastard strangles?
Dissemination of S. equi equi to other lymph nodes
Put the following in order and apply approximate timelines to a strangles infection:
Fever
Exposure
Organism shedding
Lymph node rupture
Regional LN involvement
Exposure (day 0)
Fever (and other cx 3-14d)
Regional LN (2-4 d post fever)
Shedding (2-9d after fever)
Rupture (7-14d)
Which lymph node is commonly involved in strangles?
Retropharyngeal
Which of the following diagnostics will be the best for diagnosing strangles?
a) ELISA
b) Nasopharyngeal swab
c) nasal flush + PCR
d) guttural pouch lavage + PCR
e) culture from abscess aspirate
c) nasal flush + PCR is fastest and more sensitive
e) culture from abscess aspirate is definitive though
(note - avoid PCR on guttural pouch samples d/t old S. equi DNA persistence; ELISA can be positive for vaccinations)
Which of the following are NOT appropriate for a S. equi positive horse w/fever, nasal discharge, but no lymph node abscessation?
a) Antibiotics
b) Vaccination
c) NSAIDS
d) Lance & drain lymph nodes
b) Vaccination (may cause purpurea)
d) Lance & drain lymph nodes
How should a horse with strangles and lymph node abscesses be treated?
Lance nodes and flush w/3% povidone
Treat w/abx ONLY if upper airway obstruction
Possible tracheostomy if severe
How should horses exposed to strangles be treated?
Isolation + antibiotics
How should horses with complicated strangles be treated?
Penicillin + Rifampin
Treat symptoms/conditions (guttural pouch empyema, fluids, surgery, & etc) as necessary
T or F:
Horses recovered from strangles are immune thereafter.
False!
~70% of horses develop solid immunity that lasts a few years.
Which of the following are NOT true regarding purpura hemorrhagica?
a) caused by S. equi
b) type III hypersensitivity
c) involves IgA and IgM activation
d) rare after initial exposure
e) treated by vaccination
d) rare after initial exposure
e) treated by vaccination
(rare in initial infection; usually after 2nd normal exposure; vaccination won't help)
What are some strangles complications?
Asphyxiation
Guttural pouch empyema
Bronchopneumonia
Bastard strangles
Immune mediated myositis
Laryngeal hemiplegia
Cardiac/CNS dz
What are signs of purpura hemorrhagica?
PItting edema over limbs, head, trunk
Petechiation of mucous membranes
May have severe colic
Warm painful edema
What are lab signs of purpura hemorrhagica?
Neutrophilic leukocytosis
high fibrinogen
anemia
Leukocytoclastic vasculitis
Which of the following are appropriate treatments for most cases of purpura hemorrhagica?
a) NSAIDs
b) Penicillin
c) Corticosteroids
d) All of the above are appropriate
a) NSAIDs
b) Penicillin
(Corticosteroids ONLY for severe cases; most cases are mild)
T or F:
Exercise intolerance due to lower respiratory disease usually doesn't present with abnormal breathing noises.
True!
What kind of discharge is usually associated with equine COPD?
Profuse white discharge
Which of the following can present with nasal exudate and/or dysphagia and/or epistaxis?
a) Pb toxicity
b) Guttural pouch disease
c) Pneumonia
d) Sinus cysts/nasal polyp
e) Palate disorder
b) Guttural pouch disease
What are some causes of dysphagia?
Pb toxicity
EPM
Nutritional myodegeneration
Guttural pouch dz
Epiglottic dz
Encephalitis
Palate disorder
What are some causes of nasal exudate?
Guttural pouch empyema
Sinusitis
Rhinitis
Pneumonia
Pharyngitis
Sinus cysts
COPD
What are some causes of epistaxis?
EIPH
Trauma
Guttural pouch mycosis
Ethmoid hematoma
Nasal foreign body
Neoplasia
Nasal fungla granuloma
Nasal polyp
Coagulation disorders
What are the 4 equine sinuses and which one is difficult to assess?
Frontal
Sphenopalatine (tough to assess)
Rostral maxillary
Caudal maxillary
What is the most common neoplasia of the equine sinuses?
SCC
What are the common fungal etiologies of equine nasal fungal granulomas?
Cryptococcus neoformans
Coccidioides immitis
What are the signs of equine sinus disease?
Unilateral nasal discharge
Facial distortion
Quidding & abnormal mastication
Ocular discharge
What is the common presentation of sinusitis in horses?
Older horse w/unilateral nasal discharge that doesn't clear w/antibiotics (usu a tooth root problem)
Which of the following result in PRIMARY sinusitis?
a) 1st molar impaction
b) skull fracture
c) Streptococcus infection
d) Cryptococcus infection
e) Neoplasia
c) Streptococcus infection
What are indicators for FAILURE of conservative treatment for sinusitis?
Infection/necrosis of mucosal lining
Failure of drainage/Inspissation of pus
Predisposing cause of sinusitis hasn't been identified
If you see a horse with with guttural pouch disease and it is consistently pointing its muzzle to the right, where is the lesion?
Left vestibular
What structures are in the medial guttural compartment?
Internal carotid
IX, X, XII, XII
Sympathetic trunk
Cranial cervical ganglion
What structures are in the lateral guttural compartment?
VII
Maxillary a and v
External carotid
Which bacterium is guttural pouch empyema associated with?
How is this treated?
Strangles! (beta-hemolytic S. equi equi) - treat with Penicillin if S. equi
Which fungus is often implicated in guttural pouch mycoses? What pharmaceuticals can be used?
Aspergillus nidulans or fumigatus
(Miconazole, itraconazole, enilconazole topically; itraconazole or amphotericin B systemically)
What are some signs of guttural pouch mycosis?
Nasal discharge to epistaxis
Dysphagia
Respiratory noise
Laryngeal hemiplegia
Horner's syndrome
What are the components of Horner's syndrome?
Ptosis, meiosis, enopthalmos
Sweating/warmth on affected side
Which agents are implicated in equine fungal granulomas?
Conidiobolus
Coccidiodes
Rhinosporidium
Aspergillus
T or F:
Pharyngeal lymphoid hyperplasia is always an incidental finding and treated with benign neglect.
False!
Severe PLH can cause nasal discharge, mild lymphadenopathy, and inducible cough
Which of the following should be vaccinated for S. equi?
a) Mare 1 month prior to foaling
b) A horse w/low ELISA titer
c) A horse w/high ELISA titer
d) A horse that had strangles 6 months ago
a) Mare 1 month prior to foaling
b) A horse w/low ELISA titer
T or F:
In the adult horse, you should not see idiopathic pneumonia.
True!
What bacterium is usually implicated in equine pneumonia?
S. equi zooepidemicus
Which bacteria worsen the prognosis for equine pneumonia?
Anaerobes (Bacteroides, Clostridium, Peptostreptococcus, Eubacterium)
If you recover mycoplasma from a horse with pleuritis, what antibiotic should you use?
Oxytetracycline
Which antibiotic should be used for Bacteroides pneumonia?
Metronidazole
What lab findings can be seen in pneumonia with pleural effusion?
Leukopenia
Hemoconcentration
Azotemia
Metabolic acidosis
Low Na, Cl, and total protein
Hyperfibrinogenemia
Maybe hypoxemic
With thoracic ultrasound, you see a bright line and artifacts below. What gives?
Normal thorax
With thoracic ultrasound, you see a big meaty lung. What gives?
Consolidation
With thoracic ultrasound, you see comet tails and something that looks like an octopus. What gives?
Pleuritis! Octopus is pericardiodiaphragmatic ligament
Which is better with equine respiratory disease diagnostics, tracheal wash or BAL?
Tracheal wash!
Where is thoracocentesis in a horse performed?
7th or 8th intercostal space above the costo-chondral jxn (on the left); 6th to 7th (on the right)
Diagnose the following findings in equine thoracocentesis:
Low pH and low glucose
Blood-tinged transudate
Protein <2.5g/dL
Foul-smelling
light yellow and odorless
Low pH and low glucose (septic pleuritis)
Blood-tinged transudate (neoplasia)
Protein <2.5g/dL (normal)
Foul-smelling (septic pleuritis)
light yellow and odorless (normal)
How will thoracic fluid in a horse with septic pleuritis look?
High cell count (degenerate)
High protein
low pH, low glucose
foul smell
What is the initial treatment for equine pneumonia?
Penicillin
Gentamicin
Metronidazole
Which antibiotics should you NOT use with anaerobes?
TMS, Enrofloxacin, Aminoglycosides (Penicillin also for Bacteroides)
Which antibiotics are good for anaerobes?
Penicillin (except Bacteroides)
Chloramphenicol
Tetracycline
Which are true about TMS?
a) good gram positive coverage
b) good gram negative coverage
c) never use it alone
d) good for clostridial myositis
e) not good against Strept.
a) good gram positive coverage
b) good gram negative coverage
e) not good against Strept.
Which of the following are true about Rifampin:
a) good gram positive coverage
b) good gram negative coverage
c) never use it alone
d) good against obligate anaerobes
e) not good against Strept.
a) good gram positive coverage
c) never use it alone (resistance develops rapidly)
d) good against obligate anaerobes
(has SOME gram neg coverage)
Which of the following are true against Doxycycline?
a) good gram positive coverage
b) good gram negative coverage
c) never use it alone
d) good for clostridial myositis
e) not good against Strept.
a) good gram positive coverage
b) good gram negative coverage
d) good for clostridial myositis
e) not good against Strept (there is SOME strept resistance)
Which of the following are true about Chloramphenicol?
a) good gram positive coverage
b) good gram negative coverage
c) never use it alone
d) good for clostridial myositis
e) not good against Strept.
a) good gram positive coverage
b) good gram negative coverage
Which of the following are true regarding Enrofloxacin?
a) good gram positive coverage
b) good gram negative coverage
c) cannot be used in young horses
d) risk of aplastic anemia
e) is nephrotoxic
b) good gram negative coverage
c) cannot be used in young horses
(safe for horses in renal compromise)
Which antibiotic is good against clostridial myositis?
Doxycycline
Which antibiotic carries a risk of aplastic anemia in humans?
Chloramphenicol
What else (besides antibiotics) can be done to treat equine pneumonia/pleuritis?
NSAIDS (toxemia/pain)
Butorphanol (analgesia)
IV fluids
Icing feet & other laminitis control
When is pleural lavage indicated? What lavage fluid should be used?
Indicated when thic viscous pleural fluid present
Use isotonic saline (not Ca which promotes fibrin)
Which has the best prognosis usually?
a) bronchitis or bronchopneumonia
b) lung abscess
c) pleuropneumonia
a) bronchitis or bronchopneumonia
What are some complications of equine lower respiratory dz? Which is probably the worst?
Thrombophlebitis (worst)
Laminitis
Pleural &/or pulmonary abscess
bronchopleural fistula
pneumothorax
pericarditis
colitis (abx induced)
Which fungal organism causing equine lower resp tract dz can be seen in orgeon?
Cryptococcus gattii
What is the most useful diagnostic for fungal LRTD?
Lung biopsy w/PAS staining
What is the major cause of equine parasitic pneumonias? What is the reservoir host for this organism?
Dictyocaulus arnfieldi (donkeys, mules, and asses)
Also Parascaris equorum
How is parasitic pneumonia diagnosed? Treated?
Dx (eosinophils and/or larvae in BAL or TTW fluid)
Tx (ivermectin or moxidectin)
What are risk factors for equine respiratory disease?
Transport
High-intensity exercise
Comingling
EIPH
Poor air quality
Infectious agents
Cough, exercise intolerance, and mucus accumulation in the airways describe which non-infectious equine lower resp dz?
Inflammatory airway dz of athletic horses
What is the best method for diagnosing inflammatory airway disease and what are the 3 types of findings by this method?
BAL or tracheobronchial aspirate
1) mixed inflammation
2) increased metachromatic cells
3) eosinophilic inflammation
The most common form of IAD is...
...mixed inflammation (>10% neutrophils) but also lymphs and monocytes
If a horse w/IAD shows mixed inflammation, how should it be treated?
Systemic and/or inhaled corticosteroids
If a horse w/IAD has increased mast cells, how should it be treated?
Inhaled mast cells stabilizers (nedocromil Na or cromolyn); maybe inhaled corticosteroids
If a horse w/IAD has increased eosinophils cells, how should it be treated?
Corticosteroids (inhaled and/or systemic)
Interstitial pneumonia can be confused with which disease in older horses? Younger horses? How is it treated?
Older (heaves)
Younger (bacterial pneumonia)
Tx: steroids
How is interstitial pneumonia diagnosed?
Lung biopsy
Which of the following may NOT be causes of interstitial pneumonia?
a) mineral oil
b) EHV1
c) DIC
d) Silicosis
b) EHV1 (should be EHV 5)
Pulmonary fibrosis, hypoxemia without hypercapnia, and proliferation of type II pneumocytes describes...
...interstitial pneumonia
What are the treatment goals in interstitial pneumonia?
Treat/prevent underlying infxn
Suppress inflammation
Enhance O2 delivery
Relieve bronchoconstriction
Prevent complications
Maybe address fibrosis
When does interstitial pneumonia have a good prognosis?
Foals w/o immunodeficiency
The heave line is hypertrophy of...
external abdominal oblique
Which of the following will be seen in a horse w/moderate heaves?
a) heave line
b) cough
c) exercise intolerance
d) nasal discharge
e) weight loss
b) cough
c) exercise intolerance
d) nasal discharge
(heave line and wt loss are SEVERE)
The primary lesion in heaves is...
...bronchiolitis
What agents are involved in the pathogenesis of heaves?
Aspergillus or Micropolyspora
Pollen
Influenze infections
Genetics (IL4 issue)
What signs are seen on cytology in a horse with heaves?
Increase in HEALTHY neuts
Mucus plugs (Curschmann's spirals)
maybe bacteria/fungi
T or F:
Radiography is important in a suspected heaves case only to rule-out other causes.
True!
Heaves horses often have normal rads.
What are the major treatments for heaves?
Environmental control
Corticosteroids
Bronchodilators
What are some environmental changes used to treat heaves?
Steam/soak hay
NO ROUND BALES
Keep out of stable (unless pollen-associated)
Keep horses away from hay (move when cleaning, change bedding, etc)
What are the 3 bronchodilators available for heaves treatment? Which are rescue drugs? Which is longest acting?
Atropine (rescue)
Glycopyrrolate (rescue; long-acting)
Ipatropium Br