Bryan - La Med Ii - Equine Respiratory Disease - Winter 3Rd Year

Front 1

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

Back 1

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)

Front 2

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

Back 2

d) replicates within neutrophils (NO - it replicates extracellularly leading to neutrophil accumulation and abscess formation)

Front 3

What are the 2 prime features of S. equi equi pathogenicity?

Back 3

M protein
HA capsule

Front 4

What is bastard strangles?

Back 4

Dissemination of S. equi equi to other lymph nodes

Front 5

Put the following in order and apply approximate timelines to a strangles infection:
Fever
Exposure
Organism shedding
Lymph node rupture
Regional LN involvement

Back 5

Exposure (day 0)
Fever (and other cx 3-14d)
Regional LN (2-4 d post fever)
Shedding (2-9d after fever)
Rupture (7-14d)

Front 6

Which lymph node is commonly involved in strangles?

Back 6

Retropharyngeal

Front 7

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

Back 7

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)

Front 8

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

Back 8

b) Vaccination (may cause purpurea)
d) Lance & drain lymph nodes

Front 9

How should a horse with strangles and lymph node abscesses be treated?

Back 9

Lance nodes and flush w/3% povidone
Treat w/abx ONLY if upper airway obstruction
Possible tracheostomy if severe

Front 10

How should horses exposed to strangles be treated?

Back 10

Isolation + antibiotics

Front 11

How should horses with complicated strangles be treated?

Back 11

Penicillin + Rifampin
Treat symptoms/conditions (guttural pouch empyema, fluids, surgery, & etc) as necessary

Front 12

T or F:
Horses recovered from strangles are immune thereafter.

Back 12

False!
~70% of horses develop solid immunity that lasts a few years.

Front 13

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

Back 13

d) rare after initial exposure
e) treated by vaccination
(rare in initial infection; usually after 2nd normal exposure; vaccination won't help)

Front 14

What are some strangles complications?

Back 14

Asphyxiation
Guttural pouch empyema
Bronchopneumonia
Bastard strangles
Immune mediated myositis
Laryngeal hemiplegia
Cardiac/CNS dz

Front 15

What are signs of purpura hemorrhagica?

Back 15

PItting edema over limbs, head, trunk
Petechiation of mucous membranes
May have severe colic
Warm painful edema

Front 16

What are lab signs of purpura hemorrhagica?

Back 16

Neutrophilic leukocytosis
high fibrinogen
anemia
Leukocytoclastic vasculitis

Front 17

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

Back 17

a) NSAIDs
b) Penicillin
(Corticosteroids ONLY for severe cases; most cases are mild)

Front 18

T or F:
Exercise intolerance due to lower respiratory disease usually doesn't present with abnormal breathing noises.

Back 18

True!

Front 19

What kind of discharge is usually associated with equine COPD?

Back 19

Profuse white discharge

Front 20

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

Back 20

b) Guttural pouch disease

Front 21

What are some causes of dysphagia?

Back 21

Pb toxicity
EPM
Nutritional myodegeneration
Guttural pouch dz
Epiglottic dz
Encephalitis
Palate disorder

Front 22

What are some causes of nasal exudate?

Back 22

Guttural pouch empyema
Sinusitis
Rhinitis
Pneumonia
Pharyngitis
Sinus cysts
COPD

Front 23

What are some causes of epistaxis?

Back 23

EIPH
Trauma
Guttural pouch mycosis
Ethmoid hematoma
Nasal foreign body
Neoplasia
Nasal fungla granuloma
Nasal polyp
Coagulation disorders

Front 24

What are the 4 equine sinuses and which one is difficult to assess?

Back 24

Frontal
Sphenopalatine (tough to assess)
Rostral maxillary
Caudal maxillary

Front 25

What is the most common neoplasia of the equine sinuses?

Back 25

SCC

Front 26

What are the common fungal etiologies of equine nasal fungal granulomas?

Back 26

Cryptococcus neoformans
Coccidioides immitis

Front 27

What are the signs of equine sinus disease?

Back 27

Unilateral nasal discharge
Facial distortion
Quidding & abnormal mastication
Ocular discharge

Front 28

What is the common presentation of sinusitis in horses?

Back 28

Older horse w/unilateral nasal discharge that doesn't clear w/antibiotics (usu a tooth root problem)

Front 29

Which of the following result in PRIMARY sinusitis?
a) 1st molar impaction
b) skull fracture
c) Streptococcus infection
d) Cryptococcus infection
e) Neoplasia

Back 29

c) Streptococcus infection

Front 30

What are indicators for FAILURE of conservative treatment for sinusitis?

Back 30

Infection/necrosis of mucosal lining
Failure of drainage/Inspissation of pus
Predisposing cause of sinusitis hasn't been identified

Front 31

If you see a horse with with guttural pouch disease and it is consistently pointing its muzzle to the right, where is the lesion?

Back 31

Left vestibular

Front 32

What structures are in the medial guttural compartment?

Back 32

Internal carotid
IX, X, XII, XII
Sympathetic trunk
Cranial cervical ganglion

Front 33

What structures are in the lateral guttural compartment?

Back 33

VII
Maxillary a and v
External carotid

Front 34

Which bacterium is guttural pouch empyema associated with?
How is this treated?

Back 34

Strangles! (beta-hemolytic S. equi equi) - treat with Penicillin if S. equi

Front 35

Which fungus is often implicated in guttural pouch mycoses? What pharmaceuticals can be used?

Back 35

Aspergillus nidulans or fumigatus
(Miconazole, itraconazole, enilconazole topically; itraconazole or amphotericin B systemically)

Front 36

What are some signs of guttural pouch mycosis?

Back 36

Nasal discharge to epistaxis
Dysphagia
Respiratory noise
Laryngeal hemiplegia
Horner's syndrome

Front 37

What are the components of Horner's syndrome?

Back 37

Ptosis, meiosis, enopthalmos
Sweating/warmth on affected side

Front 38

Which agents are implicated in equine fungal granulomas?

Back 38

Conidiobolus
Coccidiodes
Rhinosporidium
Aspergillus

Front 39

T or F:
Pharyngeal lymphoid hyperplasia is always an incidental finding and treated with benign neglect.

Back 39

False!
Severe PLH can cause nasal discharge, mild lymphadenopathy, and inducible cough

Front 40

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

Back 40

a) Mare 1 month prior to foaling
b) A horse w/low ELISA titer

Front 41

T or F:
In the adult horse, you should not see idiopathic pneumonia.

Back 41

True!

Front 42

What bacterium is usually implicated in equine pneumonia?

Back 42

S. equi zooepidemicus

Front 43

Which bacteria worsen the prognosis for equine pneumonia?

Back 43

Anaerobes (Bacteroides, Clostridium, Peptostreptococcus, Eubacterium)

Front 44

If you recover mycoplasma from a horse with pleuritis, what antibiotic should you use?

Back 44

Oxytetracycline

Front 45

Which antibiotic should be used for Bacteroides pneumonia?

Back 45

Metronidazole

Front 46

What lab findings can be seen in pneumonia with pleural effusion?

Back 46

Leukopenia
Hemoconcentration
Azotemia
Metabolic acidosis
Low Na, Cl, and total protein
Hyperfibrinogenemia
Maybe hypoxemic

Front 47

With thoracic ultrasound, you see a bright line and artifacts below. What gives?

Back 47

Normal thorax

Front 48

With thoracic ultrasound, you see a big meaty lung. What gives?

Back 48

Consolidation

Front 49

With thoracic ultrasound, you see comet tails and something that looks like an octopus. What gives?

Back 49

Pleuritis! Octopus is pericardiodiaphragmatic ligament

Front 50

Which is better with equine respiratory disease diagnostics, tracheal wash or BAL?

Back 50

Tracheal wash!

Front 51

Where is thoracocentesis in a horse performed?

Back 51

7th or 8th intercostal space above the costo-chondral jxn (on the left); 6th to 7th (on the right)

Front 52

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

Back 52

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)

Front 53

How will thoracic fluid in a horse with septic pleuritis look?

Back 53

High cell count (degenerate)
High protein
low pH, low glucose
foul smell

Front 54

What is the initial treatment for equine pneumonia?

Back 54

Penicillin
Gentamicin
Metronidazole

Front 55

Which antibiotics should you NOT use with anaerobes?

Back 55

TMS, Enrofloxacin, Aminoglycosides (Penicillin also for Bacteroides)

Front 56

Which antibiotics are good for anaerobes?

Back 56

Penicillin (except Bacteroides)
Chloramphenicol
Tetracycline

Front 57

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.

Back 57

a) good gram positive coverage
b) good gram negative coverage
e) not good against Strept.

Front 58

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.

Back 58

a) good gram positive coverage
c) never use it alone (resistance develops rapidly)
d) good against obligate anaerobes
(has SOME gram neg coverage)

Front 59

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.

Back 59

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)

Front 60

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.

Back 60

a) good gram positive coverage
b) good gram negative coverage

Front 61

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

Back 61

b) good gram negative coverage
c) cannot be used in young horses
(safe for horses in renal compromise)

Front 62

Which antibiotic is good against clostridial myositis?

Back 62

Doxycycline

Front 63

Which antibiotic carries a risk of aplastic anemia in humans?

Back 63

Chloramphenicol

Front 64

What else (besides antibiotics) can be done to treat equine pneumonia/pleuritis?

Back 64

NSAIDS (toxemia/pain)
Butorphanol (analgesia)
IV fluids
Icing feet & other laminitis control

Front 65

When is pleural lavage indicated? What lavage fluid should be used?

Back 65

Indicated when thic viscous pleural fluid present
Use isotonic saline (not Ca which promotes fibrin)

Front 66

Which has the best prognosis usually?
a) bronchitis or bronchopneumonia
b) lung abscess
c) pleuropneumonia

Back 66

a) bronchitis or bronchopneumonia

Front 67

What are some complications of equine lower respiratory dz? Which is probably the worst?

Back 67

Thrombophlebitis (worst)
Laminitis
Pleural &/or pulmonary abscess
bronchopleural fistula
pneumothorax
pericarditis
colitis (abx induced)

Front 68

Which fungal organism causing equine lower resp tract dz can be seen in orgeon?

Back 68

Cryptococcus gattii

Front 69

What is the most useful diagnostic for fungal LRTD?

Back 69

Lung biopsy w/PAS staining

Front 70

What is the major cause of equine parasitic pneumonias? What is the reservoir host for this organism?

Back 70

Dictyocaulus arnfieldi (donkeys, mules, and *****)
Also Parascaris equorum

Front 71

How is parasitic pneumonia diagnosed? Treated?

Back 71

Dx (eosinophils and/or larvae in BAL or TTW fluid)
Tx (ivermectin or moxidectin)

Front 72

What are risk factors for equine respiratory disease?

Back 72

Transport
High-intensity exercise
Comingling
EIPH
Poor air quality
Infectious agents

Front 73

Cough, exercise intolerance, and mucus accumulation in the airways describe which non-infectious equine lower resp dz?

Back 73

Inflammatory airway dz of athletic horses

Front 74

What is the best method for diagnosing inflammatory airway disease and what are the 3 types of findings by this method?

Back 74

BAL or tracheobronchial aspirate
1) mixed inflammation
2) increased metachromatic cells
3) eosinophilic inflammation

Front 75

The most common form of IAD is...

Back 75

...mixed inflammation (>10% neutrophils) but also lymphs and monocytes

Front 76

If a horse w/IAD shows mixed inflammation, how should it be treated?

Back 76

Systemic and/or inhaled corticosteroids

Front 77

If a horse w/IAD has increased mast cells, how should it be treated?

Back 77

Inhaled mast cells stabilizers (nedocromil Na or cromolyn); maybe inhaled corticosteroids

Front 78

If a horse w/IAD has increased eosinophils cells, how should it be treated?

Back 78

Corticosteroids (inhaled and/or systemic)

Front 79

Interstitial pneumonia can be confused with which disease in older horses? Younger horses? How is it treated?

Back 79

Older (heaves)
Younger (bacterial pneumonia)
Tx: steroids

Front 80

How is interstitial pneumonia diagnosed?

Back 80

Lung biopsy

Front 81

Which of the following may NOT be causes of interstitial pneumonia?
a) mineral oil
b) EHV1
c) DIC
d) Silicosis

Back 81

b) EHV1 (should be EHV 5)

Front 82

Pulmonary fibrosis, hypoxemia without hypercapnia, and proliferation of type II pneumocytes describes...

Back 82

...interstitial pneumonia

Front 83

What are the treatment goals in interstitial pneumonia?

Back 83

Treat/prevent underlying infxn
Suppress inflammation
Enhance O2 delivery
Relieve bronchoconstriction
Prevent complications
Maybe address fibrosis

Front 84

When does interstitial pneumonia have a good prognosis?

Back 84

Foals w/o immunodeficiency

Front 85

The heave line is hypertrophy of...

Back 85

external abdominal oblique

Front 86

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

Back 86

b) cough
c) exercise intolerance
d) nasal discharge
(heave line and wt loss are SEVERE)

Front 87

The primary lesion in heaves is...

Back 87

...bronchiolitis

Front 88

What agents are involved in the pathogenesis of heaves?

Back 88

Aspergillus or Micropolyspora
Pollen
Influenze infections
Genetics (IL4 issue)

Front 89

What signs are seen on cytology in a horse with heaves?

Back 89

Increase in HEALTHY neuts
Mucus plugs (Curschmann's spirals)
maybe bacteria/fungi

Front 90

T or F:
Radiography is important in a suspected heaves case only to rule-out other causes.

Back 90

True!
Heaves horses often have normal rads.

Front 91

What are the major treatments for heaves?

Back 91

Environmental control
Corticosteroids
Bronchodilators

Front 92

What are some environmental changes used to treat heaves?

Back 92

Steam/soak hay
NO ROUND BALES
Keep out of stable (unless pollen-associated)
Keep horses away from hay (move when cleaning, change bedding, etc)

Front 93

What are the 3 bronchodilators available for heaves treatment? Which are rescue drugs? Which is longest acting?

Back 93

Atropine (rescue)
Glycopyrrolate (rescue; long-acting)
Ipatropium Br