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285 Cards in this Set
- Front
- Back
Which cell organelle uses oxygen to provide energy for muscles?
|
mitochondria
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T/F The horse has a shit ton of mitochondria in its muscles.
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True
|
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How much oxygen per minutes does a resting horse need?
An exercising horse? |
2/3 gallons/min aka 2.5L/min
19 gallons/min (75L/min) |
|
Where is the equine soft palate in relation to the epiglottis?
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the SP is tucked tightly under the epiglottis
|
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Why are horses obligate nasal breathers?
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because their soft palate is tucked tightly under the epiglottis
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What must horses do to their airways during intense exercise?
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dilate: their nares, nasal passages, & nasopharynx
|
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You're at THE Ohio State doing your 198th week of equine rotation. Dr. THE Smith asks you how you would perform endoscopy for a URT exam. Your answer?
|
standing exam without sedation
use a twitch for physical restraint |
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Why don't you want to sedate a horse for a URT endoscopy exam?
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because xylazine causes the pharynx to collapse, preventing normal function of the URT
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Where do we put our endoscope to perform a URT exam?
Why? |
in the nostril thru the ventral meatus. to avoid hitting the ethmoid turbinates (which like to bleed)
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What meets at the nasomaxillary opening?
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where the sinuses meet...what sinuses?
|
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Thru what do the sinuses communicate with the nasopharynx?
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nasomaxillary opening
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Once inside the nasopharynx, which 5 structures are you going to identify?
|
"NODES"
Nasal septum Openings for guttural pouches Dorsal pharyngeal recess Ethmoid turbinates Soft palate |
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What forms the upper esophageal sphincter?
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cricopharyngeal muscle
|
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Once at the larynx, which structures are you going to identify?
|
"SAVER AVE"
Soft palate Arytenoid cartilages Vocal cords Epiglottis Rima glottis Aryepiglottic folds Ventricles Esophagus |
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Damage to the left recurrent laryngeal nerve results in...
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inability of the larynx to abduct
|
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Is sinusitis a disease of the upper or lower respiratory tract?
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upper of course
|
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What are the 2 clinically significant sinuses?
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frontal & maxillary
(these are the ones we knock on the horse's head during PE) |
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Where do the frontal & maxillary sinuses drain ?
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nasomaxillary opening
|
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What is the difference between primary & secondary sinusitis?
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Primary = due to respiratory tract infection
Secondary = due to tooth root infection, eg |
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Which agent most commonly causes primary sinusitis?
|
Streptococcus
|
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Sinusitis of which sinus is most common?
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maxillary sinusitis is commonest
|
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Sinusitis is very rare. Just wanted to throw that in there. Anyway, T/F It occurs following a viral URT infection.
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true
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Which sinus is affected by tooth root abscesses?
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maxillary sinus
|
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Which tooth roots cause tooth root abscesses?
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P4, M1-3
|
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What are 3 other causes of secondary sinusitis?
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sinus cysts
tumors facial bone fractures |
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What are 4 CS of sinusitis?
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nasal discharge
ocular discharge malaise facial deformity if chronic |
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How do you know if the nasolacrimal duct is patent?
What will you do when you come across that's blocked? |
put fluorescein in the eye & it'll drain down thru the nostril.
If it's plugged up, you can flush from the nose UP |
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How do you diagnose sinusitis?
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Well, on PE palpation & percussion will be off...but she doesn't like this cause it hurts...so
Endoscopy Oral exam Skull rads Sinoscopy CT MR |
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Sinusitis is an abscess! Therefore how do we treat these horses?
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drainage (trephine/balloon sinuplasty/sinoscopy/sinus flap) with repeated lavage (using balanced polyionic solution)
Antibiotics Treat inciting cause |
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What is this "balanced polyionic solution" she speaks of?
|
saline.
|
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When flushing the sinuses, we want to sedate & prevent ...
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aspiration
|
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How do you close a sinus flap?
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just lay the bone back down & it will heal
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What causes Strangles?
|
Strep equi equi
|
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Which Strep protein determines virulence?
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SeM protein (look for this in diagnostic testing)
|
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How contagious is Strangles?
How is Strangles contagious? |
very
nasal discharge contamination inhalation or ingestion |
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What is the incubation period of Strangles?
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3-14 days
|
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Who is most commonly affected by Strangles?
|
young horses
|
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How common is a fever with strangles?
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VERY VERY common
|
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Which LN are affected with Strangles?
|
submandibular
retropharyngeal parotid |
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Enlargement of which LN will cause tracheal compression & respiratory distress?
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retropharyngeal
|
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With Strangles affecting the retropharyngeal LN, you may find your patient in respiratory distress. When would you perform an emergency tracheostomy?
|
if you consider doing an emergency tracheostomy, do it!!
|
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T/F Sinusitis = abscessation of sinuses; Strangles = abscessation of LN
|
true
|
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What is hyporexia?
|
decreased appetite
|
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How the heck could Strangles (an upper respiratory tract disease) cause anemia?
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anemia of chronic inflammation/disease =)
|
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What does Strangles do to the horse's pharynx?
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causes pharyngeal obstruction, irritation, and soreness
|
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What are three historical questions you will ask the owner when you suspect Strangles?
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Is there Strangles on the farm?
Has the horse traveled? Is there a new horse on the property? |
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What are the 4 classical CS of Strangles?
|
fever
inappetance lymphadenopathy purulent nasal discharge |
|
You have a horse with enlarged LN, inappetance, fever, etc and assume it's Strangles. Strep equi equi causes Strangles, so why do you bother culturing?
|
in case it's NOT strep equi & is Strep zoo instead for example
|
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What is Strep zooepidemicus?
|
normal flora
|
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What are the 2 "absolutes" as far as treatment for Strangles goes (according to ACVIM)
|
strict isolation of affected horses & those exposed
attempt to confine disease (cause it's so highly infectious) |
|
You are the veterinarian for a busy stable in (insert state here). You have a horse you've just diagnosed with Strangles.
What do you tell the (very concerned) stable manager? |
isolate this horse, and check the rectal temp of all the other horses twice a day
|
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WHY is it so important to check rectal temps of horses with possible exposure to Strangles?
|
cause if we catch the fever we may be able to prevent the horse from shedding the bacteria....the horses will get a fever 1-2 days before they start shedding
|
|
If a horse is febrile and was exposed to Strangles, should you put him on antibiotics?
|
i'm not sure if this is a trick question....i'm going to have to listen to this recording.
Notes say: if febrile: ABx for a week will avoid CS but they may not develop good immunity... |
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If a horse exposed to a Strangles positive horse gets lymphadenopathy, what do you do?
|
isolate her...
|
|
What is the ABx of choice for Strangles?
|
Penicillin (it's a Strep)
|
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What is the most COMMON treatment plan for Strangles of a relatively healthy horse?
|
to let it run its course, ie no antibiotics, just NSADs & TLC
|
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How long do we have to isolate horses with Strangles?
|
*for 2-3 weeks after resolution of CS
*2-3 neg cultures of nasal/pharyngeal/guttural pouch areas |
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For how long can S. equi shed?
|
up to 36 mos!
|
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Once a horse has recovered from Strangles, what's her immunity like?
|
really good. She's basically immune to developing it again for at least 5 years.
|
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75% of horses develop solid immunity following infection with Strangles. What about the other 25%?
|
they may be re-infected within months & may develop complications
|
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What are the 5 complications of Strangles?
|
guttural pouch empyema
dyphagia chondroids bastard strangles purpura hemorrhagica |
|
What is Guttural Pouch Empyema?
|
when the retropharyngeal LN rupture & the guttural pouch fills with pus
|
|
How can guttural pouch empyema lead to dysphagia?
|
the inflammation in the GP leads to CN neuritis
|
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T/F Guttural Pouch Empyema is caused by Strangles
|
Partly true. Yes Strangles can cause it, but it can also be caused by Strep zooepidemicus, so you must always culture
|
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Where are the retropharyngeal LN found in respect to the guttural pouch?
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on the floor of the pouch?
|
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What are chondroids?
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inspissated pus aka hard balls of pus in the GP
|
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T/F Chondroids act as a chronic source of infection for the environment.
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True. Because horses with chondroids don't necessarily have CS, they can be carriers of Strep & a constant source of infection for other animals.
|
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How do you diagnose chondroids?
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GP endoscopy
|
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How do you treat chondroids?
|
remove
lavage instill penicillin jello |
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After removal & treatment of chondroids, when do you get to call a horse "Strep equi equi free?"
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after 2-3 neg cultures
|
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What causes Bastard Strangles?
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hematologic spread of S. equi infection
|
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What's the long-term prognosis of Bastard Strangles?
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guarded...they have to be on long-term ABx and their prognosis depends on which clinical systems were affected by the Strep
|
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What causes Bastard Strangles?
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hematologic spread of S. equi infection
|
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What is the immune-mediated vasculitis syndrome which horses with Strangles can develop?
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Purpura hemorrhagica
|
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What causes Bastard Strangles?
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hematologic spread of S. equi infection
|
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What's the long-term prognosis of Bastard Strangles?
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guarded...they have to be on long-term ABx and their prognosis depends on which clinical systems were affected by the Strep
|
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What puts horses at increased risk of developing Purpura?
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*if they're vaccinated when their titer is already really high
*if they have had previous S. equi infection |
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What's the long-term prognosis of Bastard Strangles?
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guarded...they have to be on long-term ABx and their prognosis depends on which clinical systems were affected by the Strep
|
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What is the immune-mediated vasculitis syndrome which horses with Strangles can develop?
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Purpura hemorrhagica
|
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What is the immune-mediated vasculitis syndrome which horses with Strangles can develop?
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Purpura hemorrhagica
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What are the 3 drugs you'll use to treat Purpura?
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ABx
NSAIDs CCS |
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What puts horses at increased risk of developing Purpura?
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*if they're vaccinated when their titer is already really high
*if they have had previous S. equi infection |
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What puts horses at increased risk of developing Purpura?
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*if they're vaccinated when their titer is already really high
*if they have had previous S. equi infection |
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How can you prevent Strangles?
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vx
|
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What are the 3 drugs you'll use to treat Purpura?
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ABx
NSAIDs CCS |
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What are the 3 drugs you'll use to treat Purpura?
|
ABx
NSAIDs CCS |
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What kind of horse would be a great example of one you would vx @ Strangles?
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one being transported
|
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How can you prevent Strangles?
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vx
|
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How can you prevent Strangles?
|
vx
|
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Efficacy of the Strangles vx depends upon immunity created: list the 3 bullet points under this heading....
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*SeM protein (injectable)
*mucosal immunity blocks entry of S. equi *parenteral vx also protective ...gotta listen to this lecture haha |
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What kind of horse would be a great example of one you would vx @ Strangles?
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one being transported
|
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What kind of horse would be a great example of one you would vx @ Strangles?
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one being transported
|
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Besides vx, what's an important way to prevent Strangles?
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isolate new horses for AT LEAST 3 weeks!
keep show/traveling horses separate from the farm population (if they are traveling then they are considered "new horses" too don't borrow tack or equipment |
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Efficacy of the Strangles vx depends upon immunity created: list the 3 bullet points under this heading....
|
*SeM protein (injectable)
*mucosal immunity blocks entry of S. equi *parenteral vx also protective ...gotta listen to this lecture haha |
|
Efficacy of the Strangles vx depends upon immunity created: list the 3 bullet points under this heading....
|
*SeM protein (injectable)
*mucosal immunity blocks entry of S. equi *parenteral vx also protective ...gotta listen to this lecture haha |
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In a pregnant mare, which vx are we going to give--killed or Live intranasal?
|
killed, 4-6 weeks prior to foaling
|
|
Besides vx, what's an important way to prevent Strangles?
|
isolate new horses for AT LEAST 3 weeks!
keep show/traveling horses separate from the farm population (if they are traveling then they are considered "new horses" too don't borrow tack or equipment |
|
Besides vx, what's an important way to prevent Strangles?
|
isolate new horses for AT LEAST 3 weeks!
keep show/traveling horses separate from the farm population (if they are traveling then they are considered "new horses" too don't borrow tack or equipment |
|
In a pregnant mare, which vx are we going to give--killed or Live intranasal?
|
killed, 4-6 weeks prior to foaling
|
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In a pregnant mare, which vx are we going to give--killed or Live intranasal?
|
killed, 4-6 weeks prior to foaling
|
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T/F All horses within a 200 foot radius should be vaccinated during a Strangles outbreak.
|
FALSE! "Do not vacinate during an oubreak"
|
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What are 2 complications that can arise from giving a killed Strangles vx?
|
local abscess
purpura hemorrhagica |
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How long does a killed vx @ strangles provide immunity for?
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6 mos
|
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If a horse has had Strangles in the past year, should we vaccinate?
|
no
|
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What is really really really important to remember about intranasal vx @ strangles???
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you can not have it anywhere near a horse that is receiving IM injections...if any little droplets of the intranasal vx get into the IM injection site they will get a huge abscess
|
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What are 2 complications of the intranasal stranges vx?
|
purpura hemorrhagica
pharyngitis (local abscesses if it gets near IM injection sites!) |
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Pharyngeal lymphoid hyperplasia is a disease of the _____ respiratory tract
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stil in the upper
|
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What are the 3 upper respiratory tract infections we've talked about?
|
sinusitis
strangles pharyngeal lypmphoid hyperplasia |
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Lymphoid tissue is diffusely distributed among which upper respiratory tract structures? (5)
|
"GETS D"
Guttural pouch lining Epiglottis Trachea Soft palate Dorsal & lateral walls |
|
PLH (pharyngeal lymphoid hyperplasia) is scored 0-4 based on the degree of:
|
pharyngeal lymphoid hyperplasia, lol
|
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What causes PLH?
|
environmental stimulants...bacteria, virus, endotoxins, ammonia (urine), dust, metals
|
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PLH affects what horses?
|
young (1-2 yo)
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With increasing severity, PLH causes decreased air flow to the alveoli.
What are the SYSTEMIC effects of PLH? |
there are none!
they're never systemically ill, they're BAR w/ a normal appetite |
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T/F Horses with PLH are systemically ill.
|
False!
|
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What is the lymphoid tissue's response to breathing in environmental pathogens?
|
mucus & Ab production
|
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So...I think I have this right...why does PLH cause decreased performance?
|
all the mucus causes decreased performance (this is well studied in racehorses)
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T/F Inflammation is a key component in respiratory diseases.
|
True
|
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What are the 3 commonest causes of viral respiratory dz in equines?
|
equine influenza A
herpes-1 herpes-4 |
|
Influenza A & herpes-1 & 4 are your common viruses causing respiratory infection. What are two less common viruses?
|
EVA
Rhinovirus |
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Why do upper respiratory viral infections create the potential to cause lower respiratory disease?
|
they damage the mucociliary tract
|
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What is the most frequently diagnosed cause of equine viral respiratory disease?
|
Equine Influenza A
|
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Describe the virus Equine Influenza A.
|
ssRNA
orthomyxoviridae HA & NA = surface proteins that determine host specificity |
|
What are HA & NA?
|
Hemaglutinin (HA)
Neuraminidase (NA) = surface proteins of Equine Influenza A that determine host specificity |
|
T/F Equine Influenza A is subject to antigenic shift just as with human influenza.
|
False. notes say drift...i dont remember what the difference is but I know there is one
|
|
In the USA, which strain of influenza is causing disease?
|
A2 strain (H3N8)
|
|
How old are horses that are affected by influenza?
|
usually under 3
|
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What's the morbidity/mortality of equine influenza A?
|
practically everyone gets sick but no one's going to die (less than 1% die)
|
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Is it good when horses are commingled...?
|
no...? morbidity reaches 100% & mortality can increase
|
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How is influenza spread?
|
via aerosolized respiratory secretions or direct nose-to-nose contact
|
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T/F Equine influenza has tropism for respiratory epithelium
|
true
|
|
How does influenza potentiate secondary bacterial infection?
|
by impairing the mucociliary clearance system
|
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What is the incubation time for influenza?
|
1-3 days; they're shedding within 48 hours tho, so they may start shedding before they show CS?
|
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What causes a higher fever--viral or bacterial infection?
|
viral
eg influenza causes temps of 105 for 5 days! |
|
What's an influenza cough sound like?
|
it's a dry hacking cough that persists
|
|
Viruses cause a mucopurulent or serous nasal discharge?
|
serous. it can change to mucopurulent when secondary bacteria comes in
|
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How long are horses clinically ill for with influenza?
|
1-2 weeks, tho the dry hacking cough can persist for 3 weeks
|
|
What are the complications of equine influenza?
|
well, it prevents training & thus compromises the racing industry. also,
*bacterial pneumonia *myocarditis *limb edema *weight loss |
|
When does influenza kill a horse?
|
if they're stressed or are immuno-compromised
|
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T/F There is a carrier state that develops with Influenza.
|
False
|
|
How can you prove your presumptive diagnosis of influenza?
|
collect a nasopharyngeal swab & check "PCR" on the lab sheet...or do a virus isolation
|
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Does influenza usually affect 1 or more horses on a property?
|
more than 1
|
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When is the best time to isolate the influenza virus?
|
24-48 hours following development of CS
|
|
Holy moly, trainers HATE influenza. Why??
|
because vets recommend resting the horse a full week for every day that they were sick!!
|
|
Do we treat influenza with antibiotics?
|
no, she reserves them in case secondary complications
|
|
So what's really important when it comes to treating a horse with influenza?
|
rest rest rest
no training 1 week off for every day sick |
|
T/F Unfortunately, there is no vx for influenza.
|
hellllll no
There most definitely IS a vx @ influenza, and it is intended for those expensive ones that race and show |
|
What does the influenza vaccine do?
|
it decreases the severity of the disease, it does NOT prevent it
|
|
How often do we have to vx @ influenza?
|
every 4-6 mos because the immunity is short lived
|
|
There are 3 types of Influenza vx...killed, MLV, & canary pox (recombinant). Which is intranasal?
|
MLV is intranasal
|
|
Ok, what do you tell your owner when he asks when he should start vx his foal @ influenza?
|
if the baby's mom was vaccinated, then do it at 9 mos
if she wasn't vx, start at 6 mos |
|
Why don't we vaccinate a foal under 6 mos old?
|
because he still has his maternal Ab
|
|
Which two herpesviruses are responsible for respiratory disease in horses?
|
1 & 4
|
|
What is recrudescence?
|
When they get sick again...pretty much the opposite of latent
|
|
Which herpesvirus causes abortions storms?
What else can this cause? |
EHV-1
Neuro disease (myeloencephalopathy) |
|
What kind of virus are EHV-1 & 4?
|
dsDNA, herpesviridae
|
|
Equine herpesvirus targets what cells?
|
Vascular endothelium (causing vasculitis, hemorrhage, thrombosis, necrosis)
|
|
Does herpes cause upper ormlower respiratory tract infection?
Therefore, is cough a common sign? |
Upper resp = no cough
|
|
How does a horse fight off an EHV infection?
|
Cytotoxic T-cell response
|
|
How do you diagnose EHV?
|
Nasal swab
|
|
When is Acyclovir used in equines?
|
It's reserved for EHV-1 myeloencephalopathy
|
|
What kind of virus is EVA?
|
ssRNA
|
|
What three syndromes does EVA cause?
|
Respiratory
Vasculitis Abortion |
|
EVA produces _________ respiratory signs, similar to EHV & influenza.
|
Viral
|
|
Why does EVA cause edema (sheath, limbs, pecs, mammary gland)?
|
I guess cause it causes vasculitis
|
|
Who gets the EVA vaccine?
|
1. Colts intended for breeding (6mos)
2. Mares prior to breeding a carrier stallion |
|
What do you have to tell e client to do with their mare when you vx her prior to breeding a carrier stallion?
|
Isolate for 3 weeks because she will have transient viral shedding
|
|
The target tissue for influenza = ____________.
What are the target tissues for EHV & EVA? |
Airway epithelium
Respiratory epithelium, LN, vascular endothelium |
|
T/F All viral respiratory agents can be transmitted via aerosol, vomited, and venereally.
|
False--only EVA is venereal
|
|
What age gets Rhodococcus equi infection?
|
Foals 3 wks-6 mos....they're infected early in life
|
|
Rhodococcus is a gram positive intracellular bacteria that attacks/resides in which cells?
|
Macrophages
|
|
T/F. Rhodococcus is ubiquitous in the environment (soil).
|
True
|
|
What happens when a foal gets the subacute form of Rhodococcus?
|
Dead foal
|
|
What's the gold standard for diagnosing Rhodococcus?
|
Culture of TTW
|
|
If you do TTW of a Rhodococcus goal what do you expect to see on cytology?
|
Intracellular gram + pleomorphic rods
|
|
What kind of pneumonia do foals get from Rhodococcus?
|
Chronic pyogranulomatous bronchopneumonia
|
|
What lung pattern do you see on rads of foals with Rhodococcus?
|
Bronchoalveolar
|
|
T/F Pleural disease is not readily seen with U/S.
|
False--pleural irregularities can be observed in early dz
(U/S can be used as a screening tool) |
|
T/F Pleural disease is not readily seen with U/S.
|
False--pleural irregularities can be observed in early dz
(U/S can be used as a screening tool) |
|
T/F TTW maybe shouldn't be done in patients with respiratory distress.
|
True--"caution in patient w/ring respiratory distress"
|
|
Is coughing during a TTW good for sample collection
|
no--it mixes pharyngeal bacteria into the sample then
|
|
What is in an infectious complication of performing a TTW?
|
cellulitis
|
|
What are extrapulmonary lesions that can result from Rhodococcus infection?
|
GI--colic/D+/mesenteric LN abscessation
polysynovitis panophthalmitis |
|
T/F The polysynovitis resulting from a Rhodococcus infection presents as a non-septic pleocytosis with a negative culture.
|
True...
|
|
Is polysynovitis the same as septic arthritis?
|
nope
|
|
What is panophthalmitis?
|
immune complex & fibrin deposition in the eye --> green eye
|
|
How do you treat panophthalmitis?
|
NSAIDs & atropine (to keep the iridocorneal angle open to prevent synichiae formation)
|
|
Rhodococcus used to be treated with Erythromycin & Rifampin, however erythromycin has serious side effects including...
|
hyperthermia --> tachypnea
fatal colitis in mom if she licks it off the lips of the foal |
|
Because of erythromycin's devastating side effects in adult horses, what is the typical combination to treat Rhodococcus infection today?
|
clarithromycin + rifampin
|
|
T/F Foals with a history of Rhodococcus will not make it to the racetrack.
|
False--they can. And if they do make it to the track then they may still be able to kick ass in races.
|
|
What's the prognosis of Rhodococcus?
|
60-90% survive
|
|
Who gets EIPH (exercise induced pulmonary hemorrhage)?
|
Thoroughbreds!
(all TBs, most SBs, a lot of QHs) |
|
What is the colloquial (?) term for EIPH?
|
Bleeders
|
|
T/F When a racehorse has blood in its airway (EIPH), they are going to have poor performance.
|
True. Most definitely.
|
|
T/F EIPH is almost always associated w/ blood in the nostrils.
|
False--we rarely see blood in the nostrils
|
|
T/F If you race with intensity you will bleed at least once in your career (if you're a horse).
|
True
|
|
Where do "they" think EIPH bleeds come from?
|
pulmonary capillaries...from such high pressures in them (goes from 20 to 100mmHg w/ intense exercise) due to very negative inspiratory pressures
ok so clearly i don't fully understand the concept & that was just a bunch of words from the slide...but i think it kinda makes sense |
|
How does a horse have enough O2 to run at speed for a mile?
|
Dramatic increase in CO via increased HR
|
|
Why are horses crossing the finish line hypoxemic?
|
because their blood is whizzing by the alveoli so freaking fast the RBCs can't even be loaded with oxygen
|
|
When do horses inspire when running?
|
with every single stride it takes! (that's REALLY fast breathing)
|
|
T/F EIPH is due to long duration of exercise.
|
FALSE--it's due to high INTENSITY of exercise.
Good job, i know i didn't trick you =) |
|
If you scope EIPH horses within an hour of racing what are you going to see?
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blood in the trachea.
(you are most likely NOT going to see epistaxis) |
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Which is better--BAL or TTW for EIPH diagnosis?
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BAL because it gets a deeper, more localized sample.
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BAL is classically performed for which two diseases in horses?
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EIPH & Heaves
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When do we tend to do a TTW in horses?
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infectious diseases
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Which provides a representative sample of both lung fields--BAL or TTW?
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TTW
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Which lung lobe do EIPH horses most commonly bleed into?
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caudodorsal
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Are EIPH bleeds (into the caudodorsal lung lobe) picked up well on rads?
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nope
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T/F The higher the grade of EIPH, the less likely they are to win, place, or win a lot of money.
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True
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T/F Fillies are most commonly affected by EIPH.
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False...no age, gender, or breed disposition---it just has to do w/ the intensity of exercise individual horses experience
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What is the "treatment" for EIPH?
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lasix...it decreases preload, thus decreasing contractility & pressures in the lung
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One treatment goal to prevent EIPH is to dilate the airways (nostrils) & correct ILH.
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yeah
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What's the common name for Recurrent Airway Obstruction?
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Heaves
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How do you diagnose Heaves--BAL or TTW?
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BAL
(BAL is also classically used for EIPH) |
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Why is the lower airway obstructed in Heaves?
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inflammation of the bronchial wall (w/ neutrophils) & mucus production
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What's a tracheal rattle?
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you hear the mucus in it
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What do you see in lungs that are chronically inflamed?
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chronic changes like fibrosis
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T/F Cough is not a major component of Heaves.
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False, it is.
Remember, cough is a major sign of lower respiratory disease. |
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When do you hear the classic wheezes associated with Heaves?*
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Expiration*
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What's a "heave line?"
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idk, some muscles get really big due to increased expiratory effort
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T/F Heaves results in a decreased fiO2
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true
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When are Heaves horses worse: in or outside?
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inside. always worse inside.
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T/F Heaves horses have moderately high fevers.
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False--they should be afebrile & otherwise totally healthy, with a good appetite, etc.
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What kind of lung pattern do we see on rads of a Heaves horse?
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bronchointerstitial
(which is difficult to recognize because old horse lungs already look like this) |
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When performing BAL via endoscope, what must you do with the scope first?
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sterilize it!
(remember those scopes go everywhere...stomach...ass...) |
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With which test do we use more saline--BAL or TTW?
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BAL!! We use 3 sets of 50ml w/ BAL (vs TTW = 5-10 ml or something)
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So we're putting 150cc into the horses lower airways when we perform BAL. Granted we suck as much as we can out, but what are the risks of aspiration pneumonia occurring?
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slim...this volume of water is easily absorbed. Only recommendation is to withhold exercise for a day following BAL.
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In a normal BAL sampling, there should always be less than ___% neutrophils.
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<10%
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What cell predominates in Heaves inflammation?
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neutrophils...they can make up 80-90% of cells!
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A horse has a history of poor performance and increased recovery time. You suspect heaves cause he has a Heave Line.
Thoracic auscultation is normal. What do you do next? |
re-breathing bag...with this you're more likely to hear the wheezes, expiratory crackles, & coughing.
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What's the Atropine Test about?
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via its parasympatholytic action it causes almost immediate in horses w/ bronchoconstriction (ie Heaves)
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Because atropine is a parasympatholytic, what side effects do we see?
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GI stasis
mydriasis tachycardia Hence, it can't be used on a routine basis offer temporary(ie for treatment of Heaves) |
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Besides atropine, what drug can be used to offer immediate relief of bronchoconstriction?
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buscopan
(remember, buscopan dilates the ass; it can dilate the airways too) |
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Why do arterial blood gas of Heaves suspects? ie,
do you expect to see? |
hypoxemia +/- hypercapnia
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What's the tx for Heaves?
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reduce exposure to Ag
reduce pulmonary inflammation ie CHANGE THEIR ENVIRONMENT |
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What do you feed a horse with Heaves?
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not hay. not round bales. everything has to be soaked to reduce the dust & Ag load
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How do you house a horse w/ Heaves?
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bed them on shavings, NOT straw (straw is dusty)
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Which drug is a mainstay of Heaves treatment?
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CCS
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What's the prognosis for Heaves?
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well, it's a lifelong disease, ie it has to be managed forever. remission is common.
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Which parasite = equine lungworm?
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Dictyocaulus arnfieldi
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T/F D. arnfieldi in donkeys: they have patent infections butttt they are asymptomatic.
What does that mean? |
True
It means the parasite completes its lifecycle in the donkey (ie the infective stage of the parasite will be shit out by them) but the donkeys don't get sick from them |
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What is the infective stage of D. arnfieldi?
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ingestion of L3
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How do L3s become L4s?
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They migrate thru the intestinal wall into LNs, where they mature to L4.
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Which stage of D. arnfieldi causes respiratory problems?
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L4...they are coughed up into the alveoli
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If you perform BAL of a horse and see D. arnfieldi organisms, which stage are you seeing?
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L4s...so larvae
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T/F Horses have a fully patent infection w/ D. arnfieldi
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False...therefore horses are not a source of environmental infection.
(only donkeys give horses D. arnfieldi. Horses do not transmit it to other horses) |
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D. arnfieldi causes parasitic bronchitis characterized by which sounds?
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cough, crackles, & wheezes
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If you see eosinophils on tracheal aspirations or BAL, what are you going to treat the horse with?
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ivermec or moxidectin
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Who most commonly gets Pleuropneumonia?
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traveling adult horses
aka Shipping Fever |
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T/F Shipping Fever in horses is caused by Mannheimia hemolytica.
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False--that's cows
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Why do horses w/ PP (pleuropneumonia) have decreased surfactant levels?
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because type II alveolar cells are being destroyed
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What are some things that cause Pleuropneumonia?
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transport
strenuous exercise (dirt up the shnoz in racehorses) post-anesthesia |
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Gosh, what are 3 reasons general anesthesia can cause pleuropneumonia?
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1. intubation can pass bacteria into lower airways.
2. compression atelectasis --> vascular congestion --> ischemia --> necrosis = great for bacterial growth to occur 3. GA compromises mucociliary clearance |
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What happens after bacteria colonize the lung?
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pneumonia, abscessation, & inflammation of the pleura --> accumulation of pleural fluid
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T/F Bacteroides (an anaerobe) are resistant to pencillins.
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True. They have penicillinase.
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Which is worse...aerobic or anaerobic pleuropneumonia?
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anaerobic
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Why might a horse with pleuropneumonai develop ventral edema?
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hypoalbuminemia due to dumping of proteinaceous effusive protein into the chest
(wow, that must be a dramatic amount) Also, because albumin is a neg acute phase protein (ie it goes DOWN w/ inflamm) |
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How common is endotoxemia following pleuropneumonia?
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"very very very common"
& is followed by laminitis |
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What is pleurodynia characterized by?
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pain--elbows out, small shallow breaths...maybe even colic signs
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What will thoracic auscultation sound like in a horse w/ late stage pleuropneumonia?
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absent lung sounds in ventral fields
crackles & wheezes up top (they'll also have dark red mm...from endotoxemia) |
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T/F Laminitis could be the first sign of pleuropneumonia.
|
yeah...not all owners are as "astute" as others =/
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Best imaging modality for pleuropneumonia?
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U/S to show you have a fluid component in the pleural space
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T/F On CBC of a pleuropneumonia horse, you can see neutrophilia or neutropenia.
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Yep, depends if they have margination of the neutrophils or not (due to endotoxemia)
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What's the protein counts like in a horse with pleuropneumonia?
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high fibrinogen
high globs hypoalbuminemia (again, neg vs pos acute phase proteins) |
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Should you perform an arterial blood gas in a horse in respiratory distress?
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no it can freak them out too much & kill them or something equally dramatic
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I've got some random line in my notes that says "EHV-5 = multinodular pulmonary fibrosis."
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You're welcome?
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Horses w/ Heaves...should they be kept inside or outside?
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outside! TURN YOUR HORSE OUT!
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What's a DDx for equine lungworm?
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Heaves
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When type II alveolar cells are destroyed, you have decreased surfactant production.
What's the effect of this? |
collapsed airways = no air = no oxygen = anaerobic envt = decreased macrophage function = bacteria can proliferate!
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What are 4 things predisposing to pleuropneumonia?
(i may have only asked 3 before) |
transport
viral infection strenuous exercise post-anesthesia |
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What are 4 gram neg bacteria causing pneumonia in horses?
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B-KAP
Bordetella Klebsiella Actinobacillus Pasteurella |
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What are 4 anaerobic organisms causing pneumonia in horses?
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Bacteroides
Clostridium Peptostreptococcus* Fusobacterium |
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Tell me some CS of pneumonia in horse.
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fever/lethargy/inappetance/weight loss blah
respiratory signs like cough, dyspnea, nasal d/c blah +/- ventral edema, endotoxemia, laminitis |
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Are horses with pneumonia SICK or do they have a respiratory component but are otherwise healthy?
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Pneumonia kills old people in hospitals.
It'll kill a horse too. These guys are SICK! |
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What is pleurodynia?
|
pleural pain
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Who gets pneumonia by the way?
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YOUNG horses
(adults get pleuropneumonia, and old horses get cancer) |
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What are DDx for pneumonia in an older horse...15-25 yo?
|
fungal pneumonia
granulomatous lung dz EHV-5 neoplasia |
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What do we perform to collect a sample for pneumonia? BAL or TTW?
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TTW ... remember this test is good for infectious oraganisms
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Besides the whole breathing thing, and the whole endotoxemia thing, what is a major concern for horses w/ pneumonia?
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nutrition...weight loss is a huge concern for these patients
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Why might a horse with pneumonia require colloid support?
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albumin is a neg acute phase protein = these guys are hypoalbuminemic
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What are the antimicrobials of choice for treatment of pneumonia?
|
long-term beta-lactams (+ metronidazole for anaerobic infections)
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When you do cytology of a pneumonia horse, do you expect high or low TCC?
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high nucleated cell count...like over 10,000 (mostly neutrophils)
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What's the prognosis for pneumonias?
|
GUARDED
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Horses that survive pneumonia return to previous performance how often?
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only half the survivors can
|
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What are major complications of pneumonia?
|
laminitis
thrombophlebitis enterocolitis chronic pulmonary abscessation bronchopleural fistula whatever that means bankruptcy |
|
Let's say the owner of a pneumonia horse decides they don't like the odds and/or cost of treating the disease & elects euthanasia.
What 3 lesions will you see on necropsy? |
1. fibrinous pleuopneumonia
2. fluid accumulation 3. adhesions |