Podcast
Questions and Answers
Which of the following is NOT a primary objective when assessing equine lower respiratory diseases?
Which of the following is NOT a primary objective when assessing equine lower respiratory diseases?
What is the first step in diagnostic testing of the lower respiratory tract in horses?
What is the first step in diagnostic testing of the lower respiratory tract in horses?
Which historical information is LEAST relevant when assessing a horse with a suspected lower respiratory issue?
Which historical information is LEAST relevant when assessing a horse with a suspected lower respiratory issue?
During a physical exam, what is the second critical question to ask when examining a horse with a potential respiratory condition?
During a physical exam, what is the second critical question to ask when examining a horse with a potential respiratory condition?
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Following a thorough physical examination, how should the information be best used?
Following a thorough physical examination, how should the information be best used?
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Which of the following is a common cause of overwhelmed pulmonary defense mechanisms leading to bacterial pneumonia?
Which of the following is a common cause of overwhelmed pulmonary defense mechanisms leading to bacterial pneumonia?
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Which of these would be considered a factor in suppressing the pulmonary defense mechanisms, contributing to the development of bacterial pneumonia?
Which of these would be considered a factor in suppressing the pulmonary defense mechanisms, contributing to the development of bacterial pneumonia?
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Which of the following is NOT typically considered a risk factor for bacterial pneumonia?
Which of the following is NOT typically considered a risk factor for bacterial pneumonia?
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Which bacterial genus is a frequent cause of pneumonia, and is often associated with polymicrobial infections?
Which bacterial genus is a frequent cause of pneumonia, and is often associated with polymicrobial infections?
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What clinical sign is LEAST likely to be apparent in the early stages of bacterial pneumonia?
What clinical sign is LEAST likely to be apparent in the early stages of bacterial pneumonia?
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When is a rebreathing exam contraindicated when assessing a patient for bacterial pneumonia?
When is a rebreathing exam contraindicated when assessing a patient for bacterial pneumonia?
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What is the primary diagnostic purpose of a transtracheal wash in a suspected bacterial pneumonia case?
What is the primary diagnostic purpose of a transtracheal wash in a suspected bacterial pneumonia case?
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Which of the following is considered the MOST important initial step in the treatment of bacterial pneumonia?
Which of the following is considered the MOST important initial step in the treatment of bacterial pneumonia?
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What is the typical duration of antimicrobial therapy for bacterial pneumonia in animals?
What is the typical duration of antimicrobial therapy for bacterial pneumonia in animals?
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Which of the following is NOT a common complication of bacterial pneumonia?
Which of the following is NOT a common complication of bacterial pneumonia?
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What is the typical survival rate for animals diagnosed with bacterial pneumonia?
What is the typical survival rate for animals diagnosed with bacterial pneumonia?
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What type of pathogen is Rhodococcus equi?
What type of pathogen is Rhodococcus equi?
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Which age group is most commonly affected by Rhodococcus equi?
Which age group is most commonly affected by Rhodococcus equi?
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Which of the following is NOT a typical clinical sign of Rhodococcus equi pneumonia?
Which of the following is NOT a typical clinical sign of Rhodococcus equi pneumonia?
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What is the standard antimicrobial treatment for clinical Rhodococcus equi infection?
What is the standard antimicrobial treatment for clinical Rhodococcus equi infection?
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Which diagnostic tool is NOT typically used to diagnose Rhodococcus equi?
Which diagnostic tool is NOT typically used to diagnose Rhodococcus equi?
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What is the primary method for diagnosing lungworm species that shed larvae?
What is the primary method for diagnosing lungworm species that shed larvae?
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What is the most common clinical sign associated with exercise-induced pulmonary hemorrhage (EIPH)?
What is the most common clinical sign associated with exercise-induced pulmonary hemorrhage (EIPH)?
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What would be an expected finding following a bronchoalveolar lavage in a horse with EIPH?
What would be an expected finding following a bronchoalveolar lavage in a horse with EIPH?
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Which medication is commonly used to manage EIPH by reducing blood volume and pulmonary arterial pressure?
Which medication is commonly used to manage EIPH by reducing blood volume and pulmonary arterial pressure?
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What is the primary goal of resting a horse with EIPH for months?
What is the primary goal of resting a horse with EIPH for months?
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What does the diagnostic approach to respiratory infections rely heavily upon?
What does the diagnostic approach to respiratory infections rely heavily upon?
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Bacterial pneumonia in horses is often described as:
Bacterial pneumonia in horses is often described as:
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What is the most common underlying condition associated with EIPH?
What is the most common underlying condition associated with EIPH?
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What is a primary disadvantage of using systemic glucocorticoids for treating equine asthma?
What is a primary disadvantage of using systemic glucocorticoids for treating equine asthma?
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What is a benefit of using inhaled glucocorticoids over systemic glucocorticoids for managing equine asthma?
What is a benefit of using inhaled glucocorticoids over systemic glucocorticoids for managing equine asthma?
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Which statement is most accurate regarding the use of β-2 agonists like clenbuterol in treating equine asthma?
Which statement is most accurate regarding the use of β-2 agonists like clenbuterol in treating equine asthma?
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Which common medication is considered ineffective in treating equine asthma, according to the content?
Which common medication is considered ineffective in treating equine asthma, according to the content?
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What is the primary source of Dictyocaulus arnfieldi infection in horses?
What is the primary source of Dictyocaulus arnfieldi infection in horses?
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Which of the following statements accurately describes the role of donkeys in the transmission of Dictyocaulus arnfieldi?
Which of the following statements accurately describes the role of donkeys in the transmission of Dictyocaulus arnfieldi?
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Which of these is a typical clinical sign of lungworm infection in horses?
Which of these is a typical clinical sign of lungworm infection in horses?
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During a rebreathing exam, what is the typical order of assessment?
During a rebreathing exam, what is the typical order of assessment?
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Which of the following is a major limitation of thoracic radiographs in adult horses?
Which of the following is a major limitation of thoracic radiographs in adult horses?
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What is the primary advantage of using thoracic ultrasound in equine diagnostics?
What is the primary advantage of using thoracic ultrasound in equine diagnostics?
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Which sampling method provides the most representative cytology for a generalized, diffuse lung disease?
Which sampling method provides the most representative cytology for a generalized, diffuse lung disease?
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A tracheal wash is particularly beneficial when investigating what condition?
A tracheal wash is particularly beneficial when investigating what condition?
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How long should a horse with equine influenza typically rest after they have had a fever?
How long should a horse with equine influenza typically rest after they have had a fever?
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What is the typical duration of protective immunity following natural infection with equine influenza?
What is the typical duration of protective immunity following natural infection with equine influenza?
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Which of the following equine herpesviruses is NOT associated with respiratory disease?
Which of the following equine herpesviruses is NOT associated with respiratory disease?
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In what form does equine herpesvirus persist in a horse?
In what form does equine herpesvirus persist in a horse?
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Following infection with equine herpes virus, for how long can nasal shedding of the virus be expected?
Following infection with equine herpes virus, for how long can nasal shedding of the virus be expected?
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What type of sample is required to perform a quantitative real-time PCR (qRT-PCR) for equine herpesvirus?
What type of sample is required to perform a quantitative real-time PCR (qRT-PCR) for equine herpesvirus?
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What is the typical recommendation regarding antiviral medication for treating equine influenza?
What is the typical recommendation regarding antiviral medication for treating equine influenza?
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Which of the following is a unique feature or characteristic of Equine Viral Arteritis (EVA) that distinguishes it from other equine respiratory diseases?
Which of the following is a unique feature or characteristic of Equine Viral Arteritis (EVA) that distinguishes it from other equine respiratory diseases?
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Which statement best describes what equine herpesvirus vaccines accomplish?
Which statement best describes what equine herpesvirus vaccines accomplish?
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Which of these is an advantage when performing a thoracic ultrasound?
Which of these is an advantage when performing a thoracic ultrasound?
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Study Notes
Equine Lower Respiratory Diseases
- This presentation covers diseases of the lower respiratory tract in horses.
- Learning objectives include: using history and physical exams to prioritize problems, determining appropriate diagnostic tests based on differentials, explaining diagnostic test procedures and results, outlining pathophysiology of common diseases, describing therapeutic, monitoring, management, and preventative approaches, and discussing expected outcomes and prognoses.
- The presentation also covers diagnostic testing, infectious and non-infectious conditions, and case examples in the laboratory.
Learning Objectives
- Students will be able to use a horse's history and physical exam to create a prioritized problem list.
- Students will be able to identify appropriate diagnostics based on potential differences.
- Properly performing and interpreting diagnostic tests is also something students will learn.
- Students will understand the underlying pathophysiology for common equine respiratory diseases.
- Management, therapeutic approaches, monitoring, and preventative strategies are discussed in the presentation.
- Expected outcomes and prognoses are also covered.
Overview
- Diagnostic testing methods for the lower respiratory tract are reviewed.
- The eLC from Foundations 1B is also reviewed.
- Infections of the lower respiratory tract, including viral and bacterial pneumonia, are included.
- Non-infectious conditions like asthma, lungworm, and EIPH (exercise-induced pulmonary hemorrhage) are also included.
- Case examples in the lab are presented.
Diagnostic Testing of the Lower Respiratory Tract
- A brief review of methods and additional notes from the eLC will be considered.
- History and physical exam are part of good diagnostic testing.
Diagnostic Testing
- History and physical exam is crucial.
- Re-breathing exams are also vital.
- Diagnostic imaging is discussed.
- Airway sampling procedures are important.
History
- Signalment (age, breed, sex).
- Presenting complaint and clinical signs are included.
- Duration, changes in symptoms and descriptions are analyzed.
- Medical history including vaccines, deworming, and medications is reviewed.
- Management history on housing, feed, travel, and herd information is important.
Physical Examination
- A complete systems-based exam is performed.
- Doctors determine if the animal has respiratory disease.
- They determine if the disease is upper, lower, or both.
- The nature of any infections are investigated.
- Additional diagnostics will be determined.
Rebreathing Exam
- A horse is assessed at rest.
- A re-breathing exam is conducted.
- Airflow, abnormal sounds, lungs, and trachea are examined.
- Effort and coughing are noted.
- Recovery (4-6 breaths) is also considered.
Abnormal Lung Sounds
- Wheezes are noted in the presentation.
- Crackles are also noted.
Thoracic Radiographs
- Advantages such as a visualization of deeper chest structures, lungs, mediastinum, pleura, and heart are reviewed.
- Disadvantages include equipment (portable) and non-diagnostic films.
- Horses cannot be examined with a lateral view.
Thoracic Ultrasound
- Advantages include availability, quick and easy performance, and surface lung evaluation.
- Disadvantages involve aerated lungs blocking deeper tissues.
Lower Airway - Cellular Diagnostics
- Transtracheal aspiration (TTA)
- Transtracheal wash (TTW)
- Percutaneous tracheal wash
- Transendoscopic tracheal wash
- Bronchoalveolar lavage (BAL) are explored.
Tracheal Wash
- Samples are collected from the trachea.
- The method is important.
Tracheal Wash Technique
- A series of methods for obtaining tracheal washes are displayed.
Tracheal Wash
- Methods for obtaining a sterile sample to better diagnose infections of the lower respiratory system.
- These are important samples to understand all lung tissue.
- Cytologic and bacterial culture exams are important results to consider.
Bronchoalveolar Lavage (BAL)
- BAL is used in cases with generalized/diffuse disease.
- Samples of the small airways and alveoli are collected.
- Cytology in a BAL is more representative than a TTA.
- BAL samples are usually not sterile.
Airway Sampling - BAL
- The different components of the respiratory system are shown.
BAL Cytology
- A normal cytology shows 70-95% alveolar macrophages, less than 5% non-degenerate neutrophils, and very few nonreactive lymphocytes, eosinophils, and mast cells.
Infectious Respiratory Diseases
- The presentation includes topics on Equine Viral Respiratory Disease, EHV-1, EHV-4, EHV-2, EHV 5.
Equine Viral Respiratory Disease
- Clinical signs include fever, nasal discharge, and cough.
- Diagnosis includes isolation, nucleic acid detection (PCR), serology for antibody detection, and antigen detection.
Equine Viral Respiratory Disease - Diagnostic Approach
- Physical exam
- Respiratory exam
- Minimum data base
- Lymphopenia in acute disease
- Inflammatory leukogram
- Respiratory diagnostics
- Imaging and sampling
- Educate and isolate owner/barn managers
Equine Influenza A
- The virus is enveloped RNA in the orthomyxoviridae family.
- The most common viral subtype is H3N8.
- Antigenic drift and shift are discussed.
- The incubation period is 1-3 days.
- Infected horses shed virus for 4-10 days.
- A high morbidity (100%) and low mortality are noted.
- Clinical symptoms include explosive dry cough, fever, serous nasal discharge, malaise, decreased appetite, and stiffness/reluctance to move (occasionally).
- Diagnosis involves nasal swabs, PCR, antigen detection, virus isolation and serology.
- Secondary infections can include bacterial pneumonia and pleuropneumonia, as well as generalized inflammatory airway disease (IAD) issues.
- Treatment is usually supportive and symptomatic.
- Recovery typically involves 1 week of rest per day of fever, a minimum of 3 weeks of rest, and no forced exercises.
- Prevention includes isolating new horses for 3 weeks immediately.
- Protective immunity can be expected 8-12 months post infection.
- Vaccination can be risk-based with intranasal or intramuscular options.
Equine Herpesvirus
- This is an enveloped DNA virus.
- The viruses are categorized as alpha and gamma.
- Different types of herpesviruses cause different types of diseases and symptoms.
- EHV-1 causes perinatal disease/death, respiratory disease, abortion, and neurological disease.
- EHV-3 causes equine coital exanthema.
- EHV-4 causes respiratory disease.
- EHV-2 causes mild respiratory signs, keratoconjunctivitis.
- EHV-5 causes equine multinodular pulmonary fibrosis (EMPF).
Equine Herpesvirus 1 and 4
- These viruses are ubiquitous.
- These types of viruses often establish latency.
- EHV-1 and 4 are commonly found in 85% of horses in a latent state.
- The three main latencies are the trigeminal ganglia and lymphatic tissue.
- They exist in a non-infectious latent state.
- Latent virus that is reactivated can become infectious.
- Different strains of these viruses are categorized as non-neuropathogenic or neuropathogenic.
Equine Herpes Virus Transmission
- Transmission from viral recrudescence or direct contact is possible.
- Transmission occurs from respiratory secretions that can travel up to 35 feet when transmitted.
- Feed and water can be a source of transmission.
- Nose-to-nose contact can also transmit the virus.
- Direct contact with placenta or fetal fluids can transmit the virus.
- Fomites are also a source of transmission.
Equine Herpes Virus - Diagnosis
- Quantitative Real-Time PCR (qRT-PCR) is useful to detect viral DNA from EHV-1 and EHV-4 samples.
- A swab or EDTA (anti-coagulated whole blood) is collected from the nasal surface or with a swab.
- Testing for antibodies (e.g., serology) cannot identify EHV-1 from EHV-4.
Equine Herpes Virus Biosecurity
- "Don't Panic" while following protocols, use AAEP.org as a guide in this instance.
- Detect new cases, separate and segregate, clean, and disinfect people, equipment, and the local environment.
- Communicate and report.
Equine Herpes Virus Treatment
- Treating EHV is similar to treating equine influenza- supportive and symptomatic care.
- Valacyclovir is a treatment option.
- Acyclovir is poorly absorbed.
Equine Herpes Virus Prevention
- Vaccination can help; but doesn't eliminate infection or latency status.
Other Equine Viral Respiratory Diseases
- Equine rhinitis virus (rhinovirus A&B)- RNA virus in the picornaviridae family
- Adenovirus - (DNA adenoviridae- nonenveloped)
Bacterial Infection
- Streptococcus equi subsp. equi (S. equi), a bacterium affecting horses and donkeys
- This bacteria is highly contagious and not commensal.
- It is restricted to equids.
- It causes upper respiratory tract infections.
- There is inflammation, catarrh, and abscesses that form.
- There is host restricted infections of young animals in comingling situations- shows, auctions, etc. Infection can be chronic.
- Guttural pouch infections can result in chronic persistent infections.
Bacterial Pneumonia - Definitions
- Inflammation of the lung caused by bacterial colonization and multiplication is termed bacterial pneumonia.
- A localized or encapsulated region of pulmonary necrosis, debris, and exudate is a lung abscess.
- Microbial colonization of the lung that progresses into pneumonia is termed pleuropneumonia, and extends into the visceral pleural and pleural space.
Bacterial Pneumonia - Pathophysiology
- Pulmonary defense mechanisms (e.g., mucociliary blanket, secretory system, macrophages, and lymph nodes) are overwhelmed or suppressed- this allows bacterial colonization, aspiration and/or secondary infections.
Bacterial Pneumonia - Pathophysiology - Overwhelmed
- Issues from the aspiration of oropharyngeal bacteria, issues from laryngeal dysfunction, esophageal obstruction, and general anesthesia, and/or severe bacteremia can contribute to an overwhelmed defense mechanism against the progression of the disease.
Bacterial Pneumonia - Pathophysiology - Suppression
- Transportation issues
- Exercise issues
- Viral infections
- Issues with stress response in animals
- Poor ventilation in stables or barns
- Immunosuppressive drugs.
- Immune disorders
- Systemic disease can all contribute to a weakened defense system.
Bacterial Pneumonia - Epidemiology
- Risk factors are any age, breed, sex, or occupation. Long distance transports. Strenuous exercise Viral infections General anesthesia Immune status issues
Bacterial Pneumonia - Organisms
- Common organisms include Rhodococcus equi, Corynebacterium pseudotuberculosis, Streptococcus equi (subspecies equi and zooepidemicus), Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Bacteroides spp.
- Polymicrobial infections are common and affect >50% of patients.
Bacterial Pneumonia - Clinical Signs
- Clinical signs may vary depending on the severity and presence of complications of the disease, but some are none at rest (occult infection), fever, anorexia, increased respiratory rate, nasal discharge varying from none to a severe amount of mucopurulent or hemorrhagic discharge, halitosis, cough (moist cough), abnormal lung sounds, and pectoral edema and pleurodynia.
Bacterial Pneumonia - Diagnosis
- The diagnosis includes history and physical exam.
- Auscultation of the animal should determine presence of problems and to determine if there is respiratory distress.
- Thoracic imaging
- Transtracheal wash
- Cytology
- Aerobic and anaerobic cultures
- Susceptibility analysis should be done
- Thoracocentesis- if necessary.
Bronchopneumonia - Thoracic Ultrasound
- Diagnostic images are illustrated.
Bronchopneumonia - Thoracic Radiographs
- Diagnostic images are illustrated.
Pneumonia - Transtracheal Wash Cytology
- Septic, suppurative inflammation is indicated in an example image.
Bacterial Pneumonia - Treatment
- Supportive care including analgesia, intravenous fluids, nutritional support, and intranasal oxygen may be needed in some instances.
- Broad spectrum antimicrobials are also used, as is empiric selection, systemic and inhaled beta-lactam antibiotics such as gentamicin and enrofloxacin, and metronidazole therapy.
- The duration of therapy can range from weeks to months.
Bacterial Pneumonia - Complications
- These can be weight loss, endotoxemia, colitis (especially when secondary to antibiotics, jugular thrombophlebitis, pneumothorax, pleural abscesses, bronchopleural fistulas, laminitis, and endocarditis.
Bacterial Pneumonia - Prognosis
- Prognosis is dependent on the duration of existing clinical signs before treatment, the animal's response to treatment, and any secondary complications.
- Survival rates range from 45-90%.
- The rate of return to racing is around 60%.
Rhodococcus equi Pneumonia
- Illustration of foals and their behavior is displayed; it is likely not directly related to the diseases.
Rhodococcus equi
- Rhodococcus equi (R. equi) is a gram-positive soil saprophyte.
- It is an intracellular pathogen that survives and replicates in macrophages.
Rhodococcus equi - Epidemiology
- It is distributed worldwide.
- It is a leading cause of morbidity and mortality in foals.
- Prevalence as high as 50% of cases on some farms.
- It typically affects foals between 1-3 months of age.
Rhodococcus equi - Epidemiology (Pattern)
- The bacteria occurs in farms with three different patterns- unaffected farms, sporadically affected farms, and endemic farms.
- Morbidity ranges from 5-20% and case fatality ranges from 4-30%.
- Year to year variations complicate disease prevalence.
Rhodococcus equi - Clinical Signs
- Often insidious and chronic.
- Some may exhibit peracute onset and sudden death.
- Respiratory rate and effort are increased.
- Coughing is common.
- Nasal discharge is seen.
- An affected animal may exhibit fever and malaise.
- Prevention is not effective and early detection methods are needed.
Rhodococcus equi - Diagnosis
- Diagnostic testing should include an animal and farm history.
- Physical examination is important to assess the presence of disease,
- Thoracic ultrasound and radiographs.
- Tracheal wash, collection of fluids, cytology, and cultures.
Rhodococcus equi - Treatment
- Treatment options for the infections of Rhodococcus equi are supportive care such as oxygen therapy, anti-inflammatories, and fluid/nutritional support.
- Macrolide (e.g., erythromycin, azithromycin, clarithromycin) and rifampin treatment is given.
- Macrolide drug resistance is a possible concern
Non-Infectious Lower Respiratory Disease
- Inflammation of the lower respiratory tract.
Non-Infectious Causes
- Equine asthma
- Lungworms
- Exercise-induced pulmonary hemorrhage
Defining Asthma
- Broken wind
- Pulmonary emphysema
- COPD
- Inflammatory airway disease
- Heaves
- Recurrent airway obstruction
Defining Asthma - Clinical Presentation
- Asthma has a similar presentation to human asthma, including chronic airway inflammation, dyspnea (labored breathing), wheezing, and coughing. Depending on the severity, it may vary in intensity and be triggered by exercise, allergens, or viral infections.
Mild-Moderate Inflammatory Airway Disease - Clinical Presentation
- Young-middle age animals may be affected by this disease.
- An occasional cough lasting 3 weeks or longer may occur.
- Performance/exercise intolerance is common
- The expected course of the disease will improve with time and recurrence is often low.
Mild-Moderate Inflammatory Airway Disease and Severe Recurrent Airway Obstructions - Clinical Presentation
- Affected animals in the severe category are typically older than 7 years of age.
- The animals typically experience frequent coughs, consistent exercise intolerance or difficulty with exercise, and dyspnea.
- The course of the disease may range from weeks to months and often recurrence and progressive decline in the condition is observed.
- Medical control is difficult and may or may not be successful.
Bronchopneumonia
- An inflammatory response in the bronchioles and lungs of the horse.
- This can be caused by a multitude of underlying conditions if it is severe.
Lung Worm
- Horses with lungworms may have a history of being kept with donkeys or being pastured with ruminants in areas with wet environments.
- Clinical signs include coughing, nasal discharge, poor thrift or ill thrift issues, abnormal lung sounds, and a lack of fever.
Lungworms in Horses (Dictyocaulus arnfield)
- Horses that have Dictyocaulus arnfield may have a direct life cycle, ingesting L3 from a pasture, or they may be an inapparent shedder (donkeys and mules are commonly inapparent shedders).
Lungs in Cattle (Dictyovirus viviparous)
- In cattle, Dictyocaulus viviparous is similar in prevalence. These animals will have a similar life cycle.
Lungworm - Diagnosis
- A Baermann method is used to distinguish between different species with shedding issues. Fecal flotation methods are also used to identify eggs.
- Tracheal washes are conducted and may show an eosinophilic inflammatory response. The presence of larvae in the wash is observed.
- Treatment is usually with avermectin anthelmintics
Exercise Induced Pulmonary Hemorrhage (EIPH)
- EIPH is described as a hemorrhage in the lower respiratory tract after intense exercise.
- Some racing events, polo, 3 day evenings, barrel racing, and polo increase the likelihood of hemorrhaging.
EIPH - Clinical Presentation
- EIPH is most common in young, working horses that endure strenuous activities like racing or competitive riding.
- Affected animals may be asymptomatic or exhibit poor performance, increased respiratory effort after exercise, coughing, frequent swallowing after exercise, nasal bleeding (epistaxis), and in a small percentage of cases, it may be considered rare.
EIPH - Diagnosis
- EIPH diagnosis includes history and physical examination, endoscopy, thoracic radiographs, and bronchoalveolar lavage (BAL)
EIPH - Diagnosis (Washings)
- Washing of the airways of a horse is accomplished to detect evidence of prior hemorrhage in the animal, often termed hemosiderophages.
EIPH - Management
- Limited management is available.
- Furosemide (Lasix) is administered to decrease blood volume and pulmonary arterial pressures- often 2-4 hours before exercise/racing events.
- Secondary complications can be treated if mild asthma is present
EIPH - Prognosis
- Most racehorses have EIPH, and it typically has no negative impact on their performance.
- If it affects performance, prognosis for racing is poor.
- They may require a different line of work.
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Test your knowledge on the assessment and management of lower respiratory diseases in horses. This quiz covers diagnostic testing, historical relevance, and common causes of respiratory conditions. Perfect for veterinarians and equine health enthusiasts!
