Repro formative case 1

Question 1

You are working on a busy thoroughbred stud farm in May. A 10 year old mare arrives for breeding to
one of the best stallions who has a covering fee of £4000. The mare has had a foal but does not have
the foal with her.

List six important questions you ask the owner while you start your clinical examination.

Answer 1

• Has the mare been screened for venereal pathogens (1)
• Has the mare been blood sampled for EVA (1)
• Plus any 4 from the following (maximum 1 mark for 4 questions):
• When was the foal born
• Was she mated last year? AI or natural mating?
• Previous breeding management last year (anything relating to breeding history)
• Any treatments or diagnoses made last time she was bred
• Results of last breeding (anything relating to last foaling)
• Any resorption/abortion/still birth
• Any recent vulval discharge
• Current cyclicity this year
• Any breedings this year
• What is the current behaviour (reproductive behaviour) of the mare
• Accept 1 generic question eg vaccination, worming, diet, work other husbandry.

Question 2

You undertake a general clinical examination which reveals no abnormalities and you note that the
perineal conformation is normal. Per-rectum you palpate and perform an ultrasound examination of the
reproductive tract.

Rectal palpation demonstrates that the cervix is hard and narrow, the uterus is tonic although slightly
larger than you might expect. Both ovaries are approximately fist-sized and there are no palpable
structures protuding above the margins of either ovary.
Ultrasound examination demonstrates a single corpus luteum present within the right ovary, which also
contains 4 follicles between 1 and 2 cm in diameter. The left ovary contains approximately 6 follicles
between 1 and 2.5 cm in diameter.
The uterus has the following appearance on ultrasound examination.

Describe the stage of the oestrus cycle of this mare?

Answer 2

Luteal phase (dioestrus/metoestrus also acceptable)

Question 3

List three differential diagnoses for this case.
You must rank these conditions with the most likely at the top of your list.

Answer 3

• Chronic (infectious) endometritis* (1 mark & 1 additional for top of list)
• Venereal endometritis (1)
• Pyometra (1)
• Endometrosis/endometriosis (term used in human medicine) (1)
• Persistent mating induced endometritis (1)
• Accept endometritis but no additional mark if top of the list.
• Ignore: pregnant; endometrial cysts; endometrial hyperplasia.

Marking criteria: award marks as stated with an additional mark for * at top of list, to a maximum of 4 marks in total.

Question 4

List two diagnostic tests that you could perform to reach a diagnosis in this case.
You must prioritise the list by putting your preferred test at the top of the list?

Answer 4

• Endometrial cytology*
• Endometrial bacteriology
• Endometrial biopsy
• Uterine/endometrial swab/uterine fluid sample
• Marking criteria: 1 marking for cytology + one other, 1 additional mark for * at top of the list to a maximum of 2 marks in total

Question 5

You perform endometrial cytology and take an endometrial biopsy.
For each test, list the positive features that would be diagnostic if the mare had chronic endometritis.

Answer 5

Endometrial cytology: presence of neutrophils
Endometrial biopsy: any of: mono-nuclear cells, fibrosis, dilated lymphatics
Marking criteria: 1 mark for each to a maximum of 2 marks in total

Question 6

Your diagnostic tests confirm that mare has chronic endometritis.
List four treatment regimes that you would apply.
For each treatment, detail the mechanism by which it would help resolve the problem.
You must prioritise the list by putting your first treatment at the top of the list.

Answer 6

• Inject prostaglandin: causes opening of the cervix + uterine contraction/expulsion*
• Lavage the uterus with saline: removes uterine contamination + encourages uterine contractions
• Local intra uterine antibiotics: controls bacterial growth
• Oxytocin: uterine ecbolic effect
• Manually dilation of the cervix: if a stenotic cervix exists this will enhance emptying of the uterus
• Ignore systemic antibiotics.

Marking criteria: 1 mark for each treatment option + 1 mark for correct mechanism, award an additional mark if * at the top of the list, to a maximum of 9 marks in total