Respiratory Disease Flashcards
What are 7 signs that can localize disease to the upper airways?
- nasal discharge
- sneezing/reverse sneezing
- prolonged, deep inspirations
- increased efforts on expiration and inspiration
- audible sounds - sterdor, stridor, snoring
- inability to breath easily if mouth is closed
- pawing at face
What are 4 signs that can localize disease to the lower airways?
- cough
- respiratory distress
- prolonged expiration
- abdominal push
more severe
Signalment: Keegan, 10 y/o MC Border Collie
Hx
- nasal congestion and sneezing with right-sided mucopurulent discharge over the past 5 days
- recently epistaxis has been noted
- UTD on vaccines
- receives HW and flea/tick prevention monthly
Create a problem list.
- congestion
- sneezing for 5 months
- unilateral right-sided discharge
- recent epistaxis
Where does sneezing localize disease to? What are the 2 types and what are they indicative of?
nasal cavity
- PAROXYSMAL (short fits) - acute viral disease, foreign bodies, trauma
- INTERMITTENT - intranasal tumor or chronic foreign body
What is a reverse sneeze?
forceful INSPIRATORY nasal effort secondary to nasopharyngeal irritation where the head is pulled back with the mouth closed
What is nasal discharge a sign of? What are the 2 main exceptions?
local disease within the sinonasal cavity
- bacterial pneumonia
- coagulopathies
What are the 4 ways of describing nasal discharge? What are the indicative of?
- SEROUS - viral, allergic, parasitic (many start this way)
- MUCOID - inflammation associated with FB, neoplasia, fungal rhinitis, and bronchopneumonia
- MUCOPURULENT - secondary bacterial invasion
- BROWN/RED-TINGED - blood from trauma, coagulopathy, fungal rhinitis, neoplasia, or Ehrlichiosis
When is acute nasal discharge accompanied by sneezing typically indicative of?
- viral upper respiratory disease
- FB
What is the difference between tachypnea and hyperpnea? Bradypnea and hypopnea?
TACHYPNEA = increased respiratory rate/frequency
HYPERPNEA = abnormally rapid or deep breathing
BRADYPNEA = decreased respiratory rate/frequency
HYPOPNEA = decreased depth or frequency of breathing
What is orthopnea?
sensation of breathlessness in recumbency that is relieved when sitting or standing
What is a restrictive breathing pattern?
short, rapid, and shallow breaths caused by “stiff” lungs from pnemonia, pulmonary edema, or neoplasia, where they are prevented from mechanical expansion
What is stertor? What are some causes?
upper low-pitched sound that suggests flaccid tissue is vibrating throughout the respiratory cycle, and sounds like snoring, congestion, fluttering, or gurgling (INSPIRATION)
when tissue or secretions transiently obstruct flow
- narrowed nasal cavity
- elongated soft palate
- edematous or everted laryngeal saccules
What is stridor? What is the most common cause? What does this indicate?
lower high-pitched sound from rigid tissue vibrations commonly associated with laryngeal or tracheal disease (EXPIRATION)
laryngeal paralysis and tracheal collapse - airway narrowing/stricture where air flows past rigid obstructions
What is the purpose of panting? In what animals is this concerning?
dispel heat (normal in dogs, not necessarily sign of distress)
cats —> associated with stress, respiratory disease, or cardiac arrhythmias
What are normal causes of panting in dogs? Abnormal?
overheating, stress, excitement, exertion, pain
- decreased lung compliance from pneumonia, edema, contusions, or obesity
- laryngeal paralysis
- pulmonary thromboembolism
- heart failure
- metabolic: hyperthyroidism, Cushing’s
- hyperthermia
- acidosis: DKA, renal failure, antifreeze
- hypertension
- exogenous steroids
What is the hallmark sign of lower airway disease? What can this also indicate?
coughing —> irritation of tracheobronchial mucosa or lung parenchyma by inflammatory products of neutrophils or eosinophils, excessive secretions, and airway collapse
cardiac disease
How are coughs described?
- dry, non-productive
- moist, productive (secretions)
In what 2 ways does cardiac disease cause coughing? How can this be confirmed?
- pulmonary edema
- chamber enlargement of LA compresses airway
heart murmur - not enough to prove cardiac cause, but NOT hearing one make it much less likely of being cardiac —> animal will likely also be tachycardic
Can coughing in cats also indicate cardiac disease?
NO - cats rarely cough due to congestion heart failrue
What is an obstructive respiratory pattern? How does it differ with upper vs lower airway disease?
slower and deeper than normal
- UPPER = pronounced inspiratory effort
- LOWER = increased effort during expiration due to recruitment and contraction of abdominal muscles
In what other instance is it common to see increased inspiratory effort (other than obstructive respiratory disease)?
pleural space disease
What is a restrictive respiratory pattern? What causes this?
faster and more shallow than normal breaths with an increased respiratory rate/effort and low tidal volume
decreased lung compliance from parenchymal, pleural , or chest wall disease that makes expansion of the chest difficult
What is paradoxical respiration? What are the 2 most common times this happens?
discordant motions of chest/abdominals walls
1, flail chest resulting from thoracic trauma
2. respiratory muscle fatigue from over worked muscles (respiratory failure imminent)
What is flail chest? What causes it?
freely movable segment of the thoracic wall secondary to fractures of consecutive ribs (thoracic trauma)
negative pressure gradient that normally pulls air into the lungs also exerts this force on the freely moveable flail segment, causing inward displacement
Where are the normal bronchial, vesicular, and bronchovesicular lung sounds heard? What do they sound like?
BRONCHIAL - over the trachea and large airways in health; wind blowing where expiration is lounder and longer (if heard in periphery = consolidation)
VESICULAR - peripheral airways; rustling of leaves where inspiration is longer (indicates air-filled lung)
BRONCHOVESICULAR - intermediate lung regions in health; harsh expiratory sounds closer to central airways
Why can early lung disease or congestive heart failure be heard upon auscultation of the lungs?
fluid/tissue in the lungs transmits sounds better
What do crackles sound like? What are they caused by? Common examples?
distant popping of bubble wrap or Rice Krispies in milk
snapping open of airways that have closed due to fluid in or around them
- bronchitis
- pneumonia
- fibrosis
- severe pulmonary edema
When are wheezes most commonly heard upon auscultation? What are 5 possible causes?
expiration of air through a narrow opening (continuous, long sound with musical quality)
- stricture
- compression
- FB
- tumors
- hilar lymphadenopathy
When are end-expiratory snaps or clicks heard? What causes them? Example?
over the chest and can be felt with a hand on the chest wall as the animal coughs
snapping together of the walls of large intrathoracic airways during a cough
loud snap over hilus at the end of expiration = collapse of intrathoracic trachea, carina, or mainstem bronchi
What is cyanosis? What does it indicate?
bluish discoloration of the skin resulting from poor circulation or inadequate oxygenation of the blood
severe hypoxemia resulting from the cardiac or respiratory system
How do CT scans and MRIs compare in diagnosing respiratory cases?
CT = standard for evaluating the nasal chambers and paranasal sinuses
MRI - better for soft tissues, like brain
How are bronchoalveolar lavages performed? What does success rely on?
insert sterile tube through bronchoscope and pass into airways containing abnormal secretions or pathology (can also use syringe with a catheter though an ET tube)
ability to wedge the scope gently into small airway and isolate segment of alveolar area
In what situations will lung tissue be FNA?
obtain cytology samples of large focal lung lesions or mediastinum, or interstitial lung disease in close contact with the thoracic wall
