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Small Animal Medicine > Pulmonary Parenchymal Disease > Flashcards

Pulmonary Parenchymal Disease Flashcards

1
Q

What causes lung sounds seen in lung disease?

A

lung parenchyma fills with fluid (edema) or inflammatory cells (pneumonia), causing it to become less compliant and harder for the patient to breath

  • tachypnea = increased rate
  • hyperpnea = deeper breaths
  • dyspnea = increased effort
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2
Q

What is the most common cause of pneumonia in dogs? What is the most characteristic sign? What else is seen?

A

bacterial

deep productive cough

  • expiratory dyspnea
  • tachypnea
  • nasal discharge
  • exercise intolerance, cyanosis, collapse
  • SYSTEMIC: fever, lethargy, poor appetite
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3
Q

What is commonly seen on physical exams on patients with pneumonia?

A
  • abnormal posture (orthopnea)
  • abnormal lung sounds
  • fever
  • respiratory distress
  • mucopurulent nasal discharge
  • cyanosis
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4
Q

Diagnostics for lower airway disease:

A
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5
Q

What is important to note about radiographic changes of diseased lungs?

A

radiographic changes can lag behind clinical signs. of disease with pneumonia by about 1-2 days

  • may not see anything on radiographs with acute disease
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6
Q

What does a vascular pattern on thoracic radiographs indicate? What are 3 causes?

A

enlarged and/or tortuous blood vessels result in increased soft tissue opacity in the lungs

  1. enlarged arteries
  2. elarged veins
  3. enlarged arteries and veins
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7
Q

What are the 3 causes of enlarged arteries seen on thoracic radiographs? Enlarged veins?

A
  1. heartworm disease
  2. pulmonary thromboembolism
  3. pulmonary hypertension

left-sided heart failure

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8
Q

What are 4 causes of enlarged arteries and veins (pulmonary overcirculation) seen on thoracic radiographs?

A
  1. left-to-right shunts
  2. patent ductus arteriosus
  3. ventricular septal defect
  4. atrial septal defect
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9
Q

What causes bronchial patterns on thoracic radiographs? What are some causes?

A

inflammation around the airways

  • canine chronic bronchitis
  • feline idiopathic bronchitis
  • allergic bronchitis
  • canine infectious respiratory disease complex (kennel cough)
  • bacterial/Mycoplasmal infection
  • pulmonary parasites
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10
Q

What causes alveolar patterns on thoracic radiographs? What are some causes?

A

airways stand out and are lined

  • pulmonary edema
  • severe inflammatory disease
  • bacterial/aspiration/fungal pneumonia
  • hemorrhage
  • pulmonary contusion/thromboembolism
  • neoplasia
  • systemic coagulopathy
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11
Q

What causes nodular interstitial patterns? What are some examples?

A

nodular growths on lungs change its opacity

  • neoplasia
  • mycotic infection
  • Blastomycosis/Histoplasmosis/Coccidiomycosis
  • pulmonary parasites
  • Aelurostrongylus/Paragnimus infection
  • abscess/bacterial pneumonia
  • FB
  • eosinophilic lung disease
  • idiopathic interstitial pneumonia
  • inactive lesions
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12
Q

What causes interstitial patterns on thoracic radiographs? What are some examples?

A

subtle pattern on lung tissue

  • mild pulmonary edema
  • viral/bacterial/mycotic pneumonia
  • Toxoplasmosis
  • parasitic infection (more often bronchial/nodular)
  • neoplasia
  • eosinophilic lung disease
  • idiopathic pulmonary fibrosis
  • mild hemorrhage
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13
Q

How can lung lobe consolidation and atelectasis be differentiated on radiographs?

A

CONSOLIDATION = soft tissue opacity maintains space that the lobe fills, indicating it is filled with something

ATELECTASIS = opacity is secondary to airway obstruction or absorbed air, causing the lung lobe to collapse and lose volume, which can also cause shifting of the heart

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14
Q

How are cavitary lesions seen on thoracic radiographs?

A

localized accumulations of air or fluid due to rupture of bullae, blebs, abscesses, or cysts, and emphysema

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15
Q

How can lung lobe torsion be seen on thoracic radiographs?

A

vesicular gas pattern and alveolar patterns with abrupt truncation near the hilus

  • air is trapped in the lung lobe
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16
Q

How is ultrasound used as a diagnostic for lower airway disease?

A

cannot see through air, but can see fluid-filled or dense tissue

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17
Q

In what situation is CT and MRI a good diagnostic for lower airway disease?

A

small nodules and suspected fibrosis

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18
Q

In what 2 situations is nuclear imaging especially helpful in diagnosing lower respiratory disease?

A
  1. can measure mucociliary clearance by placing a drop of technetium-labeled albumin at the carina and observing its movement with a gamma camera for diagnosing ciliary dyskinesia
  2. can measure pulmonary perfusion and ventilation for diagnosing pulmonary thomboembolism
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19
Q

For what 7 organisms is serology a helpful diagnostic?

A
  1. Histoplasmosis
  2. Blastomycosis
  3. Coccidiomycosis
  4. Toxoplasma
  5. Feline Coronavirus
  6. Cryptococcus
  7. Heartworm tests
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20
Q

For what 2 organisms is urine antigen testing a useful diagnostic?

A
  1. Histoplasmosis
  2. Blastomycosis (more sensitive than serology)
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21
Q

What cardiovascular marker can be used for diagnosing lung disease? Why is it used?

A

NT-proBNP —> hormone produced by cardiac muscle cells in response to cellular stretch

can be used as an in-house test to tell if an animal with trouble breathing is caused by cardiac or respiratory disease

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22
Q

How are NT-proBNP levels used for diagnosing cardiovascular or respiratory causes of coughing?

A
  • normal/low NT-proBNP = respiratory cause more likely
  • elevated NT-proBNP = cardiac disease associated

can have more than one issue, need full assessment still

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23
Q

How is blood gas used as a diagnostic for lung disease?

A

in severe cases of impeding respiratory failure, there will be hypercarbia with concurrent respiratory acidosis and hypoxemia

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24
Q

What are the most common causes of bacterial pneumonia in younger and older dogs? What does a definitive diagnosis rely on?

A
  • YOUNG = viral infection followed by bacterial invasion
  • OLDER = aspiration and foreign bodies

detection of intracellular bacteria in airway cytology or clinically significant bacterial growth from an airway sample

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25
Q

Is primary or secondary bacterial pneumonia most common?

A

SECONDARY —> resident flora grow out of control due to another issue, rare to see healthy adults get spontaneous pneumonia

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26
Q

What are the 3 most common primary/community-acquired pathogens that cause bacterial pneumonia? What others have been isolated?

A
  1. Bordetella
  2. Mycoplasma
  3. Streptococcus

E. coli, Klebsiella pneumonia, Pseudomonas, Enterococcus, Pasteurella multocida, Bacillus, Staph, Fusobacterium

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27
Q

What are the 3 most common causes of secondary bacterial pneumonia? What history is most commong?

A
  1. aspiration
  2. foreign bodies
  3. immune dysfunction
  • laryngeal or esophageal dysfunction
  • poor upper airway conformation
  • neurologic signs
  • hospital-acquired from anesthesia or sedation
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28
Q

What are the most common signs of bacterial pneumonia? Why may it not be noticed immediately?

A
  • lethargic, fever
  • anorexic
  • cough
  • exercise intolerance, collapse, respiratory distress
  • tachypnea, increased effort
  • mucopurulent nasal discharge
  • increased lung sounds (crackles)

dogs that do not exercise as much are not moving oxygen as much

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29
Q

What is the most commonly isolated bacteria from lower airway pneumonia? How is it treated?

A

Streptococcus spp.

Amoxicillin/Clavulanic acid (Clavamox)

30
Q

What is the most common community-acquired bacterial cause of pneumonia in young dogs? How does it cause infection?

A

Bordetella bronchiseptica

secretes exotoxins that result in dysfunction of the mucociliary escalator —> tracheobronchitis is more common, but it can progress to pneumonia

31
Q

What are the 3 most common treatments for Bordetella bronchiseptica pneumonia?

A
  1. Amoxicillin/Clavulanic acid (Clavamox)
  2. Doxycycline
  3. Enrofloxacin (Baytril)

can be difficult to eliminate, causing a chronic cough

32
Q

What species of Mycoplasma is associated with pneumonia in dogs and cats? What diagnostic works the best?

A

Mycoplasma cynos

PCR —> a special culture medium is necessary

33
Q

What antibiotics do Mycoplasma most commonly respond well to? Which ones do not work?

A

macrolides, tetracyclines, chloramphenicol, and fluoroquinolones —> Doxycycline!

those that interfere with cell-wall synthesis, which this genus lacks (beta-lactams - penicillins, cephalosporins)

34
Q

What is most commonly seen in thoracic radiographs with bacterial pneumonia?

A

alveolar pattern —> air bronchograms are classic

  • interstitial pattern is also possible
35
Q

What bloodwork is recommended for diagnosing bacterial pneumonia? What is seen?

A

CBC

  • neutrophilic leukocytosis with a left shift
  • monocytosis if chronic
36
Q

When should transtracheal, endotracheal, and bronchoalveolar washes be performed to diagnose bacterial pneumonia? What 4 things are most commonly seen on cytology?

A

before antibiotic therapy is initiated to perform a culture and sensitivity

inflammation, degenerate neutrophils, foamy macrophages, intracellular bacteria

37
Q

What 2 IV antibiotics are recommended for hospitalized cases of bacterial pneumonia? What is considered when cases are especially severe, lifethreatening situations?

A

ideally based on culture, but need broad-spectrum drugs with good lung penetration

  1. Ampicillin sulbactam (similar to Clavamox) - Gram +/- and anaerobes
  2. Enrofloxacin - Gram +/-

Gentamycin - aerobes, Gram +/-

38
Q

What 3 drugs should be avoided when treating severe pneumonia?

A
  1. diuretics
  2. cough suppressants (cough evaculates respiratory tract!)
  3. glucocorticoids
39
Q

What is recommended for moisturizing airways in cases of severe pneumonia? What should be avoided?

A

nebulization with sterile saline +/- Gentamycin 15-30 mind 2-6x a day

mucolytics will cause bronchoconstriction since they are irritating

40
Q

What additional supportive care is important for hospitalized patients with severe pneumonia?

A
  • turn recumbent animals ever 1-2 hours so the lungs can properly expand
  • mild exercise of stable animals
  • coupage to promote expectoration of exudate
  • bronchodilators in cats
  • proper nutrition
41
Q

What are 3 general characteristics of antibiotics in hospitalized patients with pneumonia? What is agreed to be a great place to start?

A
  1. parenteral, then oral
  2. must be broad-spectrum: G +/-, anaerobes, Mycoplasma
  3. continue oral for 4-6 weeks (can be up to 8)

Clavamox

42
Q

What is the prognosis of bacterial pneumonia like? What is it influenced by?

A

fair to good

  • severity and chronicity
  • underlying condition(s)
  • development of complications, like pyothorax, pneumothorax, abscesses, and fibrosis
43
Q

What causes aspiration pneumonia? What are some risk factors?

A

inadvertent inhalation of gastric acid, orophayngeal secretions, and/or ingesta

underlying conditions what cause vomiting or regurgitation and loss of normal airway protection
- sedation, anesthesia
- esophageal disease
- seizures
- laryngeal dysfuntion
- megaesophagus
- cleft palate
- laryngeal paralysis
- recent swimming

44
Q

What 3 things are commonly seen on radiographs with aspiration pneumonia?

A
  1. cranioventral bronchoalveolar pattern
  2. air bronchograms*
  3. +/- megaesophagus

(megaesophagus, right middle lung lobe consolidation)

45
Q

What is seen on CBC with aspiration pneumonia? Why are TTW cytology and culture especially important?

A

neutrophilic leukocytosis with a left shift and monocytosis if chronic

atypical (enteric) bacteria should be seen

46
Q

What is aspiration pneumonitis? What is a common secondary effect?

A

irritating chemicals from the stomach acid cause direct chemical burn to the lung caused by the caustic substances (typically polyethylene glycol)

large volumes of more benign substances can cause a drowning effect, obstruction, and inflammation, which is perfect for secondary invaders

47
Q

Aspiration pneumonia:

A

megaesophagus!

48
Q

What is treatment of aspiration pneumonia like?

A

largely supportive —> efforts should be made to prevent further aspiration by correcting predisposing factors

  • oxygen!!
49
Q

What is the most common cause of viral pneumonia? What is the best way to identify/diagnose?

A

influenza H3N8 and H3N2

PCR

50
Q

What do radiographs typically show with Toxoplasmosis? What is the best what to retrieve organisms?

A

fluffy alveolar, diffuse, and interstitial opacities (it is a multisystemic disease)

bronchoalveolar lavage - tracheal washes are not enough

51
Q

How is Toxoplasma pneumonia treated?

A

sulfonamides or clindamycin

52
Q

How are animals typically infected by fungi that can cause pneumonia? What type of inflammation is caused? What are common non-specific signs?

A

inhalation of spores

pyogranulomatous

  • inappetence and weight loss
  • fever
  • lameness (bone lesions!)
  • enlarged LNs
  • draining tracts
  • chorioretinitis, anterior uveitis
53
Q

What regions of the US are most affected by blastomycosis? What animals are most commonly affected?

A

Mississippi, Missouri, Ohio river valleys, Mid-Atlantic

dogs > cats (most common mycosis of dogs in endemic regions)

54
Q

Where in the environment is Blastomyces most commonly found?

A

in the soil, commonly in decaying material (transmitted by inhalation)

55
Q

How is blastomycosis diagnosed?

A

antigen and antibody testing on serum, plasma, and fluids; combine with other tests to verify

  • cytology
  • rads/CT/MRI
  • histopath
  • PCR
  • culture not ideal due to danger of growing the organism
56
Q

What is the most common systemic effect of fungal pneumonia?

A

SKELETAL LESIONS

  • long bone osteolysis or periosteal proliferation
  • soft tissue swelling
57
Q

In what region of the US is Histoplasmosis most common? What animals are most affected? How does it appear on cytology?

A

Mississippi, Missouri, Ohio river valleys

cats > dogs

intracellular capsules within macrophages (H. capsulatum)

58
Q

What is the main source of Histoplasmosis? How does presentation of disease differ in cats and dogs?

A

bird and bat feces (environmentally resistant) —> Cave disease in man

  • CATS = lung
  • DOGS = GI
59
Q

How is Histoplasmosis diagnosed? How does this differ in dogs?

A

serology or urine antigen testing and PCR/histopath

rectal cytology is easiest

60
Q

In what region of the US is Coccidiomycosis more prevalent? What disease does it cause? In what animals is it most common?

A

Southwestern —> California, Arizona, New Mexico

Valley fever

dogs > cats

61
Q

How does Coccidiomycosis compare to other fungal pneumonias? How do animals become infected?

A

can rarely be zoonotic —> culture NOT recommended

organism is found in the soil and can be present in dust following rain in dry seasons

62
Q

What animals are most affected by Cryptococcus? How do they become infected?

A

cats > dogs

inhalation of organism primarily residing in weathered pigeon guano

63
Q

What is the most common sign of Cryptococcus pneumonia in cats?

A

subcutaneous swelling over the bridge of the nose

64
Q

What is the best way of diagnosing Cryptococcus pneumonia? What else is commonly done?

A

cytology

  • antigen detection on serology
  • histopath
  • culture works*
65
Q

In what animals is disseminated Aspergillosis most common? When is it considered disseminated?

A

dogs > cats

when active infection is present in 2 or more separate areas of the body or when hematogenous spread occurs (can be ANYWHERE) —> most commonly allowed to occur in immunocompromised

(nasal Aspergillosis =/= disseminated Aspergillosis)

66
Q

What is the best way to diagnose disseminated Aspergillosis?

A

cytology/histopath

  • antigen detection on serology (can be positive in cases of exposure and no disease)
  • rads/CT/MRI
  • PCR
67
Q

In what animals is Pneumocystis carinii pneumonia most common? What 2 breeds specifically? How is it treated?

A

immunocompromised dogs > cats (+ people with HIV/AIDS)

  1. Cavalier King Charles Spaniel - IgG deficiency
  2. Mini Dachshund - common variable immunodeficiency

Trimethoprim / Sulfamethoxazole

68
Q

How is geographic location or travel history especially common in animals with suspected fungal pneumonia?

A
  • California/Arizona = Coccidiomycosis (Valley fever)
  • Ohio river valley = Blastomycosis, Histoplasmosis
69
Q

How are serum antibody and urine antigen tests used for diagnosing fungal pneumonia?

A
  • serum antibody = Coccidiomycosis, Cryptococcus
  • urine antigen = Blastomycosis, Histoplasmosis

NO CULTURE = blasto, histo, coccidiomycosis

70
Q

How are animals with mycotic pneumonia treated? What are 2 common side effects?

A

long term (4-12 months) of Fluconazole, Itraconazole, Terbinafine, or Voriconazole until clinical signs resolve, rads look normal, and antibodies stabilize

  1. inappetence
  2. liver enzyme elevations (monitor!)
71
Q

Why must Amphotericin B be carefully used for fungal pneumonia treatment?

A

NEPHROTOXIC —> must monitor BUN and creatinine

(lipid complex form is safer)

72
Q

What does the most severe form of mycotic pneumonia involve? What drugs should be avoided?

A

bones —> if multiple bones are affected, complete recovery is unlikely unless there is amputation

immunosuppressants —> can lead to disatrous fungal dissemination

Small Animal Medicine (52 decks)

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