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Small Animal Medicine II > Respiratory Medicine > Flashcards

Respiratory Medicine Flashcards

1
Q

How do we localize respiratory signs?

A

Upper vs. Lower

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2
Q

Classify the following as upper or lower respiratory: Nasal Discharge.

A

Upper

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3
Q

Classify the following as upper or lower respiratory: Sneezing/reverse sneezing.

A

Upper

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4
Q

Classify the following as upper or lower respiratory: Increased effort on inspiration

A

Upper

NOTE: INSPIRATION is upper, EXPIRATION is lower

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5
Q

Classify the following as upper or lower respiratory: Audible sounds (stertor, stridor, snoring).

A

Upper

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6
Q

Classify the following as upper or lower respiratory: Open-mouth breathing.

A

Upper

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7
Q

Classify the following as upper or lower respiratory: Pawing at face.

A

Upper

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8
Q

What does pawing at the face indicate usually?

A

FB in the airway

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9
Q

Classify the following as upper or lower respiratory: Cough.

A

Lower

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10
Q

What is the hallmark sign of lower respiratory disease?

A

Coughing

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11
Q

What must you also keep in mind when you see coughing?

A

Heart disease

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12
Q

Classify the following as upper or lower respiratory: Respiratory distress.

A

Lower

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13
Q

Classify the following as upper or lower respiratory: Increased effort on expiration.

A

Lower

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14
Q

What is almost always the cause of nasal discharge?

A

Nasal cavity disease.

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15
Q

Name 4 types of discharge.

A

Serous
Mucopurulent
Mucoid
Hemorrhagic

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16
Q

What often accompanies nasal discharge?

A

Sneezing

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17
Q

What are two key aspects of the physical exam?

A

Signalment and history

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18
Q

What are two ways we can examine nasal airflow?

A

Glass slide

Wisp of cotton

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19
Q

What are two things you should NORMALLY be able to do in a physical exam that you might not in nasal cavity disease?

A

Ocular retropulsion

Depress the soft palate

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20
Q

Where does sneezing localize disease to?

A

Nasal cavity

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21
Q

Is a reverse sneeze a problem?

A

No

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22
Q

What is stertor?

A

Gurgling or snoring

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23
Q

What is stridor?

A

High-pitched noise or whine usually on expiraion

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24
Q

When can you hear expiratory stridor?

A

Intrathoracic tracheal collapse (laryngeal paralysis)

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25
Q

What is the hallmark of trachea/lung disease or cardiac failure?

A

Cough

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26
Q

What are 3 triggers of coughing?

A

Inflammatory products
Excessive secretions
Airway collapse

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27
Q

How are coughs classified?

A

Dry, non-productive

Wet, productive

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28
Q

What is your next step with a non-cardiogenic cough?

A

Chest RADs

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29
Q

If you take chest RADs for a cough and they’re normal, what must you consider?

A

Tracheal disorders

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30
Q

If you take chest RADs for a cough and they’re abnormal, what does that tell you?

A

Lower airway and pulmonary parenchyma disease

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31
Q

What is important to remember about the term dyspnea?

A

It is a human term. In vet med, we should use “respiratory distress”.

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32
Q

What is tachypnea?

A

Increased RR

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33
Q

Is tachypnea always bad?

A

No

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34
Q

What is panting?

A

In dog, dispels heat. In cats can mean respiratory distress or stress.

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35
Q

What is orthopnea?

A

Upright position with elbows abducted

THINK PLEURAL DISEASE

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36
Q

What is respiratory distress most often associated with?

A

Lower airway disease

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37
Q

When does tachypnea become respiratory distress?

A

When it is causing distress

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38
Q

What is respiratory distress all about?

A

The O2.

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39
Q

What are 5 causes of respiratory distress?

A 
Insufficient O2 in inspired air
Insufficient ventilation
Insufficient circulation
Insufficient RBC
Abnormal Hb
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40
Q

What does cyanosis indicate?

A

Severe hypoexemia

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41
Q

What are 5 things you should do in your physical exam to determine site of respiratory signs?

A 
Listen
Observe respiratory pattern
Check for nasal airflow (if upper airway obstruction)
Tracheal palpation
Auscult lungs
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42
Q

What does increased INSPIRATORY effort indicate?

A

Upper airway obstruction

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43
Q

What does increased EXPIRATORY effort indicate?

A

Lower airway obstruction

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44
Q

Describe normal bronchial sounds.

A

Loudest over hilus
During expiration
Sounds like wind blowing

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45
Q

Describe normal vesicular sounds.

A

Best on inspiration
At periphery of chest
Sounds like rustling leaves

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46
Q

Describe normal bronchovesicular sounds.

A

Mixture of bronchial and vesicular, but mostly expiratory

Increase in intensity at central airway

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47
Q

What causes “crackles” in the lungs?

A

Airways snapping open (closed due to fluid in or around them)

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48
Q

What causes wheezes?

A

Airflow through a narrow opening

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49
Q

When are wheezes best heard?

A

Expiration

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50
Q

If you hear a loud snap over the hilus at the end of expiration, what should you be thinking?

A

Collapse of intrathoracic trachea, carina or mainstem bronchi

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51
Q

What do “goose honks” indicate?

A

Tracheal collapse

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52
Q

What causes a creaking/grating sound?

A

Pleural friction rubs

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53
Q

What is the most important diagnostic test for signs of respiratory system disease?

A

Imaging

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54
Q

What MUST you do before imaging?

A

Stabilize patient

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55
Q

Is a minimum database required for all respiratory cases?

A

No

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56
Q

What 2 things can sometimes be more important than the minimum database?

A

Fecal

HWT

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57
Q

What has become the standard for evaluating the nasal cavity?

A

CT/MRI

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58
Q

What are 3 indications for a nasal flush?

A

FB suspected
Cleanse airways prior to rhinoscopy
Obtain samples for cytology

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59
Q

What is the difference between a rhinoscopy and a bronchoscopy?

A

Rhinoscopy is just the nasal cavity

Bronchoscopy looks at lower respiratory tract

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60
Q

What landmark do you NEVER pass when performing a blind core biopsy?

A

Medial canthus of the eye

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61
Q

What must you be careful not to hit when performing a blind core biopsy?

A

Cribiform plate

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62
Q

When is bronchoscopy contraindicated?

A

In sever respiratory compromise UNLESS therapeutic (removing FB)

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63
Q

When is a Bronchoalveolar lavage (BAL) indicated?

A

Lung dz involving small airway, alveoli or interstitium

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64
Q

What can be done to retrieve material from within lungs for sampling?

A

BAL

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65
Q

On what patients can you perform a transtracheal wash and aspirate?

A

Medium-larger breed dogs

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66
Q

On what patients can you perform an endotracheal or transoral wash and aspirate?

A

Cats and tiny dogs

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67
Q

What are 2 indications for a transthoracic lung aspiration?

A 
Intrathoracic mass (in contact with thoracic wall)
Diffuse disease
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68
Q

What is a contraindication to a transthoracic lung aspiration?

A

An abscess

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69
Q

What are 3 possible complications of a transthoracic lung aspiration?

A

Hemothorax
Pneumothorax
Potentially pyothorax later

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70
Q

What are 2 reasons for placing a chest tube?

A

Treatment of pyothorax

Management of pneumothorax

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71
Q

What is coupage?

A

Banging on the chest

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72
Q

What is the purpose of coupage?

A

To break up mucous

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73
Q

If you see nasal discharge and depigmentation, what should you think of?

A

Aspergillosis

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74
Q

What are the top 5 things on your differential list for nasal discharge?

A 
FB
Rhinitis
Dental dz
Neoplasia
Trauma
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75
Q

What 5 things do we expect to see with a nasal FB?

A 
Acute onset
Acute sneezing
Gagging/reverse sneezing
Pawing
Discharge (serous -> mucopurulent after time)
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76
Q

What is rhinitis?

A

Inflammation of the nasal cavity

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77
Q

What 2 pathogens are responsible for 90% of feline upper resp. cases?

A

Feline herpesvirus

Feline calicivirus

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78
Q

What 4 pathogens are responsible for 10% of feline upper resp. cases?

A

Chlamydophyla felis
Mycoplasma
Coronavirus
Bordatella

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79
Q

What is a key sign of feline herpesvirus?

A

Corneal ulcers/ulcerative keratitis

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80
Q

What are 2 key signs of feline calicivirus?

A 
Oral ulcers (and on nose)
Pneumonia
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81
Q

What causes limping kitten syndrome?

A

Feline calicivirus

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82
Q

What is a key sign of Chlmydophyla?

A

Conjunctivitis with chemosis (conjunctival edema)

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83
Q

Which virus is shed with stress?

A

Herpesvirus

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84
Q

Which 2 viruses can be shed with or without stress?

A

Calici

Chlamdyophyla

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85
Q

How is feline herpes transmitted?

A

Direct contact

Fomites (US!!)

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86
Q

Why do we treat cats with herpesvirus with systemic abx?

A

Secondary infections

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87
Q

What are 3 sequelae to herpesvirus?

A 
Chronic rhinitis (turbinate damage = "snuffler")
Chronic conjunctivitis
Fibrosis of lacrimal ducts = epiphora (overflow of tears)
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88
Q

What does oral lysine do?

A

Reduces herpes virus replication

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89
Q

What are the 2 oral antivirals we use?

A

Famciclovir

Acyclovir

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90
Q

What are 2 other treatments for herpes cats that fall under “supportive care”?

A

Abx for secondary infection

Fluids (keeps animal hydrated and mucus is less sticky)

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91
Q

How can the herpes vaccine be administered?

A

Parenteral

Intranasal

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92
Q

Which herpes vaccine formulation is best in outbreaks?

A

Intranasal

Intranasal is not blocked by maternal abs like parenteral is

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93
Q

Which herpes vaccine formulation may prevent the carrier state?

A

Intranasal

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94
Q

What is important to remember about calicivirus?

A

Has a high mutation rate and no cross protection from vaccines

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95
Q

What 2 ways is calicivirus transmitted?

A

Via direct contact or fomites

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96
Q

T/F: Calicivirus is easily killed with routine disinfectants.

A

False. It is resistant and has a longer survival time in the environment

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97
Q

What are the 2 distinct calicivirus syndromes?

A

Limping Kitten Syndrome

Virulent Hemorrhagic Systemic Syndrome

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98
Q

What 3 signs do we see with limping kitten syndrome?

A

Lameness
Ulcers on paws
Sore joints

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99
Q

Does the normal calicivirus vaccine strain protect against Virulent Hemorrhagic Systemic Syndrome?

A

No

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100
Q

What is the main treatment for Calicivirus?

A

Mostly supportive

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101
Q

What 4 sequelae can you see from calicivirus?

A

Chronic rhinitis
Sinusitis
Conjunctivitis
Carrier state

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102
Q

What is the hallmark sign of Chlamydophila felis?

A

Conjunctivitis with chemosis

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103
Q

What 2 ways can you dx Chlamydophila felis?

A 
Conjuctival smear (see intracytoplasmic inclusions)
PCR: conjunctivia, nares or oropharynx
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104
Q

How do you treat Chlamydophila felis?

A

Topical tetracycline or erythromycin

If systemic: oral doxy or azithromycin

NOTE: Remember to give water with doxy to prevent esophageal stricture.

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105
Q

Why isn’t chlamydophila felis vaccine core?

A

More reactive than other antigens

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106
Q

What are the 6 basics for treating upper respiratory dx in cats?

A 
Warm and hydrated
Remove crusts
Humidify
Topical decongestants
Systemic abx
Topical opthalmics
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107
Q

What topical decongestant is preferred when treating a cat with upper respiratory dz?

A

Phenylephrine

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108
Q

What would you always consider as secondary with nasal discharge?

A

Bacterial rhinitis

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109
Q

What are the 2 big signs of nasal aspergillosis?

A

Nasal ulceration and depigmentation

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110
Q

If you suspect aspergillosis, what is the best sample to collect?

A

Plaques, though can be done on discharge if owner can’t afford rhinoscopy to retrieve plaques

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111
Q

How is aspergillosis treated?

A

Often referred.

Debride, then infuse 1% clotrimazole or 2% enilconazole over 1hr

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112
Q

What is a contraindication to treatment for aspergillosis?

A

Damaged cribiform plate

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113
Q

Most common cause of fungal rhinitis in dogs is?

A

Aspergillosis

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114
Q

Mots common cause of fungal rhinitis in cats is?

A

Cryptococcosis (sometimes dogs too)

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115
Q

What dog is most susceptible to fungal rhinitis?

A

Dolichocephalics

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116
Q

What signs do you see with Cryptococcosis in cats?

A

Chorioretinitis

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117
Q

How can you dx Cryptococcosis in cats (2 ways)?

A

Organisms often in nasal discharge

Serum titers reliable (Ag test, not Ab)

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118
Q

How do you treat Cryptococcosis?

A

Conazoles systematically

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119
Q

What are the 2 key signs of nasal mites?

A

Sneezing

Reverse sneezing

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120
Q

How do you treat nasal mites?

A

Ivermectin

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121
Q

Do you see nasal mites if the dog is on Heartworm preventative?

A

Nope

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122
Q

What is lymphoplasmacytic rhinitis?

A

Lymphoplasmacytic infiltration of nasal mucosa

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123
Q

What dogs are often affected with lymphoplasmacytic rhinitis?

A

Dolichocephalics

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124
Q

Is it likely lymphoplasmacytic rhinitis if you see destruction of nasal septum, frontal sinus or cribiform plate?

A

No

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125
Q

What would lymphoplasmacytic rhinitis look like on rhinoscopy?

A

Red, edematous mucosa that bleeds easily and turbinate atrophy

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126
Q

How do you treat lymphoplasmacytic rhinitis?

A

Nothing effective, avoid all smoke

Maroptiant used off label as an antiinflammatory

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127
Q

What are two major signs you see with nasal neoplasia?

A

Loss of airflow (d/t mass effect)

Facial deformity

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128
Q

What else can look like nasal neoplasia?

A

Fungal rhinitis

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129
Q

What 3 ways can you diagnose nasal cancer?

A

Nasal discharge cytology (sometimes you get lucky)
FNA of ipsilateral l.n. (sometimes you get lucky)
Rhinoscopy (not always available)

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130
Q

What is the last resort for diagnosing nasal cancer?

A

Rhinotomy

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131
Q

What is the treatment of choice for nasal cancer?

A

Radiation (survival to 12-16mos with debulking)

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132
Q

What is the cause of death with nasal cancer?

A

Airway obstruction

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133
Q

Why is chemotherapy not commonly used for nasal cancer?

A

Only effective on LSA

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134
Q

What 2 nasal cancers have the better prognosis?

A

Adenocarcinomas
Sarcomas

NOTE: after radiation

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135
Q

What 2 nasal cancers have the worse prognosis?

A

Undifferentiated carcinomas

Squamous cell carcinomas

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136
Q

T/F: Cats live longer than dogs with radiation.

A

True… Of course they do.

137
Q

What is the typical signalment of a dog with nasal neoplasia?

A

Older (>8yrs), long nosed breeds predisposed

138
Q

T/F: Most nasal neoplasias are malignant.

A

True

139
Q

What are the 2 most common types of nasal neoplasia in dogs?

A

Adenocarcinoma

Squamous Cell Carcinoma

140
Q

What are the 2 most common types of nasal neoplasia in cats?

A

Lymphoma

Adenocarcinoma

141
Q

What is ciliary dyskinesia?

A

Immotile ciliary

142
Q

How does a dog get ciliary dyskinesia?

A

Autosomal recessive gene

143
Q

What is affected by ciliary dyskinesia?

A

Nasal cavity, trachea and lower airways

144
Q

Describe the classic presentation of ciliary dyskinesis.

A

Young
Purebreed
Recurrent respiratory tract infection/signs**

145
Q

What is Kartagner’s Syndrome?

A

Bronchiectasis, situs inversus and chronic rhinosinusitis

Bronchiectasis = abnormal widening of the bronchi or their branches, causing a risk of infection
Situs inversus = inverted position of chest and abdominal organ

146
Q

How do you diagnose ciliary dyskinesis?

A

Biopsy and TEM

147
Q

What do you do to treat ciliary dyskinesis?

A

Nothing

148
Q

What is the most common sign of tracheal and bronchial disease?

A

Cough

149
Q

What are the top 4 signs you see with tracheal and bronchial disease?

A

Cough (#1)
Wheezing
Inspiratory sounds
Retch/gag

150
Q

What is kennel cough?

A

A complex caused by both bacteria and viruses.

Can be one or multiple organisms

151
Q

What 4 organisms most commonly cause kennel cough?

A

Parainfluenza
Canine adenovirus 2
Mycoplasma
Bordatella

152
Q

What severity of signs do you see with kennel cough caused by Parainfluenza?

A

Mild

153
Q

What severity of signs do you see with kennel cough caused by Canine adenovirus 2?

A

Mild

154
Q

What severity of signs do you see with kennel cough caused by Mycoplasma?

A

Mild to severe

155
Q

What severity of signs do you see with kennel cough caused by Bordatella?

A

Mild to severe

156
Q

How is kennel cough spread?

A

Respiratory secretions and fomites

VERY CONTAGIOUS!!

157
Q

Describe “uncomplicated kennel cough”.

A

Happy dog with dry cough on tracheal palpation, serous oculonasal discharge, gagging/retching.

Upper resp. only.

158
Q

Describe “complicated kennel cough”.

A

Sick dog with moist cough, mucopurulent oculonasal discharge, can progress to bronchopneumonia.

Upper and lower resp.

159
Q

When do clinical signs of kennel cough develop?

A

4-10 days post exposure

160
Q

If you have the complicated form of kennel cough, what else might you want to look at besides history and clinical signs?

A

Hemogram
Thoracic RADs
TTW cytology and culture

161
Q

How do you treat uncomplicated kennel cough?

A

Restrict exercise
Doxycycline (if Bordatella suspected)
Cough suppressants

162
Q

How quickly does uncomplicated kennel cough usually resolve?

A

Within 2 weeks

163
Q

How do you treat complicated kennel cough?

A

Restrict exercise
Systemic Abx (2weeks)
Nebulization with Gentamycin to decrease cough (patient will be hospitalized)
Cough supressants (UNLESS BACTERIAL PNEUMONIA PRESENT)
Brochodilators (Theophylline

NOTE: Penicillin not a good choice d/t poor levels in respiratory secretions

NOTES: Avoid or decrease bronchodilator dose by 30% if using quinolone Abx

164
Q

What is a general rule about the use of cough supressants?

A

DO NOT USE in a productive cough

165
Q

What is the prognosis of kennel cough?

A

Good to excellent

166
Q

What are 4 ways to prevent kennel cough?

A

Parenteral vaccine (CAV and Parainfluenza)
Intranasal and oral vaccine (Parainfluenza and Bordatella)
Sanitation (Bleach diluted 1:32)
Ventilation in kennels

167
Q

What is canine influenza related to?

A

Equine flu

168
Q

How is canine influenza transmitted?

A

Direct contact with respiratory secretions/fomites

169
Q

What percentage of dogs with influenza have signs?

A

80%

170
Q

What is your window to get samples for a PCR to confirm canine influenza?

A

Within 72 hours of onset

171
Q

Describe mild/uncomplicated canine influenza.

A

Looks like mild/uncomplicated kennel cough.

172
Q

Describe severe/complicated canine influenza.

A

High fever
Hemorrhagic pneumonia (coughing up blood)
Rapid onset, can be fatal in hours

173
Q

What is the mortality rate of severe/complicated canine influenza?

A

5-8%

174
Q

How do you treat canine influenza?

A

Supportive care

Systemic Abx if severe

175
Q

How do you prevent canine influenza?

A

Vaccine available, but not core!
Isolate sick and exposed dogs.
Change clothes and wash hands between patients

176
Q

What age of dog do you typically see Oslerus osleri in?

A

Younger dogs

177
Q

What 3 signs do Oslerus osleri commonly cause?

A

Cough
Wheezing
Dyspnea

178
Q

How can you diagnose Oslerus osleri?

A

Tracheal mass on xray
Mass seen with broncoscopy
Brushings/biopsy of mass
Fecal exam

179
Q

What 2 drugs can you use to treat Oslerus osleri?

A

Ivermectin

Fenbendazole

180
Q

What is the typical signalment for collapsing tracheas?

A

Middle age to older, small or toy breed dogs, often obese

181
Q

What is tracheal collapse?

A

Reduction in chondrocytes allows cartilage to weaken so tracheal rings collapse -> causes irritation, edema and inflammation -> rings loose firmness and collapse

182
Q

What is the typical sign of collapsing trachea?

A

Goose honk cough

183
Q

What types of things might exacerbate a collapsing trachea?

A

Excitement, exercise, eating

184
Q

What else do dogs with a collapsing trachea seem to have commonly?

A

Hepatomegaly

Theory: O2 deprivation results in liver disease. Liver function improves with the placement of a stent.

185
Q

What 3 ways can you dx a collapsing trachea?

A

Thoracic/cervical RADs
Fluoroscopy
Bronchoscopy

186
Q

What is the BEST dx tool for a collapsing trachea?

A

Bronchoscopy

187
Q

What 5 steps should you take in the case of an acute severe collapsing trachea?

A 
Clam patient/owner
Cough suppressant
Corticosteroid
O2
Be prepared to intubate
188
Q

What are 4 things the owner can do to help their chronic collapsing trachea dog?

A

Weight loss
Avoid neck collars
Avoid excitement
Avoid smoke, dust, pollen, carpet cleaner

189
Q

What 3 things can we use to treat the chronic collapsing trachea dog?

A

Cough suppressants
Short course, low dose corticosteroids
Abx for secondary infection

190
Q

What is another name for chronic canine bronchitis?

A

Chronic obstructive pulmonary disease

191
Q

What is the result of chronic canine bronchitis?

A

a daily cough >2mos duration

192
Q

What is chronic canine bronchitis?

A

Inflammation of bronchial walls -> thickened walls -> increased mucus blocking small air ways

193
Q

What are 3 long term sequelae of chronic canine bronchitis?

A

Emphysema
Bronchiectasis
Pneumonia

194
Q

T/F: Chronic canine bronchitis is similar to asthma in people or cats.

A

FALSE!!!!

195
Q

What is the signalment of a chronic canine bronchitis dog?

A

Same as for collapsing trachea.

Small breed, middle to old age, obese small breed.

196
Q

What might you also find on physical exam of a dog with chronic canine bronchitis (2 things)?

A

Concurrent tacheal collapse

Mitral insufficiency

197
Q

How do you diagnose chronic canine bronchitis (3 ways)?

A

Chest RADs
Bronchoscopy
Bronchial cytology and culture

198
Q

Why does it help to keep a dog with chronic canine bronchitis hydrated?

A

Aids mucociliary clearance

199
Q

What can you give a dog with chronic canine bronchitis to reduce inflammation?

A

Prednisolone

200
Q

What is the signalment for a cat with idiopathic feline bronchitis.

A

Any age, but commonly young to middle age

SIAMESE predisposed

201
Q

What are the 2 major signs of idiopathic feline bronchitis?

A

Chronic or intermittent cough

Acute respiratory distress (911!!!!)

202
Q

What is another name for idiopathic feline bronchitis?

A

Feline asthma

203
Q

What 3 things might you note with feline asthma on auscultation?

A

Wheezes
Crackles
Increased inspiratory effort

204
Q

Compare the sounds heard on auscultation of an asthma cat and a cat with pleural effusion.

A

Asthma will hear more bronchovesicular sounds.

Pleural effusion will result in muffled sounds.

205
Q

What is the temprament of a cat with asthma.

A

Usually an otherwise happy cat.

Contrast: Pleural effusion cats are sick kitties

206
Q

What is the first step in working up a cough/wheeze in a cat (3 things)?

A

RADs if cat is stable
CBC
Fecal exam

207
Q

What 2 things are in the second step of a work up for a cat that has a cough/wheeze?

A

TTW/Bronchoscopy

Cytology/culture

208
Q

What percentage of cats with asthma have normal RADs?

A

23%

209
Q

What is the most common radiographic sign you will see in an asthmatic cat?

A

Bronchial pattern

210
Q

What are 4 other things you might see on RADs of an asthmatic cat (besides bronchial pattern)?

A

Interstitial and patchy alveolar opacities
Hyperinflation of lungs (REALLY black lungs)
10% have collapse of right middle lung lobe
Flattening of diaphragm

211
Q

What will you see on cytology of an asthma case?

A

Increased eos or neuts and mized inflammation

212
Q

What will you see on cytology of a coughing/wheezing cat with an infection etiology?

A

Degenerate neuts +/- intracellular bacteria

213
Q

If culture is positive in a coughing/wheezing cat, is it likely asthma?

A

No, but should consider secondary infection

214
Q

What 4 things do you do to manage the acute bronchoconstricted or severe respiratory distress cat?

A

No stress
O2
Terbutaline (might make cat “spacey”) or Albuterol via MDI
Dex

215
Q

What 4 things do you do to manage the chronic intermittent coughing or wheezing cat?

A

Prednisolone
No more smoke in the house, avoid other irritants
Metered dose inhaler once signs are under control with oral steroids

216
Q

What are 3 advantages of an MDI?

A

Less systemic corticosteroid effects
Easier to treat
Possibly higher drug concentration to the lungs

217
Q

What are 3 disadvantages of an MDI?

A

Increased risk of dental dz (immune compromise in the mouth)
Re-emergence of latent herpes virus
Local dermatitis (irritating to lips)

218
Q

What are 2 other possible long-term treatments?

A

Oral bronchodilators

Antibiotics

219
Q

What 2 oral bronchodilators would you use?

A

Oral theophylline

Terbutaline

220
Q

What are the 3 major indications for a bronchodilator in a cat?

A

When large quantities of glucocorticoid needed
Adverse to glucocorticoid
Owner can’t use MDI

221
Q

What is the prognosis for long term medically treated feline asthma?

A

Good

222
Q

What is the prognosis for untreated feline asthma?

A

Permanent changes

  • Bronchitis with fibrosis
  • Emphysema
223
Q

What is the typical signalment for chronic bronchitis in cats?

A

Typically older cats

224
Q

What are 2 major characteristics of chronic bronchitis?

A

Neutrophili inflammation

Excessive mucus production

225
Q

What do the clinical signs of chronic bronchitis look like?

A

Feline asthma

226
Q

What is the focus of management in chronic bronchitis?

A

Control of inflammation with glucocorticoids

227
Q

What are 5 major signs of lung disease?

A 
Difficulty on expiration
Cough
Exercise intolerance
Abnormal lung sounds
Abnormal posture
228
Q

What posture would you see in lung disease?

A

Orthopnea

229
Q

What is pneumonia?

A

Inflammatory disorder of lung parenchyma

230
Q

What are 5 causes of pneumonia?

A 
Bacterial
Aspiration
Viral
Fungal
Parasitic
231
Q

What is the most common cause of pneumonia in dogs?

A

Bacteria

232
Q

Describe the cough in a pneumonia case.

A

Soft and ineffectual

233
Q

What 3 systemic signs you expect with a pneumonia case?

A

Fever
Lethargy
Poor appetite

234
Q

What age group typically gets PRIMARY bacterial pneumonia?

A

Yonger dogs

235
Q

What age group typically gets SECONDARY bacterial pneumonia?

A

Older dogs

236
Q

What are the 2 main causes for primary bacterial pneumonia?

A

Bordatella

Pasturella

237
Q

What are the top 5 causes for secondary pneumonia?

A 
Aspiration
FB
Neoplasia
Viral or fungal infection
Bronchitis
238
Q

What is an important thing to remember if a dog was recently sedated or anesthetized and has pneumonia?

A

Likely more resistant because of “hospital bugs”

239
Q

What are 2 good ways to dx bacterial pneumonia?

A

Thoracic RADs

Hemogram

240
Q

What 2 things do you expect to see on thoracic RADs of a bacterial pneumonia suspect?

A

Interstitial pattern

Alveolar pattern

241
Q

What 2 things do you expect to find on a hemogram of a bacterial pneumonia suspect?

A

Neutrophilic leukocytosis with left shift

Monocytosis IF chronic

242
Q

What can bacterial pneumonia result in?

A

Sepsis -> ALI (acute lung injury) -> ARDS (acute respiratory distress syndrome) (death)

243
Q

What 3 general things can you do to treat bacterial pneumonia?

A

Abx
Nebulization
Supportive care

244
Q

What sort of Abx would you look to to treat bacterial pneumonia?

A

Broad-specturum (4 quadrant = G+, G-, aerobe, anaerobe)

245
Q

How long should you treat a bacterial pneumonia case with Abx?

A

4-8 WEEKS

246
Q

What dose nebulization help do?

A

Mobilizes airway secretions

247
Q

What is often added to saline in a nebulizer to treat G-?

A

Gentamicin

248
Q

What 4 things would you considder as supportive care for a bacterial pneumonia case?

A

Fluids
O2
Coupage
+/- Bronchodilators

249
Q

What respiratory signs will you see with a mycotic pneumonia?

A

Similar to bacterial pneumonia (cough, exercise intolerance)

250
Q

What 3 things can you use to diagnose mycotic pneumonia?

A

Cytology/Histology
Urine
Serum antigens

251
Q

What do you see in serum of bacterial pneumonia vs. mycotic pneumonia?

A

Bacterial: Degenerate neuts with bacteria
Mycotic: eos, monos, plasma cells, happy neuts

252
Q

What 3 things might you use to treat mycotic pneumonia?

A

Itraconazole
Amphotericin B
Ketoconazole

253
Q

How might geographic location help with determining fungal organism.

A

Certain fungi are common to certain areas

254
Q

What else might you see in the case of a mycotic pneumonia caused by histoplasmosis?

A

GI signs

255
Q

What cytology will help you determine causative agent in mycotic pneumonia?

A 
L.N.
Draining lesions
TTW/BAL
Endotracheal wash
Lung aspirate
256
Q

What fungi is detected by serum ANTIGEN titer?

A

Cryptococcus

257
Q

What 3 fungi are detected by urine ANTIGEN?

A

Blasto
Histo
Valley fever

258
Q

How long do you treat mycotic pneumonia?

A

4-12+ MONTHS

259
Q

Which conazole is good to use in mycotic pneumonia cases with CNS signs?

A

Fluconazole

260
Q

What do you need to monitor when treating with Amphotericin B and why?

A

Monitor BUN and Creatinine because nephrotoxic

261
Q

What do you expect in the first week of treating mycotic pneumonia?

A

Increase chance of worsening of respiratory signs

262
Q

How effective is treatment on Blasto and Crypto?

A

80%

263
Q

What is the prognosis of localized Histo vs. disseminated Histo?

A 
Disseminated = guarded
Localized = better
264
Q

What is the recovery rate of Coccidio?

A

60%

BUT meds often needed for 6-12 months+ (sometimes lifetime)

265
Q

What are the 2 causes of parasitic pneumonia?

A 
Aleurostrongylus abstrusus (cat)
Paragonimus kellicoti (dog/cat)
266
Q

What would you see on chest RADs in a cat with Aleurostrongylus abstrusus?

A

Diffuse, nodular densities usually in caudal lobes

267
Q

How do you diagnose Aleurostrongylus abstrusus?

A

Larvae in fecal exam

268
Q

How do you treat Aleurostrongylus abstrusus (2 meds)?

A

Fenbendazole

Ivermectin

269
Q

What is a possible complication of Paragonimus kellicoti?

A

Cysts rupture = Pneumothorax

270
Q

What might you see on chest RADs with Paragonimus kellicoti?

A

May see air-filled sacs

271
Q

What is idiopathic pulmonary fibrosis?

A

Chronic fibrosis of lung interstitium

272
Q

How is idiopathic pulmonary fibrosis characterized (2 things)?

A

Infiltration of fibroblasts

Collagen deposition

273
Q

What is the typical signalment for idiopathic pulmonary fibrosis?

A

Terriers
Middle age to older
Some cats

274
Q

What is the history of idiopathic pulmonary fibrosis?

A

Slow onset exercise intolerance

275
Q

What is the most noticeable clinical sign of idiopathic pulmonary fibrosis?

A

Respiratory distress and tachypnea

276
Q

What is the hallmark finding on a dog with idiopathic pulmonary fibrosis?

A

Inspiratory crackles

277
Q

What woudl you find on a blood gas of a dog with idiopathic pulmonary fibrosis?

A

Hypoexemia if severe

278
Q

What can you use to help eliminate other Ddx when you suspect idiopathic pulmonary fibrosis?

A

TTW/BAL

Will find non-degenerate neuts, lymphocytes
Epithelial dysplasia

279
Q

What is the definitive dx for idiopathic pulmonary fibrosis?

A

Lung biopsy

280
Q

How can you treat idiopathic pulmonary fibrosis?

A

Corticosteroids + bronchodilators

281
Q

What is the prognosis for a dog with idiopathic pulmonary fibrosis?

A

Guarded d/t progressive respiratory failure

282
Q

What are the 2 types of primary pulmonary neoplasia?

A

Adenocarcinoma

Squamous Cell Carcinoma

283
Q

What are the 4 types of metastatic pulmonary neoplasia?

A

Adenocarcinoma
Osterosarcoma/Chondrosarcoma
Hamangiosarcoma; oral/digital melanoma
SCC

284
Q

What type of cancer is most common in the lungs?

A

Metastatic

285
Q

What are 3 types of multicentric pulmonary neoplasia you might see?

A

Lymphoma
Malignant histiocytosis
Mastocytoma

286
Q

Why are mets so common to find in the lung?

A

The lung acts as a filter for these cells

287
Q

What is the signalment for pulmonary neoplasia?

A

Usually older animal

288
Q

What respiratory signs do you see with pulmonary neoplasia?

A

Cough
Laboured breathing
Increased RR
Hemoptysis (coughing up blood)

289
Q

What would you expect to hear in the lungs if you suspect pulmonary neoplasia?

A

Crackles
Wheezes
Muffled

290
Q

What non-respiratory signs might you expect to see (5 things)?

A 
Weight loss
Inappetence
Lameness (Hypertrophic osteopathy)
Dysphagia/regurg
Head/neck edema
291
Q

Why might you see lameness in a case of pulmonary neoplasia?

A

HOP (hypertrophic osteopathy)

292
Q

How do you gain a tentative diagnosis of pulmonary neoplasia?

A

Thoracic RADs

THREE VIEWS!!!!!

293
Q

Where do you gain a histological or cytological sample?

A

Bronchoscopy (and BAL)
FNA

NOTE: BAL may not show anything because don’t often exfoliate cells

294
Q

What is the treatment for a primary pulmonary neoplasia?

A

Surgery if it’s a single nodule

295
Q

What is the treatment for mets in the lungs?

A

Treat primary mass

Can use chemotherapy in lymphoma

296
Q

What is the prognosis for pulmonary neoplasia?

A

Guarded to poor

297
Q

T/F: Malignant pulmonary neoplasia better than benign?

A

False

298
Q

T/F: Primary pulmonary neoplasia better than mets?

A

True

299
Q

T/F: SCC better than adenocarcinoma in the lungs?

A

False

300
Q

T/F: Small pulmonary neoplasia better than large?

A

True

301
Q

T/F: Tumors in one lung better than entire lung?

A

True

302
Q

T/F: No l.n. involvement better than l.n. involvement?

A

True

303
Q

What is pulmonary edema?

A

Accumulation of fluid in alveoli or pulmonary interstitium

304
Q

What do you need to determine in pulmonary edema?

A

Cardiogenic or non-cardiogenic

305
Q

If you have pulmonary edema, where will you hear crackles?

A

Perihilar area

306
Q

What are 4 general mechanisms of non-cardiogenic pulmonary edema?

A

Vascular overload/increased hydrostatic pressure
Decreased oncotic pressure (PLE and PLN)
Increased alveolar-capillary membrane permeability***
Lymphatic obstruction

307
Q

What are 3 pulmonary causes for increased alveolar-capillary membrane permeability?

A

Aspiration
Upper airway obstruction
Smoke

308
Q

What are 5 non-pulmonary causes for increased alveolar-capillary membrane permeability?

A 
Sepsis
Electric shock
CNS dz
Pancreatitis
DIC
309
Q

What 2 things can pulmonary edema progress to?

A

Acute Lung Injury (ALI)

Acute Respiratory Distress Syndrome (ARDS) -> Respiratory failure

310
Q

What would you hear on thoracic auscultation with non-cardiogenic pulmonary edema?

A

Crackles

311
Q

What would you see on thoracic RADs with non-cardiogenic pulmonary edema?

A 
Perihilar infiltrate
Alveolar pattern (bilateral)
Caudodorsal lung fields are affected
312
Q

How do you treat non-cardiogenic pulmonary edema (3 things)

A

Aggressive control of primary dz
Cage rest with O2
Supportive care (sedation to relax, cautious fluid therapy, Positive Pressure ventilation in severe cases)

313
Q

What is the prognosis for non-cardiogenic pulmonary edema?

A

Guarded if d/t permeability edema

Better if d.t fluid overload and if renal fxn is intact

314
Q

What is the cause of ALI?

A

Pulmonary inflammation and edema

NOTE: NOT a dx, but a clinical description

315
Q

What is ARDS?

A

Severe form of ALI

316
Q

What is the difference between ALI and ARDS?

A

Degree of hypoxemia

317
Q

What are ARDS/ALI most commonly a sequela of (3 things)?

A

Sepsis
Shock
Bacterial pneumonia

318
Q

How soon after the inciting incident might you see clinical signs of ARDS/ALI?

A

1-4days

319
Q

What are the clinical signs of ARDS/ALI?

A

Progressive hypoxemia
Respiratory distress
Cyanosis

320
Q

Is ALI/ARDS primary?

A

No, will be secondary to something else.

321
Q

How do you treat ALI/ARDS?

A

Aggressive supportive therapy
24-7 care
Positive pressure ventilation

322
Q

What is the prognosis for ALI/ARDS?

A

Mortality close to 100%… so not good.

323
Q

What 2 clues might you see to tip you off to pulmonary contusions?

A

Bloody nose

Bloody mouth

324
Q

What are clinical signs of pulmonary contusions?

A

Various degrees of respiratory distress

325
Q

What might you see pulmonary contusions concurrent with?

A

Blunt force trauma (eg. HBC)

326
Q

What is important to remember with pulmonary contusions?

A

Changes may take 2-12 hours to show up.

MUST MONITOR for 24-48hrs

327
Q

What is eosinophilic bronchopneumopathy?

A

Inflammation of lungs caused by hypersensitivity to unknown antigen.

328
Q

What breed is predisposed to eosinophilic bronchopneumopathy?

A

Siberian huskies

329
Q

What age do we typically see eosinophilic bronchopneumopathy in?

A

Young to middle age dogs

330
Q

What do we typically see clinically with eosinophilic bronchopneumopathy?

A

Harsh cough

Lack of response to Abx also common

331
Q

When it comes to treatment of eosinophilic bronchopneumopathy, what do we need to consider if planning on giving steroids?

A

If patient has bacterial or fungal infection, will make infection WORSE

332
Q

What might you see on the hemogram in a patient with eosinophilic bronchopneumopathy?

A

1/2 the cases have increased WBCs (neuts or eos)

333
Q

What 2 other tests should be done if you see eosinophilic bronchopneumopathy?

A

Heartworm

Fecal

334
Q

If you perform a TTW, BAL or endotracheal wash on a patient with eosinophilic bronchopneumopathy, what cell type will predominate?

A

Eosinophils (20-25%)

335
Q

How do you treat eosinophilic bronchopneumopathy?

A

Find and treat the underlying cause
Can give corticosteroids BUT…

BE CAREFUL TO LOOK FOR PROTOZOAL, BACTERIAL OR FUNGAL INFECTIONS FIRST

336
Q

How long is treatment for eosinophilic bronchopneumopathy?

A

Often need long term because of replases

337
Q

What is the treatment for pulmonary thromboembolism (6 things)?

A 
O2
Keep calm
Tx underlying dzz
Bronchodilators
Pred if IMHA or HW
Low dose heparin if DIC or hypercoagulable
338
Q

What is the prognosis for pulmonary thromboembolism?

A

Poor to grave

Small Animal Medicine II (8 decks)

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