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VET 433c > Cardio/ Resp pt.1 > Flashcards

Cardio/ Resp pt.1 Flashcards

1
Q

Effort on inspiration vs expiration vs both

A 
Inspiratory = extrathoracic
Expiratory = intrathoracic
both = large airway
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2
Q

Pattern of Resp - deep breathing, slow or fast

A
  • obstructive
  • generally, airway disease (obstruction, constriction, compression)
  • hyperpnea
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3
Q

Pattern of Resp - rapid, +- shallow breathing

A
  • restrictive
  • generally, pulmonary (stiff lungs) or pleural disease (decreased expansion)
  • tachypnea
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4
Q

What is nasal depigmentation a classical sign of in the dog?

A

aspergillus

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5
Q

Age-related URT signs

A
  • young – infectious
  • old – neoplastic
  • any age – chronic rhinitis
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6
Q

Tracheal Sounds

A
  • loud, equal on insp and exp
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7
Q

Bronchial sounds (central/ hilar)

A
  • louder and longer on exp
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8
Q

Stertor

A
  • snoring sound
  • insp or exp
  • vibration of soft tissue (like the soft palate)
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9
Q

Stridor

A
  • high pitched insp sounds

- vibration of rigid tissues

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10
Q

Vesicular Sounds (peripheral)

A
  • soft, longer on inspiration
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11
Q

Bronchovesicular sounds

A
  • soft, equal on insp and exp
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12
Q

Crackles

A
  • discontinuous
  • coarse or fine
  • early or late
  • insp or exp
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13
Q

Wheezes

A
  • continuous
  • musical
  • usually expiratory
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14
Q

Space occupying masses

A
  • decreased thoracic compressibility
  • swollen head/ front limbs - cranial vena cava syndrome
  • Horners ( miosis, enophthalmos, ptosis of upper lid, elevation of 3rd eyelid)
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15
Q

Why can you get horner’s from a space occupying lesion?

A
  • damage to the cranial sympathetic trunk via the mass
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16
Q

T/F: dorsal eval of pleural effusion and ventral eval of pneumothorax both appear the same, normal

A

T

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17
Q

Aus and Perc on ventral eval of pleural effusion

A

absent aus

dull percussion

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18
Q

Aus and Perc on dorsal eval of pneumothorax

A

Absent aus

hyper-resonant percussion

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19
Q

what causes normal heart sounds?

A
  • valve closure abruptly alters blood flow –> vibration of tissues and adjacent blood columns
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20
Q

What does S1 represent

A

closure of AV valves (mitral and tricuspid)

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21
Q

What does S2 represent

A

closure of semilunar valves

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22
Q

Why might you have louder heart sounds?

A
  • lean body condition, inc sympathetic tone, hypertension
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23
Q

Why might you have quieter heart sounds?

A
  • obesity, pleural or pericardial effusion, diaphragmatic hernias, myocardial failure
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24
Q

Turbulence caused by changes in 3 things

A
  • vessel diameter
  • blood velocity
  • viscosity
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25
Q

3 ways to characterize murmurs

A
  1. grade
  2. location
  3. timing
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26
Q

Grades of murmus

A
  1. soft, focal, not readily apparent
  2. soft and focal, readily apparent
  3. moderate and radiates
  4. very loud but no thrill and radiates widely
  5. palpable thrill
  6. no stethoscope needed
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27
Q

3 common locations for dog murmurs

A
  1. left apex (M)
  2. left base (A or P)
  3. right apex or sternal (T)
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28
Q

3 common locations for cat murmurs

A
  1. left caudal parasternal
  2. right caudal parasternal
  3. left cranial
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29
Q

Timing of murmurs options

A

systolic, diastolic, both, continuous

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30
Q

T/F: a murmur in a cat is useful and indicates the presence of pathology

A

F

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31
Q

T/F: the lack of murmur in a dog eliminates clinically important heart disease

A

T

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32
Q

Gallop Sounds

A
  • low pitched diastolic extra heart sounds

- more specific indicator of structural cardiac disease in cats

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33
Q

S3 gallop sounds

A
  • over-distended, poorly compliant ventricle
  • rapid deceleration of LV walls and blood and rapid equilibration of LA and LV pressure following MV opening
  • lub-dub-thud
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34
Q

S4 gallop sounds

A
  • implies diastolic dysfunction
  • impaired relaxation in early diastole –> delayed filling –> reliance on enhanced atrial systole to fill ventricles
  • bub-lub-dub
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35
Q

Tracheal Collapse

A
  • tracheomalacia

- small breed dogs (cervical, intrathoracic, both)

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36
Q

Bronchial collapse

A
  • bronchomalacia
  • small and large breed dogs
  • brachycephalic breeds
  • can accompany chronic bronchitis or eosinophilic lung disease
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37
Q

Airway collapse timing

A

on inspiration –> extrathoracic

on expiration –> intrathoracic

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38
Q

Pathophys of Tracheal collapse

A
  • hypocellular tracheal rigns ( dec glycosaminoglycan –> dec bound water)
  • genetic or congenital influences (early onset signs)
  • acquired conditions contribute to signs
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39
Q

Triggers of airway collapse clinical signs

A
  • intubation
  • weight gain
  • chronic bronchitis
  • infection
  • upper airway obstruction
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40
Q

Airway Collapse (clinical Signs)

A
  • goose honk cough (paroxysmal)
  • gagging or wretching
  • exercise intolerance
  • respiratory distress
  • cyanosis
  • syncope
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41
Q

Airway Collapse (physical exam)

A
  • can appear normal at rest
  • laryngeal/ tracheal auscultation
  • tracheal palpation (abn rings may be felt)
  • pulmonary auscultation (can be normal)
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42
Q

Airway Collapse (Diagnostics)

A
  • CBC Chem UA
  • Rads (chest and neck)
  • Fluoroscopy
  • Bronchoscopy
  • Airway sampling for infectious dz
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43
Q

Airway Collapse (treatment)

A
  • weight loss
  • stress/ env control (ace/ trazadone)
  • antitussives (anti-cough) (opioids)
  • bronchodilators (for intrathoracic tracheal or bronchial collapse)
  • corticosteroids/ abx
  • surgery or stent
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44
Q

Canine Infectious Respiratory Disease Complex

A
  • multiple organisms (not just bordetella)
  • young dog w/ history of exposure
  • highly contagious
  • CS: sudden onset, dry cough; trach sensitivity in healthy dog
  • Treatment: rest, supportive care, maybe abx
  • Prevention: vaccination
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45
Q

3 Ddx for airway collapse

A
  1. CIRD
  2. Airway Foreign body
  3. Tracheal irritation or trauma
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46
Q

Oxygenation vs Ventilation

A

Oxygenation –> adding O2

Ventilation –> removing CO2

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47
Q

Cyanosis

A
  • blue membranes = severe hypoxemia

- may not be apparent in anemic animals

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48
Q

Hypoxemia

A

PaO2 < 80mmHg

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49
Q

What is the 5x Rule

A

FiO2 x 5 = PaO2

  • only at sea level
  • used to ensure that the patient has adequate lung function
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50
Q

What is the PF ratio?

A
  • P/F = 500

- if <300-400, then lung dysfunction is present

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51
Q

A-a gradient

A
  • PAO2 - PaO2 < 15 mmHg

- hypoxemia with an elevated A-a gradient indicates venous admixture

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52
Q

3 causes of hypoxemia

A
  1. low inspired O2
  2. hypoventilation
  3. venous admixture
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53
Q

Rule of 120

A

PaCO2 + PaO2 > 120
–> no venous admixture , hypoventilation alone

PaCO2 + PaO2 < 120
–> venous admixture

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54
Q

Endocarditis (pathogenesis)

A
  • portal of entry into bloodstream
  • bacterial adherence:
  • -> previous valve injury
  • -> inf. begins on valve surface that faces blood flow
  • -> trauma to valve increases chance of colonization
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55
Q

Endocarditis (Gross Lesions)

A
  • vegetative lesions (cauliflower), frequently w/ hemorrhage

- mitral (atrial) and aortic (ventricular) most common

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56
Q

Endocarditis (most common organisms)

A

Cats - pasteurella

Dogs - strep, staph, e. coli, bartonella

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57
Q

T/F: a patient with endocarditis is often presenting for a fever of unknown origin

A

T

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58
Q

T/F: the ideal endocarditis line-up is new murmer, febrile, inflammation, and a (+) blood culture

A

T

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59
Q

Endocarditis (treatment)

A
  • bactericidal abx that penetrate fibrin

- Clavamox, Baytril, Doxycyline all together

60
Q

Endocarditis (prognosis)

A
  • poor
61
Q

Endocarditis (predisposing factors)

A
  • immunosuppressive therapy

- sub-aortic stenosis

62
Q

3 Causes of Pericardial Effusion

A
  1. Transudate (hernias, cysts, congestive heart failure)
  2. Exudate ( perforating foreign body, fungal disease)
  3. Hemorrhage (idiopathic, rupture or L atrium, neoplasia)
63
Q

Cardiac Tamponade

A
  • increased pressure in the pericardial space inhibiting cardiac function
  • fast onset = high pressure
  • low onset = low pressure
64
Q

Pericardial Effusion (PE findings)

A
  • muffled heart sounds
  • weakness, lethargy, collapse
  • pulsus paradoxus (abn large dec in systolic BP during inspiration)
  • R heart failure signs (hepatomegaly, ascites, pleural effusion)
65
Q

Pericardial Effusion (ECG findings)

A
  • decreased QRS

- large ST segment d/t epicardial ischemia

66
Q

Pericardial Effusion (treatment)

A
  • pericardiocentesis
  • treat CHF
  • in constrictive pericardial dz/ –> removal of pericardium
67
Q

Pericardial Effusion (prognosis)

A
  • w/ tumor ass. hemorrhage –> v poor

- otherwise good

68
Q

Ace, Dex, Benzos, Opioids effect on respiratory system?

A

opioids are the only ones that suppress the respiratory system. others are good to go

69
Q

bronchitits

A
  • bronchial inflammation

- results in cough in the absence of specific etiology

70
Q

Canine Chronic Bronchitis (Signalment, Clinical Signs)

A
  • daily cough > 2 months
  • middle-aged to older animals
  • large and small breed dogs
    CS:
  • cough primarily
  • exercise intolerance
  • tachypnea or exercise difficulty
  • collapse
71
Q

Canine Chronic Bronchitis (Physical Exam)

A
  • systemically healthy/ overweight
  • inducible cough/ tracheal sensitivity
  • harsh crackles, expiratory wheezes
  • increased expiratory effort
  • abdominal push
  • normal/ low heart rate, resp arrhythmia
  • cyanosis (late in disease)
72
Q

T/F: Bronchitis is a diagnosis of exclusion

Also, what are some diagnostics

A

T

  • minimum database WNL
  • airway inflammation and mucus present
  • rads can be normal or show thick walls or increased wall count
73
Q

Chronic Bronchitis (Diagnosis)

A
  • bronchoscopy

- BAL or TW – neutrophilic cytology, no intracellular bacteria, minimal/ light bacterial growth on culture

74
Q

Chronic Bronchitis (Treatment)

A
  • weight loss
  • anti-inflammatory doses of steroids (pred)
  • Bronchodilators (XR-theophylline)
  • Cough suppressants (anti-tussives) (when inflammation is controlled, airway collapse is present)
75
Q

T/F: anti-tussives are contraindicated in pneumonia patients

A

T, we don’t want stuff growing in the lungs

76
Q

Feline Bronchial Disease (Signalment, History, Trigger Events)

A

Signalment: female, siamese
History: intermittent or chronic cough, wheeze; panting with exercise; acute respiratory distress
Trigger Events: upper resp infection, stress, dust, smoke, aerosol spray

77
Q

Feline Bronchial Disease (Pathology)

A
  • Epithelial disruption and erosion
  • hypertrophy of goblet cells
  • hyperplasia of submucosal glands
  • smooth muscle hyperplasia and constriction
  • submucosal inflammatory infiltrate
78
Q

Feline Bronchial Disease (Clinical Signs)

A
  • cough
  • audible breath sounds or wheezing
  • exercise intolerance
  • abdominal effort
  • difficult or rapid breathing
  • open mouth breathing
79
Q

Feline Bronchial Disease (Physical Exam)

A
  • can be normal at rest
  • may have post-tussive crackles
  • increased tracheal sensitivity
  • harsh lung sounds, crackles, wheezes
  • prolongation of the expiratory phase or an expiratory push
  • tachypnea or resp distress
  • cyanosis
80
Q

Feline Bronchial Disease (Radiography)

A
  • normal, interstitial, or bronchial

- possible atelectasis of the right middle lung lobe (or others)

81
Q

Feline Bronchial Disease (Airway Wash)

A
  • Cytologic analysis (can be eosinophilic, neutrophilic, or rule out airway parasites or organisms)
  • Aerobic bacterial culture (but >75% + in healthy cats)
  • mycoplasma culture
82
Q

Feline Bronchial Disease (Acute Therapy)

A
  • limit stress
  • oxygen
  • sympathetic beta stimulants (albuteral, terbutaline)
  • short acting corticosteroids (dexamethason)
83
Q

Feline Bronchial Disease (Chronic Management)

A
  • prednisolone
  • maybe inhaled steroids (flovent)
  • Bronchodilators (not very useful)
  • nebulization for airway hydration and mobilization of secretions
84
Q

Bronchiectasis

A
  • irreversible dilation or airways (focal or diffuse) (suppuration is common)
85
Q

Bronchiectasis (Etiology)

A
  • sequela to uncontrolled inflammation (chronic bronchitis)
  • sequela to uncontrolled infection
  • post-obstructive (fb)
  • inhalation of noxious fumes
86
Q

Primary Ciliary Dyskinesia

A
  • inherited disorder of microtubule formation

- immotile cilia (nasal discharge, recurrent pneumonia, immotile sperm, deafness, hydrocephalus)

87
Q

Primary Ciliary Dyskinesia (diagnosis)

A
  • tracheal scintigraphy
  • electron microscope
  • semen motility
  • genetic testing
88
Q

Primary Ciliary Dyskinesia (Treatment)

A
  • abx

- nebulization and physiotherapy

89
Q

Bronchiectasis (Clinical Presentation)

A
  • recurrent or resistant pneumonia
  • rads - thickened airways
  • CT more sensitive
90
Q

Bronchiectasis (Treatment)

A
  • dilation is irreversible
  • long-term therapy for pneumonia
  • lobectomy for focal disease
  • avoid cough suppressants
91
Q

Pneumonia (history and clinical signs)

A
  • moist, often productive cough
  • +/- nasal discharge
  • abn respirations
  • exercise intolerance
  • lethargy, anorexia, weight loss
92
Q

Pneumonia (PE)

A
  • respiratory (restrictive pattern of breathing, increaed tracheal sensitivity, abn lung auscultation)
  • systemic abn often accompany viral, fungal, and neoplastic
93
Q

Diagnostics for parenchymal lung disease

A
  • CBC for infection vs inflammation
  • Chem and UA for underlying causes
  • heartworm testing
  • serology
  • pulse oximetry, art blood gas
94
Q

5 types of Pneumonia

A
  1. bacterial
  2. aspiration
  3. fungal
  4. eosinophilic
  5. interstitial
95
Q

Bacterial Pneumonia (etiology)

A
  • hematogenous
  • aspiration
  • foreign body
  • predisposing pulmonary disease or pulmonary immune dysfunction
96
Q

Bacterial Pneumonia (Physical Exam)

A
  • cyanosis
  • fever
  • tachypnea, tachycardia
  • tracheal sensitivity
  • harsh lung sounds
  • crackles
97
Q

Becterial Pneumonia (treatment)

A
  • abx (bacteriocidal)
  • oxygen supplementation
  • airway therapy (nebulization)
  • treatment of any underlying disease)
98
Q

Bacterial Pneumonia (Monitor)

A
  • respiratory pattern, rate, and effort
  • pulse oximetry
  • changes in CBC
  • recheck 10-14 days after starting abx
99
Q

T/F: Feline pneumonia occurs less frequently than canine pneumonia

A

T

100
Q

Aspiration Pneumonia

A
  • middle lung lobe infiltrate or cranioventral

- right cranial most common

101
Q

Aspiration Pneumonia (treatment)

A
  • abx

- airway therapy, do not coupage if vomiting is present

102
Q

Foreign Body Pneumonia

A
  • dogs > cats
  • coughing
  • fever, left shift common
  • can lead to bronchiectasis
103
Q

Foreign Body Pneumonia (diagnosis)

A
  • history of exposure
  • bronchoscopy
  • treatment via CT, bronchoscopy, and surgery
104
Q

Fungal Pneumonia (based on location)

A

Ohio/ Mississippi - Histoplasma, Blastomycosis
Southwestern US - coccidiodes
Worldwide - cryptococcus

105
Q

Fungal Pneumonia (Diagnosis)

A
  • exposure history most common
  • physical exam findings
  • lab data : NNN, neutrophilia, monocytosis, low alb, low platelets (histo), high calcium (blasto)
106
Q

Fungal vs Cancer

A

Fungal lesions tend to all be the same size while neoplastic ones tend to vary

107
Q

Fungal Pneumonia (treatment)

A
  • anticipate 6-12 month treatment

- monitor: radiograph and clinical response

108
Q

Eosinophilic Lung Disease

A
  • etiology unknown but probs immune-mediated, hypersensitivity, or parasites
109
Q

Eosinophilic Lung Disease (History, Signs)

A

History:

  • young-middle aged female dogs
  • large and small breeds

Signs:

  • cough - nonresponsive to abx
  • yellow, green nasal discharge in some
  • tachypnea, anorexia
110
Q

Eosinophilic Lung Disease (Diagnostics, Treatment)

A

Diagnostics:

  • eosinophilia ~60%, neutrophilia ~25%
  • rads - bronchial pattern most common
  • Bronchoscopy - yellow, green mucus, hyperemia, granulomas, airway collapse, bronchiectasis

Treatment:

  • fenbendazole
  • maybe pred
111
Q

Interstitial pneumonia

A
  • West Highland White Terrier
  • unknown etiology
  • thickened alveolar membrane
  • non-distinct clinical signs or rads, but CT will have ‘ground-glass’ appearance
  • occurs later in life
112
Q

Pulm. Neoplasia

A
  • Clinical Signs - cough, labored breathing, weight loss, lethargy, focal or diffuse infiltrates
  • Diagnostics - thoracic US and FNA
  • Cats: systemic signs often predominate, often see cavitating masses on rads
  • Treatment: surgical resection
113
Q

What are some limitations of echo?

A
  • requires a skilled operator and interpreter
  • won’t diagnose left heart failure
  • won’t provide histopath
  • can’t image great vessels
  • can’t assess/ predict anesthetic risk
114
Q

2D echo (B-mode)

A
  • foundation of everything
  • permits real-time 2D view of single or multiple parts of heart
  • evaluate cardiac morphology and anatomy
  • does not give info on blood flow velocity or direction
115
Q

1D echo (M-mode)

A
  • displays a time-motion graph
  • can see fine undulations of valve movement very well
  • proper cursor alignment is crucial
116
Q

Doppler Echo

A
  • allows detection and analyssi of moving blood cells or myocardium
  • 4 types: Color, Pulsed-Wave (velocity at single point), Continuous Wave (velocity over entire line), Tissue
117
Q

Echo - Left Atrial Size

A
  • reliably reflects hemodynamic burden of left-sided heart disease
  • right parasternal short-axis basile view (LA/Ao view)
  • LA:Ao > 1.6-7 = enlarged
118
Q

T/F: normal blood flow velocity should be <2m/s

A

T

119
Q

T/F: continuous wave doppler over any of the valves will provide E and A waves with normal function E > A

A

T

120
Q

How to calculate blood velocity through tricuspid valve

A
  • requires tricuspid regurgitation jet velocity

- deltaP = 4 x V^2

121
Q

Mediastinal Boundaries

A
  • thoracic inlet to the diaphragm
  • L and R lung excluded
  • sternum to vertebral column
  • continuous w/ fascial planes in the neck and retroperitoneal spaces
122
Q

Mediastinal Contents

A
  • heart and great vessels
  • esophagus
  • trachea
  • thoracic duct
  • phrenic nerve
  • thymus
  • lymph nodes
123
Q

Widened Mediatstinum

A
  • common and normal finding in brachycephalic breeds
124
Q

Mediastinal Shift

A
  • ipsilateral collapsed lung lobe or atelectasiss
  • contralateral mass
    PE:
  • heart louder on collapsed side w/ no lung sounds
125
Q

Mediastinal Mass (4 locals)

A
  • cranioventral
  • craniodorsal
  • perihilar
  • caudal
126
Q

Mediastinal Disease (History and Clinical Signs)

A
  • rapid or obstructive breathing
  • anorexia, lethargy, exercise intolerance
  • neurological signs (horner’s)
  • dysphagia
  • laryngeal paralysis -> stridor
  • decreased thoracic compression
127
Q

Pleural Disease (auscultation for effusion vs pneumothorax)

A
  • Effusion:
    V: Neg Ausc – Dec Percussion
    D: normal
  • Pneumothorax
    V: normal
    D: Neg Ausc – high Percussion
128
Q

Pneumothorax

A
  • loss of negative intrapleural pressure
  • Types: traumatic, spontaneous, tension
  • If not traumatic causes, look for underlying cause via fecal exam and CT and thoracotomy
129
Q

Pneumothorax (Diagnosis, Treatment)

A

Diagnosis: respiratory pattern, auscultation and percussion, thoracocentesis

Treatment: chest tap (simple pneumo), sedation + O2, Chest tube for tension pneumothorax

130
Q

T/F: DV positioning reduces resp. stress while VD improves fluid detection for pleural effusion cases

A

T

131
Q

Types of Pleural Effusion and a cause of each

A
  1. Pure Transudate (dec oncotic pressure)
  2. Modified Transudate (r heart disease, diaphragmatic hernia, lung lobe torsion, pericardial dz)
  3. Exudate (septic or non-septic)
132
Q

Exudate (FIP) (CS, PE, ClinPath, Fluids)

A
  • mutation of coronavirus
  • Clinical Signs: lethargy, anorexia, evidence of organ dysfunction
    PE: wet (abd distension) – dry (pneumonia ass. w/ pyogranulomatous inflammation)
    ClinPath: chronic inflammation, coronavirus titer indicates exposure only
    Fluid Analysis: prot > 5, cells ~3k
133
Q

Pyothorax (diagnosis, tx, prog)

A
  • bacteria visible on cytology
  • polymicrobial infection
    Tx: conservative, aggressive medical, or surgical debridement
    Prog: 50-60% resolution w/ aggressive therapy w/ 3-6months of abx — better with surgery
134
Q

When is surgery indicated for pyothorax?

A
  • no response to medical
  • pulmonary lesions
  • foreign body evident
135
Q

Chylothorax

A
  • TP > 2.5, Cells >500
  • Origin: intestinal lymphatics that leak from the thoracic duct
    Causes:
  • idiopathic
  • thoracic duct obstruction
  • trauma
    Fluid Analysis: high TG, low cholesterol
    Treatment: Surgery
136
Q

Hemothorax

A

Etiology: trauma, coagulopathy (high PCV), neoplasia, lung lobe torsion (low PCV)
Diagnosis: diagnostic tap (do not drain), coag. testing
Tx: coag –> vit. K or plasma

137
Q

3 primary surgical approaches to the chest

A
  • median sternotomy (allows access to both sides of the chest, but no dorsal structures)
  • intercostal thorocotomy (better access to dorsal)
  • thoracoscopy (min invasive)
138
Q

Post-op care for pleural space disease

A
  • analgesics
  • resp status monitoring
  • abx if necessary
  • monitor persistent atalectasis
  • iatrogenic pneumothorax
139
Q

Lung Lobe Torsion (Surgery)

A
  • lung lobectomy w/ no de-torsion

- better with appropriate stabilization and perioperative care

140
Q

T/F: the best way to id the thoracic duct is via CT

A

T

141
Q

Chylothorax (post op)

A
  • pain management
  • thoracostomy tube
  • resp monitoring
142
Q

Pleural Ports

A
  • must use a special (Huber) needle to access the silicone diaphragm
  • think SUBS but for thorax
143
Q

Pyothorax (surgery)

A
  • drainage is vital

- going to surgery might be a better

144
Q

T/F: Spontaneous pneumothorax in dogs is almost always a surgical disease while cats often can do very well with medical

A

T

145
Q

Heimlich Valve

A
  • one way valve to remove air from the chest in pneumothorax
146
Q

T/F: Traumatic diaphragmatic hernias tend to occur through the musculture.

A

T

VET 433c (6 decks)

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