Clinical Exam of the Resp Tract in SA

Question 1

What characteristics make up signalment?

Answer 1

Age, breed, species, sex/repro status

Question 2

What are some important clinical history questions you might ask that relate to the respiratory system?

Answer 2

*recent contact with other/new animals? Kennels? Dog parks? etc.
*indoor/outdoor?
*vaccinations
*meds
*C/S/Nasal d/c, RR
*Duration, progression, any exacerbating factors?

Question 3

What are some clinical signs assoc’d w/ resp dz?

Answer 3

*C
*increased RR & effort (tachypnoea vs dyspnoea)
*S vs reverse S
*nasal d/c
*postural breathing
*abnormal breathing sounds (stertor, stridor, wheezing, crackles)
*abnormal breathing pattern
*cyanotic MM
*other systemic clin signs

Question 4

What are the 3 phases of cough?

Answer 4

1. Deep inhalation
2. Increase in airway pressure leads to contraction of resp muscles against closed glottis
3. Rapid expiration

Question 5

Stimulation of cough receptors can occur in what locations?

Answer 5

Larynx, trachea, bronchi

Question 6

What is the expiration reflex?

Answer 6

stimulation of larynx that sounds similar to a cough but has no inspiratory phase

Question 7

What is a sneeze?

Answer 7

rapid expulsion of air/particles through the nose at expiration

Question 8

Where are the stimulation receptors for a sneeze?

Answer 8

nasal mucosa

Question 9

What is a reverse sneeze?

Answer 9

intake of air through the nose as a sign of nasopharyngeal irritation

Question 10

How would you characterize nasal d/c?

Answer 10

*unilateral vs bilateral
*types of d/c (mucopurulent - white/green; clear; epistaxis)
*other alterations (depigmentation, etc)

Question 11

When you see epistaxis, what might you first think to differentiate the cause?

Answer 11

is it intranasal or systemic?

Question 12

Nasal d/c is typically secondary to…

Answer 12

intranasal dz

Question 13

What are signs of postural breathing?

Answer 13

‘Air hunger’ –> mouth open, neck extended, elbows abducted, reluctance/inability to lie down

Question 14

What is stertor?

Answer 14

Inspiratory nasal sound when awake that disappears when mouth breathing

Question 15

What is stridor?

Answer 15

inspiratory laryngeal sound present when mouth breathing

Question 16

What are the 4 types of respiratory patterns?

Answer 16

normal
obstructive
restrictive
paradoxical

Question 17

What are the 3 types of obstructive respiratory patterns?

Answer 17

inspiratory
expiratory
mixed

Question 18

What is an inspiratory obstructive pattern and where do you hear it?

Answer 18

Present in upper respiratory tract
increased duration of inspiration often assoc’d w/ loud inspiratory noise

Question 19

What is an expiratory obstructive pattern and where does it come from?

Answer 19

Lower respiratory tract
increased duration of expiration often assoc’d w/ effort
Wheeze often audible by stethoscope
May be externally audible

Question 20

What is a mixed inspiratory & expiratory obstructive pattern?

Answer 20

increased duration of both inspiration & expiration
Due to fixed airway obstruction or dz affecting multiple sites

Question 21

What is a restrictive pattern of breathing?

Answer 21

Rapid respiration w/o exaggeration of the inspiratory or expiratory component
May be panting

Question 22

When might you see a restrictive pattern of breathing?

Answer 22

pleural space or interstitial lung dz

Question 23

What is a paradoxical respiratory pattern?

Answer 23

movement of the chest or flanks in the opposite direction to what is expected during inspiration & expiration

Question 24

When might you see a paradoxical respiratory pattern?

Answer 24

pleural effusion
other causes of marked dyspnoea

Question 25

What are the 4 things you might hear upon lung auscultation?

Answer 25

normal breath sounds
wheezes
crackles/rales
referred noises

Question 26

What are wheezes and when might you hear them?

Answer 26

Air flowing through narrow airways
Most commonly on expiration

Question 27

What are crackles/rales and when might you hear them?

Answer 27

Popping open of small airways & alveoli
Inspiration

Question 28

What signs would point to an extrathoracic airway issue?

Answer 28

Inspiratory
Obstructive
Mild increase in RR
stertor - nasal/ stridor - larynx
normal chest percussion

Question 29

What signs would point to an intrathoracic large airway?

Answer 29

expiratory
obstructive
normal to mildly increased RR
Wheeze +/-
Normal chest percussion

Question 30

What signs would point to an intrathoracic small airway?

Answer 30

Expiratory
obstructive
increased RR
+/- wheeze
normal or resonant chest percussion

Question 31

What signs would point to an issue in the pulmonary parenchyma?

Answer 31

inspiratory +/- expiratory
restrictive
increased RR
+/- crackles
normal/dull chest percussion

Question 32

What signs might point to an issue in the pleura & chest wall?

Answer 32

inspiratory
restrictive
increased RR
reduced sounds
Dull chest percussion - solid/liquid; resonant - air

Question 33

What initial diagnostics might you run to help diagnose a respiratory tract problem?

Answer 33

General blood panel
faecal/serology for infectious dz
initial imaging - chest rads or u/s

Question 34

What advanced imaging tests might you run to help diagnose a resp tract problem?

Answer 34

Fluoroscopy
CT
bronchoscopy
Sampling: BAL, U/S-guided cytology

Question 35

What would be required for direct examination of the upper airway?

Answer 35

Sedation

Question 36

Why and what would you need for tracheo-bronchoscopy or rhinoscopy?

Answer 36

General anesthesia
For targeted sampling or direct observation of trachea & bronchi

Question 36

When doing an upper airway exam, what are the main structures that can be assessed?

Answer 36

oral cavity, soft palate, larynx

Question 37

When would you do a bronchoalveolar lavage (BAL)?

Answer 37

For cytology, culture, PCR for infectious dz
For lesions affecting airways or alveoli

Question 38

Echographic-guided cytology can be used for…

Answer 38

superficial focal lesions that require specific sampling