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Clinical respiratory Flashcards

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1
Q

What is the etiology of tracheal collapse ? What component of cartilage is decreased ?

A

Progressive cartilage malacia associated with a reduction of glycoaminoglycans and chondroitin leading to dorsoventral collapse of the trachea

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2
Q

What breeds are mostly affected by tracheal collapse?

A

Yorkshire terrier, maltese, chihuahua, pomeranian

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3
Q

What frequent concurrent condition is often present ? What is the definition for this condition ?

A

Bronchomalacia is a weakness of the wall of principal or smaller bronchi
Causes a bronchial collapse

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4
Q

What is the best dx option ?

A

Fluoroscopy. Radiograph is less sensitive (dynamic component to the disease).
Can see cervical lung lobe prolapse

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5
Q

When do tracheal IT or cervical collapse happen

A

Cervical : During inspiration
Intrathoracic : During expiration

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6
Q

What dx procedure should be done before stent placement ?

A

Tracheobronchoscopy to assess the degree of severity and the involvement of the bronchi (bronchial collapse) ?

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7
Q

What is the grading system for tracheal collapse

A

Grade I : 25% loss of lumen
Grade 2 : 50
Grade 3 : 75
Grade 4 :100

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8
Q

What are the medical management for tracheal collapse ?

A
  • Weight loss, harness, prevent irritant in the air
  • Sedative : Butorophanol or ACP
  • Anti-tussive : butorphanol, hydrocodone, codein
  • Bronchodilator : B2 agonist or methyxanthines
  • Steroids : fluticasone (inhaled) or prednisone PO
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9
Q

What are sx option for tracheal collapse and complications ?

A

Stent : Stent migration, granuloma formation (19%), stent fracture (25%)

Extraluminal tracheal ring : necrosis; only for cervical collapse

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10
Q

What parasites dan cause tracheal granuloma ? iatrogeinic ?

A

Oslerus osleri (dogs)
Tracheal cuterebra (cats)

Stent placement

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11
Q

What is the treatment for milf tracheal tear

A

Can heal without intervention

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12
Q

How is the dx of tracheal injury or obstruction made ?

A

Radiographs or treachoscopy

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13
Q

What are CS of tracheal injury?

A
  • Pneumomediastin
  • SC emphysema
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14
Q

What are the three criterias for chronic bronchitis in dogs ?

A
  • Chronic cough (>2 months)
  • Excessive mucous or mucous hypersecretion
  • Exclusion of other chronic cardiopulmonary dz
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15
Q

What are the complications of long term chronic bronchitis ?

A

Bronchiectasis
Bronchomalacia
Both

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16
Q

How do we dx chronic bronchitis ?

A

Dx of exclusion (Thoracic radiographs, fluoro, CT, tracheobronchoscopy, BALF, fecal flottaison, baerman, echocardio, Heartworm testing

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17
Q

What are the dx test that can help evaluate the presence of microaspiration ?

A

Bile acids in BALF
Change in lung microbiota

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18
Q

What is the pathophysiology for CB ?

Which dogs are affected ?

A
  • Increased mucus production
  • Bronchial wall thickening
  • Bronchomalacia
    Leading to bronchial airflow obstruction

Middle-age to older small breed dogs

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19
Q

What are the treatment for CB in dogs ?

A
  • Env : weightloss, harness, prevent irritant
  • Mainstay : Corticosteroids to reduce mucus secretion and mucosal bronchial thickening and reduce airway inflammation
  • Bronchodilators : B2 or theophyllin
  • Cough suppressant if dog is exhausted
  • ATB (doxycycline or azythromycine : AI properties) if exacerbation and suspicion of infection
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20
Q

What atb is contraindicated with theophylline

A

Enrofloxacin can cause theophylline toxicosis

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21
Q

Quel est le signe clinique associé à la CB ?

A

Toux pis rien d’autre

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22
Q

What is idiopathic eosinophilic bronchopenumopathy ? Which dogs are affected ?

A

Eosinophilic infiltration of the pulmonary and bronchial mucosa
secondary to immunological hypersensitivity(CD4+ Th 2 )

Siberian Husky and Malamutes presented for cough and retching

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23
Q

How do we dx idiopathic eosinophilic bronchopneumopathy ?What are the findings? What can be seen on CBC? in whihch % of dogs ?

A

Bronchoscopy ( yellow-green mucous, mucopurulent material, sevre thickening of the mucose with irregular or polupoid surfaces) + BALF (marked eosinophilic component usually > 50% of inflammatory cells)

Normal baerman and fecal flottasion (to repeat in time)

Peripheral eosinophilia (> 60% of dogs)

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24
Q

What is the main ddx for idiopathic eosinophilic bronchopneumopathy ?

A

Parasitic diseases
- Occult Heartworm disease, angiostrongylus vasorum
- Eucoleus aerophilus, Oslerus osleri, filaroides hirthi, crenosoma vulpis or paragonimus kellicoti

In hum : Strongyloides, ascaris, toxocara or ancylostoma (in dogs ?)

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25
What is the treatment for idiopathic eosinophilic bronchopneumopathy?Prognosis?
Oral corticosteroids at immunosuppressive doses gives good prognosis despite recurrence. Inhaled steroid therapy is increasingly used (concomitant to PO at least initially) Relapse frequent weeks to months after stopping tx.
26
What is Kartagener syndrome ?
- CPD - Situs inversus - Bronchiectasis - Chronic rhinosinusitis
27
What breed has a genetic predispostion ?
Old English Sheepdog (CCDC39)
28
What are the other systemic signs of Primary ciliairy dyskinesia ?
Otitis media, infertility, asthenoteratospermi, hydrocephalus, dilation of renal tubules
29
What are the treatment for primary ciliary dyskinesia ? Prognosis ?
- Judicious ATB use - Coupage - Vigorous exercise - Hydration Poor prognosis
30
What is bronchiectasis ? Consequence ?
Abnormal and permanent dilation and distorsion of the subsegmental airways which results from chronic airway inflammation This leads to bronchial wall destruction and impaired clearance.
31
What is the clinical relevance of bronchial mineralization
Can occur 2nd to chronic inflammation or infection May also be unassociated with clinical evidence of dysfunction
32
What are the causes of bronchiectasis ? What are the breed usually affected ?
Subsequent to acquired dz American Cocker Spaniels, Miniature Poodles, Siberian Huskies & English Springer Spaniels > 7 y.o
33
How do we dx Bronchiectasis?
CT scan ( Bronchoarterial ratio ( normal< 2)
34
What is bronchomalacia?
Weakness of the walls of the primary and smaller bronchi leading to airway collapse during expiration and cough
35
What are the 2 types of bronchomalacia & their characteristics ?
- Static : brachycephalic breeds , does not require therapy - Dynamic : Dogs with tracheal collapse (80%) but can also happen as isolated disease
36
What are the 2 conditions of feline lower airway disease ? How do we differentiate them ?
Feline asthma and chronic bronchitis (spectrum, different dz ??) BALF: % neutrophils & eosinophils
37
What is thought to cause chronic bronchitis ? Asthma ?
1. CB = Arise due previous insult tht has permanently damaged the airway 2. Asthma = Allergic
38
Which breed might be predisposed to feline asthma ?
Siamese
39
How do we dx Feline lower airway disease ? (asthma, chronic bronchitis)
- Radiographs : Bronchointerstitial pattern and bronchial wall thickening, hyperinsufflation, middle right lung lobe collapse, air trapping - CT is more sensitive - Blood : 20% have peripheral eosinophilia - R/O : Heartworm, pulmonary worms (aelurostrongylus abstusus, toxocara cati) - Bronchoscopy + BALF: * neutrophilic > 50% neutrophilis * eosinophilic > 20% eosinophilic Can be altered if received GC already
40
What are the risks of bronchoscopy in cats ?
Bronchospasm
41
What is the most common cause of feline spontaneous pneumothorax?
Asthma
42
Name arising biomarker for asthma ?
ET1
43
DDX for asthma /CB
infectious BP, neoplasia, parasitic dz (A, abstusus, Troglostrongylus brevior, Eucoleus aerophilus, D, immitis, toxocara cati.
44
What is the tx for asthma ?
- Corticosteroid PO + inhaled initially then inhaled - Bronchodilator : terbutaline, B2 agonist (albuterol inhaled) - Thoracocenthesis if pneumothorax Salbutamol should not be used alone because it does not tx inflammation. POtential AE : Tachycardia, CNS, termors, hypoK+. No nebulization : stress + bronchospasm. /
45
Prognostic factors for feline asthma ?
Reponse to corticosteroids (failure is Negative PF)
46
Paragonimus kellicoti - type of lungworm - HI - lesions - treatment
- trematode (lung fluke), only one - HI : cray fish - Migration : adults will go in the pleural space (immature in subpleural) so can cause eosinophilic-neutrophilic pleuritis - lesions : bullae, cysts in the right caudal lungs = pneumothorax, hemoptysis. - treatment : fenbendazole, praziquantel
47
which intestinal lung worms have pulmonary migration
ancylostoma toxocara
48
most common feline lung worm and location
aerulostrongylus, southern US
49
site of aerulostrongylus in lung
- terminal bronchioles and alveoli
50
transmission of aerulostrongylus
- mollusk (L3) ; migration from intestines to pleural to ... - shed in the feces after being coughed up
51
treatment of aerulostrongylus
fenbendazole ou selamectins
52
Filaroides : - Type : N or T - HI - Transmission - lesions - Diagnosis - Tx
- Nematode - HI. : none - Fecal-oral transmission - Usually asymptomatic, but can cause fatal granulomatous infection due to death of worms - Dx : L1 in BAL or Sulfate de zinc Tx : Fenbendazole, Ivermectine
53
Which pulmonary parasites are diagnosed by sulfate de zinc
- Filaroides, oslerus, eucolus (fecal flottation)
54
which pulmonary parasites are diagnosed by baerman
- angiostrongylus, aerulostrongylus, crenosoma
55
signs associated with aerulostrongylus infection
- same as asthma (also bronchoinstrestitial to alveolar eosinophilic infiltrates)
56
where is paragonimus present geographically
great lakes, midwest, south
57
how is paragonimuss diagnosed
fecal sedimentation or BAL (operculated eggs)
58
what is the intermediary host of crenosoma
mollusk
59
what population acquires filaroides
research colonies, young, immunosuppressed dogs
60
Crenosoma vulpis : - Type : N or T - Geographic location - HI - lesions - Diagnosis - Tx
- Nematode - Canada, or N-E US - Mollusk - Trachea, bronchioles, bronchi causing cough or nasal discharge - BAL , Baermann Tx fenbendazole, ivermectine, milbemycine oxime
61
Oslerus osleri : - Type : N or T - HI - Transmission - lesions - Diagnosis - Tx
Nematode No HI By saliva (dam cleaning her pups) Trachea distal and proximal bronchi, granulomatous nodules Sulfate de Zinc Fenbendazole, ivermectine
62
Eucolus aerophilis
Nematode Direct oro-fecal transmission or by ingestion of earthworm Trachea , bronchioles, bronchi
63
Angiostrongylus - Type : N or T - HI - Transmission - lesions - Diagnosis - Tx
- Nematode - HI mollusk or parathenic host (frog) - Mature parasites in pulmonary artery, right heart, pulmonary arterioles, will cause HP but also a inflammatory response to parasite (ARDS) and bleeding. Pneumothorax - Diagnosis : Ag test, Baermann - Fenbendazole pr moxidectine-imidaclopride

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