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Flashcards in Exam 1 Deck (216):
1

Does anorexia in adult animals result in significant hypoproteinemia?

No

2

Mechanisms of decreased protein production

Hepatic failure

Inflammatory disease

Malnutrition (maldigestion,malabsorption)

3

Mechanisms of protein loss

Renal (PLN)

Intestinal (PLE)

Third spacing

burns/wounds

4

Common presenting complaints of patients with hypoproteinemia

Peripheral limb swelling

Abdominal distention

Coughing/dyspnea

Decreased appetite

Vomiting/diarrhea

None

5

Causes of hypoglobulinemia

PLE

Blood loss

Failure of passive transfer

Combines immunodeficiency

6

Which values on a chemistry panel are indicators of liver function?

Tbili
Albumin
Glucose
Cholesterol
BUN

7

Medical concerns associated with hypoproteinemic animals

Fluid overload (decreased oncotic pressure, consider colloids or plasma)

Anesthesia (protein bound anesthetic agents)

Wound dehiscence

8

Why are hypoproteinemic animals prone to thromboembolism?

Loss of protein also leads to loss of antithrombin

Consider giving clopidogrel

9

Congenital causes of hypoproteinemia

Hepatic shunt
Failure of passive transfer

10

Infectious causes of hypoproteinemia

Parasites
Viral
Fungal

11

Inflammatory causes of hypoproteinemia

Inflammatory bowel disease

Lymphangectasia

Protein-losing enteropathy

12

Metabolic causes of hypoproteinemia

Hepatic disease
Renal disease (PLN)
EPI

13

Definition of heat stroke

Severe illness characterized by core temperatures of >104 F in humans and >105.8 F in dogs as well as CNS dysfunction

14

Two classifications of heat stroke

Classic/non-exertional

Exertional

15

Patient predisposing factors for heat stroke

Exercise
Age
Brachycephalic
Obesity
Hypothyroidism
Laryngeal paralysis
Cv disease
CNS disease
Prior heatstroke

16

What are the protective mechanisms the body uses against heat illness?

Thermoregulation

Acclimatization

Acute phase response

Heat shock response proteins

17

Heat dissipation mechanisms

Sensible response (conduction, convection, radiation)

Insensible response (evaporative cooling (panting))

18

70% of total body heat loss in dogs and cats is due to which mechanisms?

Radiation and convection

19

What is the insensible response to heat?

Evaporative cooling via panting

Activation of hypothalamic panting center causes mucosal vasodilation

Partial air system uses unidirectional air flow in through nose and out of mouth to maximize evaporative cooling and heat loss

Salivation further increases evaporative cooling

20

Physiologic effects of increased body temp

Inc. sympathetic tone -> inc. HR and CO -> dec splanchnic circulation -> cutaneous vasodilation -> inc muscle blood supply -> inc cutaneous circulation -> heat loss via radiation, conduction, convection

Evaporative cooling via panting

21

At what point does evaporative cooling fail?

Environmental temp > body temp

OR

Humidity > 80%

22

How does dehydration affect heat dissipation?

Decreases evaporative heat loss because less water is available for respiratory system

Decreases heat dissipation through radiation and convection due to decreased blood flow to periphery

23

What is acclimatization and how long does this process take in dogs?

Adaptive physiologic response to environment and climatic change

Partial acclimatization in 10-20 days

Full acclimatization in 60 days

24

How does the body acclimatize to a higher environmental temperature? (7 things)

Increased ability to resist rhabdomyolysis

Body water conservation via aldosterone and ADH

Activation of RAAS

Salt conservation

Increased GFR

Plasma volume expansion

Enhanced CV performance (inc HR and CO)

25

What does the acute phase response work (heat stroke)?

Stimulation of anti-inflammatory acute phase proteins in liver

Inhibits production of reactive oxygen species

Inhibits release of proteolytic enzymes from activated leukocytes

Promotes wound healing and repair by stimulating endothelial cell adhesion, proliferation, and angiogenesis

26

What are heat shock proteins (HSP) and what do they do?

Protective proteins produced with cell stress (heat, ischemia, endotoxemia, oxidative/nitrosative stress)

Increase levels of HSPs allow a transient state of tolerance to otherwise lethal stage of heat stress allowing cells to survive

27

Reduced numbers of heat shock protein have been found with

Aging

Lack of acclimatization

Certain genetic polymorphisms

28

What are the physiologic effects of heat shock proteins?

Prevents protein breakdown and assists in refolding of denatures proteins into normal configuration

Prevents loss of epithelial barriers and prevents endotoxin leakage

Interferes with oxidative stress and blocks apoptotic cell signaling pathway

Prevents arterial hypotension to decrease cerebral ischemia and neural damage

Offer CV protection by regulating baroreceptor reflex response to abate hypotension and bradycardia

29

How does heat shock cause cardiovascular collapse?

Decreased central venous pressure and CO (circulatory shock)

Decreased plasma volume and hypoperfusion

Indirect myocyte injury

30

What effects can heat stroke have on the respiratory system?

Direct pulmonary epithelial damage

Increased pulmonary vasculature resistance

Can result in non-cardiogenic pulmonary edema, DIC, ARDS

31

What effect does heat stroke have on the kidneys?

Direct thermal injury

Indirect injury - hypoxia, microthombi

Rhabdomyolysis (nephrotoxic myoglobin)

32

What effects can heat stroke have on the brain?

Indirect injury due to edema, hemorrhage, infarcts

33

What effects does heat stroke have on GI system?

Hypovolemia and splanchnic pooling can cause microthrombi -> hypoxia and ischemia

Causes loss of GI integrity (ulceration and sloughing)

Results in bacterial translocation, sepsis, and endotoxemia

34

How does heat stroke affect the liver?

Decreased hepatic blood flow and thermally-altered hepatocyte function leads to decreased blood detoxification

Can cause centrilobular necrosis and cholestatic liver disease

35

How does heat stroke affect coagulation?

Direct:

Direct damage to vascular endothelium -> release of cytokines and inflammatory responses, adherence of leukocytes and platelets to damaged endothelium

Release of tissue factor (activating clotting cascade, producing uncontrolled systemic coagulation)

Depletion of coagulation factors and platelets

Reduced synthesis of coagulation factors from hepatocytes

Development of DIC


Indirect:

Hemoconcentration due to dehydration

36

Most consistent clinical signs of heat stroke

Panting

Dry, hyperemic MM

Tachycardia

Hyperdynamic femoral pulses

Ptyalism

Can by hyper, normo, or hypothermic!

37

Bloodwork findings with heatstroke

Nucleated RBCs
Thrombocytopenia
Prolonged PT/PTT
Inc ALP/ALT
Axotemia
Inc. muscle enzymes
Hypoglycemia

38

Treatment for heatstroke

Rapid cooling - whole body wetting with water combined with muscle massage and fans, IV fluids

Oxygen supplementation

CV support (control hypotension, arrhythmias)

management of secondary complications (shock, hypoglycemia, DIC, ARDS, renal failure)

39

When should you stop active cooling techniques in heat stroke patient?

103.5-104 F

40

Should you use alcohol to cool a patient with heat stroke?

No

Risk of fire if need to defibrillate

41

What are exogenous pyrogens?

Infectious agents
Immune complexes
Inflammation
Drugs (e.g. tetracyclines)

Do not directly cause an increase in body temp, but cause an increase in endogenous pyrogens

42

What are endogenous pyrogens?

IL-1, IL-6, TNF, INF

Bind to vascular endothelial cells within anterior hypothalamus ->

Cause PGE1 and PEG2 production ->

Alters the set temperature (thermostat) within the hypothalamus

43

3 most common causes of FUO

Infection
Immune-mediated disease
Neoplasia

44

What are the risks associated with therapeutic trials for patients with FUO?

Continued disease progression

Drug toxicity/side effects

Exacerbating underlying diseae

45

How to treat a fever?

Artificial cooling techniques

Fluid therapy

Antipyretic agents

46

When should you use anti-pyretic agents?

Fever > 106F

47

Which fungi are dimorphic?

Blastomyces
Histoplasma
Coccidiodes
Sporothrix

48

Which fungi have broad-based budding?

Blasto
Histo

49

Even though Blastomyces is present in all soil, why don’t all animals contract this disease?

Soil organisms destroy blastomyces in the soil

50

What environmental conditions precede highest incidence periods of blastomyces infection?

Heavy rainfall
Warm temperatures

51

How is blastomyces transmitted?

Inhalation
Contamination of puncture wounds/open sores

52

Which dogs are prone to getting blastomyces?

Males > females
Sporting dogs and hounds

53

Transformation from blastomyces conidia to yeast occurs where?

Lungs

54

What important virulence factors does blastomyces have?

BAD-1 (cell surface glycoprotein tht binds to host cell receptors on macrophages and allows fungus to evade host immune system)

Alpha-1,3-glucan

+/- melanin

55

Common clinical signs associated with blastomyces infection

Respiratory signs (cough, dyspnea, exercise intolerance)

Ocular disease (anterior uveitis, chorioretinitis, endophthalmitis, optic neuritits)

Skin disease (cutaneous/SQ nodules, draining tracts)

56

Definitive diagnosis of blastomyces infection is based on

Cytological, histopathologic, or culture demonstration of organism

57

Diagnostic tests for blastomyces?

Cytology
ELISA Ag assay - may cross react with histoplasma

58

Thoracic rads are abnormal in what % of blastomyces cases?

85%

59

Treatment for blastomyces infection

Intraconazole
Fluconazole
Amphotericin B
Steroids

Treat for at least 60-90 days and continue 1-2 mo past resolution of clinical signs

60

Prognosis for blastomyces infection

~80% cured, 20% relapse

Prognosis poor if CNS involvement

61

Most common systemic mycoses in the cat

Cryptococcosis

62

Which fungus is narrow-budding?

Cryptococcus

63

Route of transmission of cryptococcus?

Inhalation

Hematogenous spread to extra-pulmonary sites

64

How does cryptococcus evade host immune system?

Polysaccharide capsule inhibits phagocytosis, plasma cell function, and leukocyte migration

65

Most common clinical signs seen with cryptococcosis in cats?

Sneezing and nasal discharge (50-8%)

Cutaneous/SQ masses (40-50%)

Ocular lesions (20-25%)

Non-specific signs (lethargy, anorexia)

CNS signs (20%) (blindness, depression, behavior changes, seizures)

66

Most common clinical signs of cryptococcosis in dogs?

Nasal signs

CNS (dull mentation, blindness, hypermetria, cranial nerve deficits)

Eyes

Skin nodules/draining lesions
Non-specific signs

67

How do you diagnose cryptococcosis?

Latex agglutination for Ag in serum, aqueous humor, or CSF

90-100% sensitive

Useful to monitor response to therapy

68

Treatment for cryptococcosis

Itraconazole
Fluconazole (in cats)
Amphotericin B (for systemic or refractory disease or those with ocular or CNS involvement)

Continue for at least 1-2 months past resolution of clinical signs and negative titers

Mean treatment time ~8.5 mo

69

Primary reservoir for histoplasma

Bat (guano and GI tract)

Decaying avian guano (esp. blackbird/starling roosts, chicken coops)

NOT found in fresh feces or shed feces of birds

70

Pathophysiology of histoplasma infection

Inhaled microconidia transform into yeast at body temperature

Yeast binds to CD-11 -18 integrins on alveolar macrophages and are phagocytized

Replicate within and destroy macrophages

Spread via hematogenous or lymphatics

*Most animals’ immune system is able to clear infection

71

Clinical signsof histoplasma infection in dogs

Anorexia/weight loss
Fever
Cough/dyspnea
Large bowel diarrhea

72

Diagnostic tests used to diagnose histoplasma infection

Cytology (rectal scrape, BAL)

ELISA Ag assay (urine)

73

Treatment for histoplasma infection

Itraconazole
Amphotericin B (cases with CNS involvement or disseminated disease)

Treat for 60-90 days or at least 1-2 mo past resolution of measurable signs

74

Prognosis of histoplasma infection

Excellent with only pulmonary involvement

Guarded to fair with dissemination

75

Which fungus has a sperule containing multiple endospores?

Coccidiodes

76

Which fungus prefers dry, warm climates and sandy soils at low elevation (Ca, NM, AZ, UT, NV)?

Coccidiodes

77

Infection of coccidiodes follows what type of environmental condition?

Moist conditions followed by a dry period, then soil disruption

78

Clinical signs of coccidiodes infection in dogs?

Cough, weakness, lethargy, anorexia, weightloss, fever

Lameness with painful, swollen bone lesions

Localized lymphadenopathy

Ocular lesions

Skin lesions

Diarrhea

79

Clinical sign of coccidiodes infection in cats?

Skin lesions
Fever
Anorexia
Weight loss

80

Diagnosis of coccidiodes

ANTIBODY serology (IgM detectable 2-5 wks, IgG detectable 8-12 wks)

Cytology, histopathology

Bony lesions - may be more proliferative than lytic

81

Treatment of coccidiodes

Treat for 6 months minimum

Itraconazole
Fluconazole (if CNS involvement)
Amphotericin B

Bony lesions -> amputation
Enophthalmitis -> enucleation

82

What organism causes nasal aspergillosis?

Aspergillus fumigatus

83

What organism causes disseminated aspergillosis?

Aspergillus terreus

84

Why are german shepherds more prone to aspergillosis than other breeds?

IgA deficiency

85

Most consistent clinical findings with disseminated aspergillosis?

Vertebral pain, paraparesis, paraplegia, lameness with swelling, draining tracts, kidney disease

Other non-specific signs

86

Diagnosis of aspergillosis

Serological test -aspergillus glactomannan antigen

Cytology/histopathology

PCR for *definitive diagnosis*

87

Treatment for systemic aspergillosis?

Posaconazole
Itraconazole
Amphotericin B

Static disease rather than cure more common, poor prognosis

88

Transmission of sporothrix

Usually cutaneous and SQQ inoculation of organism through puncture wound

Can follow inhalation

89

Clinical signs of sporothrix infection

Cats > dogs

Male cats > female cats

Cutaneous lesions on nose and nasal planum

Regional lymphadenopathy

90

Spread of which fungal disease is facilitated through contaminated claw/bite wounds and autoinoculation during grooming?

Sporothrix

91

Which fungus is cigar shaped with a double wall?

Sporothrix

92

Which fungus is round with a double wall?

Histoplasma

93

Treatment of sporothrix

Itraconazole

16-8 weeks

Supersaturated KI/NaI (old treatment) for 30 days beyond remission

94

Which fungus is potentially zoonotic?

Sporothrix

95

“Large, infrequently septate hyphae with non-parallel walls” describes which organisms?

Phythium and lagenidium

96

In what ways are oomycets not like fungus?

No chitin or ergosterol in cell wall

Diploid

Non-septate hyphae

97

Pathophysiology of pythiosis

Infective, motile flagellate zoospore attracted to damaged tissue

Encysts in damaged skin or GI mucosa

98

What are the two disease spectrums of lagenidium

Chronic nodular dermopathy

Fatal dermatologic and disseminated disease

99

Main body systems affected by pythium vs lagenidium

Pythuim: cutaneous and GI

Lagenidium: cutaneous and vascular/lymphatic

100

Diagnosis of pythium/lagenidium

PCR

101

Why is it important to diagnose the species when dealing with phythium/langenidium?

Need to know species to determine

Prognosis
Prediction of behavior
Treatment options

102

Treatment for pythium/lagenidium

Aggressive surgical resection

Combination antifungal therapy

Newer generation azoles

Caspofungin, mefenoxam (novel agents)

Hyperbaric therapy

Immunotherapy

Prognosis poor without resection,

103

What are basidiobolus and connidiobolus?

Zygomycetes (actual fungi) that can cause skin, nasopharynx, GI lesions and sometimes lower respiratory dz.

104

How do you treat basidiobolus and connidiobolus?

Aggressive surgical excision and anti-fungal medication

105

How do you diagnose basidiobolus and connidiobolus?

Culture

106

What is phaeohyphomycosis?

Cutaneous, SQ, cerebral or disseminated infections caused by cutaneous inoculation with pigmented ( diatiaceous) fungi containing melanin in their cell walls

107

What is hyalohyphomycosis?

Non-pigmented (hyaline or transparent) fungal infection in tissue that can cause systemic, disseminated disease

108

How do you diagnose phaeohyphomycosis/hyalohyphomycois?

Culture + PCR

109

How do you treat phaeohyphomycosis/hyalohyphomycois?

Phaeohyphomycosis: aggressive surgical resection, itraconazole/posaconazole for 3-6 mo after surgery

Hyalohyphomycois: challenging due to systemic disease, poor prognosis

110

Griseofulvin

Derived from penicillium

Disrupts mitosis

Used for dermatophytosis

Oral administration (give with fatty meal)

Side effects: GI, BM suppression, teratogenic

111

Amphotericin B

Derived from streptomyces

Binds sterols -> inc wall permeability

IV administration

NEPHROTOXIC

Acute toxicity - vomiting, myalgia, fever, anaphylaxis

Poor penetration of bones, brain, eyes

112

How can you reduce nephrotoxicity of amphotericin B?

Lipid binding

Cumulative dosing

Monitoring renal values before each treatment

Ensure hydration before administration

113

What fluid type should Amphotericin B be administered with when given IV? Sq?

IV: 5% dextrose, Give NaCl or LRS AFTER

SQ: Give in 2.5% dextrose + 4.5% NaCl

114

How does lipid bound amphotericin B work?

Taken up by macrophages and taken to site of inflammation

Achieves greatest concentrations in liver, spleen, and lung (spares kidneys)

Still need to monitor renal values!

115

Flucytosine

Fluorinated pyrimidine that inhibits DNA/RNA synthesis

Good oral absorption

Penetrates BBB/CSF, use in severe CNS disease

Nephrotoxic

Dogs -> drug eruption

Cats -> thrombocytopenia

116

Mechanism of action of azoles

Inhibits cytochrome p-450

FUNGISTATIC

NEED TO TREAT BEYOND CLINICAL SIGNS OF DZ

117

hY should you not use antacids concurrently with azoles?

Azoles need acid for absorption

118

Ketoconazole

Oral administration (fatty meal)

Poor penetration of brain and eye

Topical administration for candida and malassezia

Side effects: GI, hepatotoxicity, thrombocytopenia, cortisol suppression

119

How are azoles metabolized?

Liver

120

Itraconazole

Oral administration (capsules -> fatty food, liquid -> fasted)

IV administration

Does not penetrate CNS

Side effects: nausea, vomiting, inappetence, hepatotoxicity, cutaneous drug rxn

121

Which fungal diseases can itraconazole treat?

Histo
Blasto
Crypt
Coccidiodes
Asprgillus
Sporothrix

(Pretty much all of them)

122

Fluconazole

Good oral bioavailability

DOES penetrate brain, eye

Renal excretion

123

Which antifungal is the drug of choice for crypto?

Fluconazole

124

What fungal diseases can fluconazole treat?

Crypto
Candida
Blasto
Histo

125

Voriconazole

Good oral bioavailabilty

More potent than itraconazole, fluconazole

Expensive

126

Posaconazole

Itra analogue

Expensive

127

Which fungal disease can posaconazole treat?

Candida
Crypto
Systemic asper
Blasto
Histo

128

Main use of topical azoles (clotrimazole, enilconazole)?

Primary nasal aspergillus

129

Side effects of topical azoles

Irritation
Erythema
Airway obstruction

130

What is clotrimazole used for?

Nasal aspergillosis

Non-responsive candida cystitis

Renal pelvis infusions (renal aspergillosis)

131

Iodides as antifungal therapy

KI, NaI

Used for sporothrix

Not commonly used

132

Mechanism of action of terbinafine

Inhibits ergosterol synthesis

133

Terbinafine

Commpnly used for dermatophytosis

Good oral bioavailability

Renal excretion

Side effects: GI, hepatotoxicity, pancytopenia

134

Which drugs are chitin synthesis inhibitors?

Lufenuron

Nikkomycin

135

Which drug is a glucan inhibitor?

Caspofungin



*slow onset of action, expensive*

136

What is mefenoxam?

Agricultural fungicide

Inhibits RNA polymerase

Effective against plant pathogen oomycets

Has been used to tx pythium

137

What is the MIC?

Minimum inhibitory concentration

Lowest concentration of a drug that inhibits growth of the organism cultured

NOT the concentration that kills the organism

138

When do you consider anti-fungal sensitivity testing?

Systemic aspergillosis

Non-responsive infection

Minimal $$ constraints

139

Why is nasal discharge not noticed until underlying cause is fairly advanced?

Usually the animal will swallow the discharge, so seeing it come out the nose means that the capacity of the mucociliary clearance has been exceeded

140

Differentials for unilateral nasal discharge

Foreign bodies
Neoplasia
Tooth root abscess
Fungal rhinitis

141

Differentials for bilateral nasal discharge

Bacterial/viral infection
Allergic rhinitis
Fungal rhinitis
Advanced neoplasia

142

Differentials for epistaxis

Fungal disease
Neoplasia
Hypertension
Ricketsial disease
Thromocytopneia/pathia
Coagulopathy
Trauma

143

Are large populations of bacteria seen on nasal cytology concerning?

No, can be normal

144

Diagnostic test that is most likely to yield a specific diagnosis if there is primary nasal disease

Biopsy

145

Test that are recommended before performing nasal boipsy

Platelet count
PT/PTT
BMBT
BP
Crossmatch

146

How do you prevent penetrating the calvarium via cribiform plate during nasal biopsies?

Measure the distance between the nostril and the medial canthus of the eye with the biopsy instrument and do not advance past that

147

3 primary biopsy techniques used in nasal biopsy

Pinch biopsy
Core biopsy
Traumatic nasal flushing

148

Clinical signs of nasal tumors

Nasal discharge

Sneezing

Decreased airflow through nostril

Deformation of nasal bones, hard palate, or maxillary dental arcade

Non-specific signs such as weightloss and anorexia

149

Treatment of choice for benign nasal tumors? Malignant tumors?

Benign: surgical excision

Malignant: radiation, NSAIDs

150

Survival time for malignant nasal tumors treated with radiation?

6-12 months

151

Clinical signs of nasal polyp

Stertorous breathing
Nasal discharge
Upper airway obstruction
Signs of otitis externa/media/interna (horner’s, head tilt, nystagmus)

152

Primary pathogens in bacterial rhinitis

Bordetella bronchiseptica
Mycoplasma spp

153

How can cardiac disease cause coughing?

1. Chamber enlargement putting pressure on airway

2. Congestion or pulmonary edema

154

T/F: fecal examination should be done on almost all patients presenting for chronic cough

True

155

Most common complication associated with pulmonary aspirates

Pneumothorax

156

Main use of bronchoscopy

Facilitate collection of samples from the lower respiratory tract

157

What should you do is your patient experiences transient hypoxemia after tracheal wash or BAL?

This is normal

Will respond to oxygen therapy, crackles are normally heard for several hours after and are not of concern if other respiratory parameters are WNL

158

Diseases that present with an acute cough

Canine infectious respiratory disease

Pneumonia

PTE

CHF

Non-cardiogenic pulmonary edema

159

How do you definitively diagnose canine infectious respiratory disease?

PCR

160

Best antibiotic choices for canine infections respiratory disease?

Doxy
TMS
Clavamox

161

When should you use antibiotics with aspiration pneumonitis?

No improvement after 2-3 days

Inflammatory leukogram getting worse

Fever develops

Animal has been on H2 blockers or PPIs

162

Causes of chronic cough

Collapsing trachea
Canine chronic bronchitis
Bronchiectasis
Primary ciliary dyskinesis
Parasites
Eosinophilic bronchopneumopathy

163

What radiographic view can you see intrathoracic tracheal collapse? Extrathoracic?

Intra: expiratory films

Extra: inspiratory films

164

Emergency management of a patient with tracheal collapse and in respiratory distress should include:

Oxygen
Anxiolytic
Anti-inflammatory (short-acting steroids)

Intubation or tracheostomy

165

Medical management of tracheal collapse includes:

Weight reduction
Minimize exercise
Replace collar with harness
Reduction of inhaled irritants
Anti-tussives
Lomotil
Glucocorticoids
Bronchodilators

166

When should surgery be considered for a patient with tracheal collapse?

Only in cases where medical management has failed and owners are prepared to accept negative outcomes

167

Most common clinical sign of canine chronic bronchitis

A dry cough exacerbated by excitement and exercise

168

Treatment for chronic canine bronchitis includes:

Glucocorticoids

Bronchodilators (B agonists or methylxanthines)

Antibiotics

Cough suppressants


169

What is bronchiectasis?

Permanent dilation of the bronchi and is commonly a complication of chronic respiratory disease such as chronic bronchitis

170

What is primary ciliary dyskinesis?

Congenital defects in the ciliary microtubule structure, resulting in reduced clearance of respiratory secretions, inhaled particles, and infectious agents.

Dogs < 2 yrs, English Pointers and Springer Spaniels

Usually also infertile because cilia on sperm and fallopian tubes are abnormal

Diagnosed with electron microscopy

171

What is eosinophilic bronchopneumopathy?

Used to describe a variety of conditions which share the central feature of eosinophilic infiltration of lung and bronchial mucosa

Cause is usually not identified

172

Treatment for eosinophilic bronchopneumopathy?

Steriods

173

5 mechanisms by which hypoxemia occurs

1. Decreased inspired O2

2. Hypoventilation

3. Diffusion abnormalities

4. Anatomic shunts

5. V/Q mismatch

174

Clinical signs of laryngeal paralysis

Stridor
Bark change
Cyanosis
Syncope

175

Treatment for laryngeal paralysis

Oxygen
Anxiolytic
Anti-inflammatory
Intubation/tracheostomy

Surgery

176

Components of brachycephalic airway syndrome

Elongated soft palate

Stenotic nares

Everted laryngeal saccules and laryngeal collapse

Hypoplastic trachea

177

Diagnosis of laryngeal collapse

Laryngoscopy

178

Surgery can help with which components of brachycephalic airway syndrome?

Elongated soft palate

Stenotic nares

Everted laryngeal saccules

179

Primary diseases that have been associated with PTE

Hyperadrenocorticism
Hypothyroidism
PLN
IMHA
HW disease
Sepsis
DIC
Pancreatitis
Neoplasia

180

Clinical signs of PTE

Sudden onset of dyspnea in an animal previously not know to have respiratory disease

Acute dyspnea, tachypnea, depression

181

Diagnosis of PTE

Angiograpahy
Scintigraphy
CT/MRI angiography

182

Treatment of PTE

Anticoagulants (heparin, warfarin)

183

What should you know about the use of heparin for treatment of PTE?

Heparin prevents the deposition of fibrin and platelets on the thrombus surface.

For heparin to be effective, adequate concentrations of antithrombin III must be present in the plasma.

High variation between patients.

184

How do you monitor effects of heparin in treatment for PTE?

Activated partial thromboplastin time

185

What is the prognosis for PTE?

Poor

Usually associated with underlying disease

186

Physical exam findings with feline asthma

1. Increased expiratory effort
2. Increased expiratory time
3. Expiratory wheeze
4. Crackles (+/-)

187

Treatment for feline asthma

Long-term corticosteroids
Bronchodilators

188

Causes of non-cardiogenic pulmonary edema

Neurogenic causes
Electrocution
Upper airway obstruction
Vasculitis
ARDS
Allergic reactions
Inhalation of toxins

189

How does near drowning result in severe pulmonary damage?

Aspiration pneumonia

Water dilution of pulmonary surfactant leading to alveolar collapse and reduced compliance

190

Clinical signs associated with smoke inhalation

Carboxyhemoglobinemia

Tissue hypoxia

Thermal injury to airways (inflammation, edema)

Direct toxic effects with certain chemicals

Suppression of pulmonary mucociliary and macrophage mechanism

DIC

191

How much fluid does it take for clinical signs of pleural effusion to become apparent?

60 ml/kg

192

Reasons for negative tap (thoracocentesis)

No fluid present

Fluid in walled off pocket or on contralateral side of chest

Very thick fluid

Fluid more ventral or deeper than needle

193

What are transudates?

Fluids with low protein (< 2.5 - 3 g/dL) and low nucleated cell counts (<500 - 1000/ ul)

194

What are modified transudates?

Fluids with protein concentrations up to 3.5 g/dl and cell counts up to 5000/ul

195

What starling forces result in transudates or modified transudates?

Increased hydrostatic pressure
Decreased oncotic pressure
Increased vascular permeability

196

What are exudates?

Fluids with protein > 3 g/dl and cell count >5000/ul

197

Differentials for non-septic exudate pleural effusion

FIP
Neoplasia
Lung lobe torsion
Chronic diaphragmatic hernia
Resolving septic exudate

198

Differentials for septic exudate pleural effusion

Idiopathic
Penetrating wounds
Migrating grass foreign body
Extension of bacterial pneumonia

199

Treatment for pyothorax

Antibiotics(IV ampicillin, enrofloxacin initially, then orals)

Chest tubes

+/- lavage

200

Comparing what component of pleural fluid and serum can help identify chyle?

Triglycerides

201

Common causes of chylothorax

Most are idiopathic

Trauma

Cardiac disease

HW

Lung lobe torsion

Diaphragmatic hernia

202

Treatment for chylothorax

Medical treatment - low fat diet, rutin, intermittent chest taps

Surgery

203

Differentials for hemothorax

Trauma

Systemic bleeding disorders

Neoplasia

Lung lobe torsion

204

What is the only neoplasia that readily exfoliates into effusions?

Lymphoma

205

What is a tension pneumothorax?

One-way valve is formed by the tissue at the site of the leak, allowing air to move into pleural space during inspiration but prevents it from moving out during expiration

206

Most common cause of pneumomediastinum?

Rupture of airways

207

How is pneumomediastinum diagnosed radiographically?

When you are able to see

1. Dorsal and ventral tracheal walls

2. Cranial branch of aorta

3. Longissimus dorsi muscle

208

Treatment of pneumomediastinum?

Strict cage rest

Bronchoscopy to locate lesion

Surgery (esophageal laceration)

209

How can mediastinal masses cause respiratory distress?

Displacing lung tissue and decreasing lung volume

Displacing tracheal lumen

Causing pleural effusion

210

CT finding most consistent with nasal aspergillosis?

Loss of turbinate density

211

Diseases that would benefit from cough suppressants

Collapsing trachea

Chronic allergic or sterile bronchitis

Neoplasia

212

What causes crackles?

Fluid in the small airways/alveoli

Opening or collapse of small airways/alveoli

Parenchymal fibrosis

213

What does an end-expiratory grunt indicate?

Air trapping and/or obstruction of lower airways

214

Disease that cause inspiratory distress?

Laryngeal paralysis
Tracheal collapse
Brachycephalic airway syndrome
Pleural space disease

215

Diseases that cause expiratory distress?

Asthma
Pneumonia
CHF
PTE

216

Parasitic rhinitis can be cause by which organisms?

Pneumonyssoides caninum

Cuterebra