Exam 2 - Pulmonary Parenchymal Disease

Question 1

what are some differentials for canine eosinophilic airway/pulmonary disease?

Answer 1

allergic bronchitis/eosinophilic bronchopneumopathy

parasites/heartworms

fungal

rarely neoplasia

Question 2

what are the anatomic components that are commonly affected in pulmonary parenchymal disease?

Answer 2

alveoli. interstitium, & sometimes pulmonary vasculature

Question 3

what was eosinophilic bronchopneumopathy formerly called?

Answer 3

pulmonary infiltrate with eosinophils

Question 4

what is included in the syndrome of idiopathic eosinophilic lung disease?

Answer 4

allergic bronchitis

eosinophilic bronchopneumopathy

eosinophilic granulomatosis - intraluminal mass lesions

Question 5

what is the underlying cause of eosinophilic bronchopneumopathy?

Answer 5

unknown

Question 6

how is eosinophilic bronchopneumopathy characterized?

Answer 6

eosinophilic infiltration of lung & bronchial mucosa

Question 7

what are the common clinical signs associated with eosinophilic bronchopneumopathy?

Answer 7

cough, exercise intolerance, tachypnea, & dyspnea

less commonly - nasal discharge & systemic signs such as lethargy & inappetance

Question 8

what may owners mistake eosinophilic bronchopneumopathy for?

Answer 8

gagging/retching problem

Question 9

what dogs are typically affected by eosinophilic bronchopneumopathy?

Answer 9

wide age range, but often young adult dogs

Question 10

are signs of eosinophilic bronchopneumopathy often progressive or static?

Answer 10

progressive

Question 11

T/F: in animals with eosinophilic bronchopneumopathy, 50% of cases will have a peripheral eosinophilia

Answer 11

true

Question 12

what may be seen on thoracic radiographs on a dog with suspected eosinophilic bronchopneumopathy?

Answer 12

bronchointerstitial pattern, diffuse interstitial pattern, patchy alveolar pattern, & rare nodular pattern

Question 13

how is eosinophilic bronchopneumopathy diagnosed?

Answer 13

cytology & excluding other differentials

Question 14

what may be heard on auscultation of a patient with suspected eosinophilic bronchopneumopathy?

Answer 14

normal or may have crackles

Question 15

T/F: radiographic changes associated with eosinophilic bronchopneumopathy are often more severe in pattern when compared to chronic bronchitits

Answer 15

true

Question 16

T/F: eosinophilic bronchopneumopathy is a diagnosis of exclusion

Answer 16

true

Question 17

what diagnostics may be run when trying to rule out eosinophilic bronchopneumopathy?

Answer 17

fecal float, baermann test, culture of airway wash fluid, heartworm test, histoplasma antigen EIA test

Question 18

what is the general treatment used when treating eosinophilic bronchopneumopathy?

Answer 18

prednisone 1mg/kg PO every 12 hours for 2 weeks then tapered off over 3 months

Question 19

what medication is avoided when treating eosinophilic bronchopneumopathy?

Answer 19

cough suppressants

Question 20

what is the prognosis of eosinophilic bronchopneumopathy dependent on?

Answer 20

severity of the disease

Question 21

T/F: many patients with eosinophilic bronchopneumopathy may require lifelong therapy

Answer 21

true

Question 22

what are 4 host defenses against bacterial pneumonia?

Answer 22

1. nasoturbinate filtration
2. protective airway reflexes (sneezing, coughing, bronchoconstriction)
3. mucociliary clearance
4. phagocytosis & killing by macrophages

Question 23

what are some common causes of aspiration pneumonia?

Answer 23

vomiting, swallowing disorder, regurgitation, or iatrogenic causes

Question 24

what are the main ways bacterial pneumonia occurs?

Answer 24

hematogenous or secondary

Question 25

what are some rare funguses that can cause fungal pneumonia?

Answer 25

cryptococcus, aspergillus, & sporothrix

Question 26

what are some common fungal causes of fungal pneumonia?

Answer 26

histo, blasto, & coccidioides

Question 27

what is a causative organism of protozoal pneumonia?

Answer 27

toxoplasmosis

Question 28

what are some organisms that commonly cause viral pneumonia?

Answer 28

kennel cough, distemper, FIP, & rare calicivirus

Question 29

what are some organisms that commonly cause parasitic infections leading to pneumonia?

Answer 29

heart worms, lung worms, & aberrant migration

Question 30

what is bacterial bronchitis?

Answer 30

infection is limited to airways & peribronchial tissues

Question 31

what is bronchopneumonia?

Answer 31

infection of airways, peribronchial tissue, & lung

Question 32

what is hematogenous pneumonia?

Answer 32

infection that spreads to the lungs via the bloodstream

Question 33

what is aspiration pneumonia?

Answer 33

infectious and/or chemical pneumonia resulting from aspiration of material into the lungs

Question 34

about 1/2 of the cases of bacterial pneumonia seen in puppies are caused by what agent? what other 2 agents are also common?

Answer 34

bordetella bronchiseptica streptococcus species & mycoplasma

Question 35

what are some examples of underlying causes of bacterial pneumonia?

Answer 35

kennel cough, bronchiectasis, foreign material, neoplasia, or ciliary dyskinesis

Question 36

what are the common clinical signs seen with bacterial pneumonia?

Answer 36

soft cough, purulent nasal discharge, tachypnea/dyspnea, crackles on auscultation, & sometimes fever SIRS may occur

Question 37

what diagnostic test is commonly used when bacterial pneumonia is suspected?

Answer 37

transtracheal wash - run cytology

Question 38

what is the classic distribution of hematogenous pneumonia?

Answer 38

caudodorsal - increased blood flow to these lung lobes

Question 39

hematogenously-borne pneumonia typically involves what?

Answer 39

alveolar infiltrates

Question 40

what may be seen on cytology with a hematogenous pneumonia?

Answer 40

neutrophils, may be degenerate bacteria found in <50% of samples

Question 41

what additional diagnostic should be run in suspected cases of hematogenous pneumonia?

Answer 41

culture & susceptibility testing

Question 42

what is the treatment used for hematogenous pneumonia?

Answer 42

supportive therapy based off of severity of symptoms, & antibiotics for 1-2 weeks beyond clinical & radiographic remission

Question 43

what are some common causes of bacterial pneumonia from immune dysfunction?

Answer 43

congenital immunodeficiency disorders FeLV/FIV primary ciliary dyskinesis

Question 44

what causes aspiration pneumonia?

Answer 44

inhalation of liquid or solid material into the lungs

Question 45

aspiration pneumonia may lead to what other 2 pneumonias?

Answer 45

bacterial and/or chemical

Question 46

why can aspirated gastric contents be problematic?

Answer 46

the acid causes tissue necrosis, edema, & hemorrhage

Question 47

what pattern is almost pathognomic for aspiration pneumonia?

Answer 47

cranioventral distribution

Question 48

T/F: bronchoconstriction can occur as a result of aspiration pneumonia

Answer 48

true

Question 49

what are the clinical signs associated with aspiration pneumonia?

Answer 49

acute severe signs may be coughing/systemically sick crackles may be heard upon auscultation

Question 50

how is aspiration pneumonia diagnosed?

Answer 50

usually presumptive based on radiographic changes

Question 51

when may radiographic changes be seen in patients with aspiration pneumonia?

Answer 51

24-48 hours after the event

Question 52

if the patient is stable, what diagnostic test may be used?

Answer 52

tracheal wash - help guide antibiotic therapy

Question 53

what should be apart of your evaluation when looking for a cause of aspiration pneumonia?

Answer 53

history of vomiting, seizures, regurgitation neurological problems esophagus problems

Question 54

T/F: bronchoscopy is used for diagnosing aspiration pneumonia

Answer 54

false - usually avoided

Question 55

what are some examples of a systemic neuromuscular disorders causing aspiration?

Answer 55

myasthenia gravis, polyneuropathy

Question 56

what are some examples of a iatrogenic mechanisms causing aspiration?

Answer 56

force-feeding or misplaced feeding tube

Question 57

what are some examples of decreased mentation causing aspiration?

Answer 57

post-anesthesia/sedation post-seizure CNS disease metabolic disease

Question 58

what are some examples of oropharyngeal disorders causing aspiration?

Answer 58

cricopharyngeal dyssynchrony pharyngeal mass BOAS

Question 59

what are some examples of laryngeal disorders causing aspiration?

Answer 59

laryngeal paralysis & laryngoplasty

Question 60

what are some examples of esophageal disorders causing aspiration?

Answer 60

megaesophagus, dysmotility, & obstruction

Question 61

what is included in emergency management of a patient with aspiration pneumonia?

Answer 61

if under anesthesia - suction airway oxygen supplementation, treat shock if present, & can try bronchodilators

Question 62

how are antibiotics used in treating aspiration pneumonia?

Answer 62

IV - immediately if severe respiratory distress or sepsis IV fluids to maintain hydration - don't over-hydrate patients, can cause pulmonary edema nebulize & coupage, turn recumbent patients

Question 63

what medications should be avoided in aspiration pneumonia patients?

Answer 63

diuretics - would dry up lungs cough suppressants - don't want to suppress the patient's ability to cough

Question 64

how is aspiration pneumonia monitored?

Answer 64

clinical status, radiographic improvement, recheck rads after 1 week, & treat for 1 week beyond radiographic/clinical resolution

Question 65

how is non-cardiogenic pulmonary edema determined to be non-cardiogenic?

Answer 65

physical exam, thoracic rads, & +/- echo

Question 66

what is the mechanism of non-cardiogenic pulmonary edema?

Answer 66

increased capillary permeability & changes in hydrostatic & oncotic pressure

Question 67

what are some underlying diseases associated with non-cardiogenic pulmonary edema?

Answer 67

post-seizures, head trauma, upper airway obstruction, near-drowning, electrocution, smoke inhalation, & pulmonary thromboembolisms

Question 68

what is acute respiratory distress syndrome?

Answer 68

form of non-cardiogenic pulmonary edema with a peracute onset that is associated with severe underlying inflammatory processes

Question 69

T/F: acute respiratory distress syndrome affects cats more than dogs

Answer 69

false - dogs more than cats

Question 70

what are the components involved in possible causes of SIRS?

Answer 70

sepsis, pneumonia, aspiration, pancreatitis, heatstroke, or multi-systemic trauma

Question 71

what is the diagnostic criteria for acute respiratory distress syndrome?

Answer 71

acute onset of <72 hours of tachypnea & labored breathing known risk factors evidence of pulmonary capillary leakage without increased pulmonary capillary pressure evidence of hypoxemia evidence of pulmonary inflammation - neutrophilic inflammation on airway wash

Question 72

what is the common pattern of non-cardiogenic pulmonary edema?

Answer 72

interstitial to alveolar lung pattern in caudodorsal lung fields

Question 73

T/F: neurogenic pulmonary edema occurs within minutes of the inciting incident

Answer 73

true

Question 74

how is acute respiratory distress syndrome managed?

Answer 74

treat underlying disorders, fluid therapy to avoid hypotension, oxygen therapy, early nutritional support, & mechanical ventilation

Question 75

what are the conditions that cause a hypercoagulable state?

Answer 75

1. activation of vascular endothelium - vessel wall injury 2. procoagulant states - hypercoagulability 3. stasis of blood flow

Question 76

what diseases are associated with pulmonary thromboembolism?

Answer 76

PLN, HAC, IMHA, HW disease, sepsis, pancreatitis, SIRS, surgery, & neoplasia

Question 77

what is the mechanism of pulmonary thromboembolism?

Answer 77

occlusion of pulmonary vasculature by a clot impairs oxygen transport from the lungs - ventilation perfusion mismatch

Question 78

how are pulmonary thromboembolisms diagnosed?

Answer 78

usually presumptive & difficult to confirm

Question 79

what clinical signs are associated with pulmonary thromboembolism?

Answer 79

acute onset of tachypnea/dyspnea, can develop cough/hemoptysis/cyanosis, or collapse, may hear crackles hypoxemia seen on arterial blood gas & hyperventilation (low PaCO2)

Question 80

if you have a low d-dimers results, are you more or less likely to have a pulmonary thromboembolism?

Answer 80

less likely

Question 81

what is the test of choice for diagnosing pulmonary thromboembolism?

Answer 81

CT angiogram

Question 82

how is a patient with a suspected pulmonary thromboembolism managed?

Answer 82

supportive care, treating underlying condition, & inhibit further clot formation

Question 83

what platelet inhibitor can be used for treating PTE?

Answer 83

clopidogrel

Question 84

how to anticoagulant drugs work in treating PTE?

Answer 84

inactivate factors IIa & Xa by competing with antithrombin

Question 85

what is the most common cause of bacterial pneumonia?

Answer 85

aspiration

Question 86

neurogenic non-cardiogenic pulmonary edema most commonly occurs with what?

Answer 86

seizures, head trauma, upper airway obstruction, or electrocution

Question 87

what is it called when acute respiratory distress syndrome occurs as an adverse reaction to a blood transfusion?

Answer 87

tranfusion-related lung injury