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ECVIM Certifier > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Side effects of bronchodilators?

A

Tachycardia, skeletal muscle tremors, inhibit uterine motility, hypokalaemia, airway inflammation if inhaled.

Can get tolerance due to receptor downregulation with chronic use. Corticosteroid use can mitigate beta receptor loss.

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2
Q

Methylxanthine mechanisms of action?

A

Theophylline - relax bronchial smooth muscle (phosphodiesterase inhibitor? 3/4 - no breakdown cAMP/cGMP so no inflamm mediator release from mast cells and no smooth muscle contraction)

Might be anti-inflamm - enhance activity corticosteroids?

Imp mucocilliary clearance?

Other suggestions - adenosine antagonism, altered intracellular calcium handling

SE - CNS stim, diuresis, cardiac stim - latter two mild

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3
Q

What is aminophylline?

A

80 % theophylline, can be used interchangeably with intermediate release theophylline

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4
Q

How is theophylline metabolised?

A

90 % liver 10 % excreted unchanged in urine

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5
Q

How might you monitor theophylline tx?

A

Can measure trough conc - < 10 - 20? Might get anti inflamm below this level

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6
Q

SEs of theophylline?

A

Restless, GI. Can reinstate at lower dose.

Cardiac stim poss but uncommon. More potent than caffeine or theobromine.

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7
Q

What inhibits theophylline metabolism?

A

Enrofloxacin, erythromycin and cimeditine

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8
Q

Increase metabolism theophylline?

A

Rifampin, phenobarbital

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9
Q

Glucocorticoid airway effects?

A

Inhibit cytokine, chemokine, adhesion molecule production.

Decreased inflammatory prostaglandin, leukotriene and platelet activating factor.

Mast cells NOT affected

Enhance bronchodilators (modify receptor/augment muscle relaxation)

Decrease the sensitisation of the resp mucosa and then can taper

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10
Q

Potency of fluticasone versus dexamethasone

A

18 x potency

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11
Q

Response of cats with bronchitis to fluticasone?

A

Reduced need for oral pred

Reduce bronchial hyper responsiveness and bronchoconstriction

Decreased inflamm cells/prostaglandin in BAL fluid

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12
Q

Systemic effects inhaled steroid?

A

Probably HPA axis suppression but no lymphocyte number/function changes

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13
Q

T/F: leukotrienes are important in the pathophys of feline asthma

A

No - imp in human not cat

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14
Q

Guaifensin mechanism action?

A

Expectorant - stim bronchial secretion via vagal or increases particle clearance

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15
Q

Acetylcysteine resp mechanism of action?

A

Exposed compound sulfhydryl groups interact with dilsulfide bonds on mucoprotein

But may be irritant to resp mucosa and bronchoconsstriction in cats when nebulised

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16
Q

What predicts pulmonary antibiotic concentration?

A

Concentration of drug in epithelial lining fluid in alveolus. Might be more predictive of drug in airway secretions.

NB in disease different - diseased ELF may be diff and alveolar wall might be disrupted.

Haematogenous - invasion via interstitium

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17
Q

What properties favour epithelial lining fluid antibiotic penetration?

A

High lipophilicity, high potency (low MIC) and increased conc free drug in interstitial fluid

Macrolide, quinolone and tetracycline AB ELF conc much higher than plasma.
Beta lactam and aminoglycosidees might diffuse to interstitial space and help in the presence of infection, inflammation and barrier disruption.

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18
Q

FHV and calicivirus - DNA or RNA? Genetic variation?

A

FHV: DNA, antigen stable
Calici: RNA, multiple strain varied virulence

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19
Q

What other infectious agents are implicated in feline URT infections?

A

Chlamydia felis, Bordetella, Mycoplasma, Strep canis

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20
Q

Clinical signs go each pathogen?

A

Calici - mouth, eyes, nose lower airway. NB systemic and joints. Less severe signs cf FHV

FHV: eyes, nose, mouth, lungs (lysis turbinates), skin

Bordetella: trachea, bronchi lower airway, eyes, nose

Chlamydia - eyes, mild upper airway

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21
Q

Most appropriate AB for feline URT?

A

Doxycycline - chlamydia and mycoplasma

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22
Q

Why are beta lactase not effective cf mycoplasma?

A

No cell wall

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23
Q

Lysine use?

A

Essential AA, interferes with FHV replication in vitro.

Not found to be effective.

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24
Q

Mechanism of action of oseltamivir?

A

Neuramininidase inhibitor.

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25
Q

Only primary bacterial nasal cavity diseases in dogs?

A

Pasteurella, bordetella

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26
Q

Most common site of oronasal fistula?

A

Maxillary third incisor, first and second premolar, mesial root third premolar

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27
Q

Therapy for nasal parasites?

A

Pneumonyssus caninum, ivermectin 2 doses

Use milbemycin if MDR1 mutation

Eucoleus boehmi - ivermectin or fenbendazole

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28
Q

Most common cause of canine fungal rhinitis?

A

Aspergilus fumigatus

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29
Q

What causes bony destruction in aspergillosis?

A

Inflammatory response to fungus

NB dysregulation of TLR and NOD

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30
Q

Success of anti fungal tx for aspergillosis?

A

Around half first tx, 70 % multiple

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31
Q

What antifungals might be synergistic?

A

Terbinafine plus azole

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32
Q

Immune dysregulation in LPR?

A

TLR/NOD dysreg in nasal mucosa

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33
Q

Other factors in LPR?

A

Higher transcription of fungal genes using PCR when compared with neoplasia - is hypersensitivity to commensal fungus an issue? Oral antifungals may yield dramatic improvement/resolution on rare occasion.

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34
Q

What is xeromycteria?

A

Dry nose - loss of lateral nasal gland secretion - facial nerve parasympathetic supply can be affected by otitis media

Tear production normal because preganglionic not affected

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35
Q

What would you use an antigen latex agglutination serologic test for?

A

Cryptococcus in cats - v sens and spec when pronase step is used to degrade ABs binding to the capsular antigen

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36
Q

Cryptococcus culture?

A

Used for sub typing/susceptibility but NB false pos - commensal

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37
Q

What is galactomannan?

A

Polysach component fungal cell wall - poorly sensitive, better specificity but not perfect (cats)

Immune mediated clearance (cats) causes poor sens

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38
Q

How might you design a PCR specific for particular Aspergillus species?

A

Look at gene sequence analysis of partial betatubulin or calmodulin genes

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39
Q

Secondary bacterial infection in feline rhinosinusitis?

A

pasteurella, E coli, Corynebacterium, Bordetella, Strep, Pseudomonas, Actinomyces, Bacteroides, Mycoplasma

Doxycycline activity against most

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40
Q

AB for penetration of bone?

A

Clindamycin

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41
Q

T/F: different Aspergillus species produce different clinical presentations in cats?

A

True - A fumigatus the species doesn’t cause sino-orbital aspergillosis, another in the A fumigatus complex

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42
Q

What anti fungal not useful for A fumigates complex in cats?

A

Fluconazole - widespread resistance

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43
Q

Therapy for Sino-orbital aspergillus in cats?

A

Poss use azole with amphotericin B/terbinafine to imp outcome

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44
Q

Cryptococcal recrudescent infection in cats?

A

15 - 20 % casess

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45
Q

Primary and secondary components of BOAS?

A

Primary: stenotic nares, turbinate distortion and overgrowth, narrow nasal cavity, soft tissue in nasopharynx and oropharynx, elongated and thickened soft palate, macroglossia, tracheal hypoplasia, redundant oesophagus, gastric stasis, pyloric hypertrophy/stenosis

Secondary: worsening turbinate deviation, worsening of soft tissue in pharynx, worsening of thick soft palate
Everted saccules laryngeal collapse, bronchial collapse, hiatal hernia, GERD, eosphagitis, pyloric hypertrophy worsening, gastroduodenitis

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46
Q

T/F: pug bronchial collapse worsens post-BOAS surgical outcome?

A

False. But is correlated with laryngeal collapse.

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47
Q

What breeds are overrepresented for components of BOAS?

A

Pug - bronchial and laryngeal collapse, distorted and protruding turbinates

Bulldog - tracheal hypoplasia, macroglossia, oesophageal redundancy,

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48
Q

What is the major cause of nasal stenosis in BOAS?

A

Alar cartilage

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49
Q

What middle ear abnormality occurs with nasopharyngeal disease?

A

Bullous effusion - 34 % cats nasopharyngeal disease, 100 % caudal nasopharyngeal disease

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50
Q

Follicular nasal hyperplasia in nasopharynx?

A

Poss nasal mites

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51
Q

Histopath of nasopharyngeal polyp?

A

Fibrovascular connective tissue and mixed inflamm cells, stratified squamous columnar/ciliated columnar epithelium, often ulcerated

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52
Q

How do you decrease polyp recurrence rate?

A

Steroids

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53
Q

What ‘polyps’ occur in the nasal cavity of young cats?

A

Mesenchymal hamartomas

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54
Q

Where do nasal polyps live in dogs?

A

Caudal nasal cavity attached to caudal turbinates, rostral nasopharynx

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55
Q

What drug should you have ready when balloon dilating nasopharyngeal strictures?

A

Atropine as can get vagal mediated bradycardia

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56
Q

Breeds associated with congenital laryngeal paralysis?

A

Husky, bouvier de flandres (auto dom nerve degen), bull terrier, white GSD

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57
Q

Larpar polyneuropathy?

A

Dalmatian, rottie, Pyrenean mountain dog

Many idiopathic get generalised neuro signs in a year

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58
Q

Acquired larpar breeds?

A

GRet, st Bernard, Newfie, Irish setter, leonberger

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59
Q

What exacerbates larpar?

A

Humidity, exercise, heat, stress, obesity

Oedema of mucosa on arytenoids ensues

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60
Q

What impact would temporary tracheostomy have on larpar case?

A

Has been assoc with negative px following surgery - more likely to have major complications

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61
Q

T/F: the management for unilateral larpar is tieback?

A

False - not usually severely clinically affected until bilateral and only unilateral tiebacks are performed.

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62
Q

T/F: in larpar surgery the arytenoid should be pulled as laterally as possible

A

No - might increase risk postop aspiration pneumonia if increase surface area of rima glottis beyond epiglottal margins, with no improvement in clin signs or outcome

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63
Q

Predictors of complication/poor outcome in larpar?

A

Pre-op asp pneumonia, oesophageal dysfunction, generalised neuropathy, temp tracheostomy preop, concurrent neoplasia

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64
Q

Difference between canine and feline larpar?

A

Cats have signs with unilateral, L > R

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65
Q

Degeneration tracheal rings?

A

Hypocellularity, decreased glycosaminoglycan, glycoprotein, chondroitin sulphate and calcium

Can’t retain water

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66
Q

Factors causing progression to symptomatic tracheal collapse?

A

obesity, recent endotracheal intubation, respiratory infection, cardiomegaly, cervical trauma, and inhalation of irritants or allergens, chronic bronchitis, pulm oedema, upper airway obstruction, periodontal disease

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67
Q

Tracheal mucosa changes in tracheal collapse?

A

Loss of epithelium, fibrinous membrane formation, and squamous metaplasia with polypoid proliferation evident in advanced cases.

Decreased ciliated cells, hyperplasia of sub endothelial glands and increased viscous mucous

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68
Q

How many tracheal collapse cases symptomatic at 6m?

A

25 %

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69
Q

Success of extraluminal prosthesis for tracheal collapse?

A

Decreased clin signs 75 - 85 %

High rate complications and most had extra thoracic collapse (no intrathoracic due to even higher morbidity)

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70
Q

Success tracheal stenting?

A

75 - 90 % improvement with less complications

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71
Q

Landmarks for trach stent?

A

Cricoid cartilage, carina

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72
Q

Where does granulation tissue develop after stenting?

A

Cranial aspect - movement or coughing

Could consider colchicine?

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73
Q

Does tracheal stent fracture affect prognosis?

A

No - not if restent

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74
Q

When should you trust a positive BAL culture?

A

> 1.7 x 10^3 CFU/ml, no squamous cells or simonsiella, increased. neuts

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75
Q

Mediator of smooth muscle contraction in feline asthma?

A

Mast cell serotonin

Histamine role less certain

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76
Q

Cytokine array in feline asthma?

A

Th2 with IgE

IgE, NO, IL4, IFNgamma and TNF in BAL and serum but can’t be used diagnostically

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77
Q

Cat breed predip for asthma?

A

Siamese

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78
Q

Normal cat eosinophils on BAL?

A

Up to 20 - 25 % cell population

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79
Q

Significance of mycoplasma in lower airway in cats?

A

Not normal - only pathogen. Mycoplasma can degrade neutral endopeptidase, which degrades substance P, which causes bronchoconstriction and oedema. Ioslated from 25 % cats lower airway dz

Klebsiella and Pseudomonas can be recovered from healthy airways

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80
Q

What are leukotrienes?

A

Arachidonic acid derived eicosanoids

Leukotrienes, including LTE4 are not found in cats with asthma and leukotriene metabolism or receptor blockers don’t improve feline asthma

One case report advocated zafirlukas/montelukast (cysteinyl leukotriene receptor 1 blocker)

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81
Q

Fluticasone mechanism of action?

A

18 x affinity dex for steroid receptor.

Inhibit inflamm cells and their mediators.

Plasma levels don’t predict therapeutic effects. Clinically effective absorption into airway mucosa might be delayed 1-2w

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82
Q

What predisposes animals to pneumonia?

A

Concurrent dz or environmental stressors

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83
Q

Causes of peracute severe pneumonia in cats and dogs?

A

Strep equi zooepidemicus, E coli, usually associated with stressor

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84
Q

Puppies with CAP?

A

Bordetella half, gram neg enteric half

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85
Q

Risk factors for MDR pathogens in HAP?

A

AB in 90 d, hosp in 90d, current hosp > 48h, high MDR in hosp

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86
Q

Phases of aspiration lung injury?

A

Phase 1 - 1-2h, direct pulmonary parenchymal injury

Phase 2 - ALI, neutrophilic infiltrate to alveoli, start several hours and progress 24-48h

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87
Q

Risk factors for gastric colonisation with bacteria?

A

SI obstruction/ileus
Gastrroparesis
Feeding tube
Tx gastroprotectants (esp G neg)

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88
Q

Risk factors for aspiration pneumonia in dogs?

A

Laryngeal paralysis, oesophageal disease, vomiting, neuro disease, recent GA

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89
Q

Most frequent bacteria in canine aspiration pneumonia?

A

E coli
Mycoplasma
Pasteurella
Staph

Some no pos culture and most have two or more organisms

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90
Q

Outcome aspiration pneumonia?

A

80 % recovery

One study found poor px = more than one lung lobe affected, another found no corr with XR

No diff choice of AB

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91
Q

How to prevent aspiration pneumonia?

A

Position, enteral feeding esp nasogastric, promotility, gastric pH modification

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92
Q

Cytokine profile in EBP?

A

Th2 - increased CD4+ in BAL, increased eotaxin

Also upreg collangenolysis
Increase metalloproteinase 8/9/13

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93
Q

What does BWBP measure?

A

Barometric whole body plethysmography - HPenh300 index (conc histamine required to increase enhanced pause by 300 %) - decreased in EBP, returns to N after tx

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94
Q

What predicts most poor response to tx in EBP?

A

Abrupt cessation meds or irregular parenteral depository steroid inj

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95
Q

What secondary immunosuppressive could you use in EBP?

A

Ciclosporin

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96
Q

What is the main receptor involved in eosinophil recruitment?

A

CC chemokine receptor type 3

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97
Q

Most commonly affected lung lobes for torsion?

A

Right middle, right cranial

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98
Q

Sensitivity of cytology for neoplastic pleural effusion?

A

50 %

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99
Q

FIP and effusion content?

A

If albumin > 48 % or alb:glob <0.81, FIP unlikely

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100
Q

What does the thoracic duct drain?

A

Lymph from intestine, liver and hindlimbs

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101
Q

Bacterial population pleural effusion?

A

Often mixed so give aerobic, anaerobic and g pos/neg cover - amoxiclav and enro

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102
Q

How long to wait in pyothorax off before surg management

A

Cat - if no resolution effusion after one week

Dogs - improved outcome with surg intervention from the start (might be because more FB in dogs cf cats), however recent studies show excellent outcome with medical/no evidence for surgical superiority

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103
Q

Survival rate pyothorax?

A

> 50 %, recurrence < 5-10 %

Marked increase survival rate for those alive at 24h

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104
Q

Why might pericardectomy be an effective tx for chylothorax?

A

If causing RHS increased cardiac pressure

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105
Q

Chylothorax breed predisposition?

A

Afghan, shiba inu

Himalayan, siamese

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106
Q

How to dx chylous effusion?

A

Trigs usually 10xhigher cf serum, can decrease if affected animal anorexic

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107
Q

Benzopyrone?

A

Might be of use in chylothorax - improve macrophage function and chyle resorption.

Rutin

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108
Q

Surgical management to chylothorax?

A

Thoracic duct ligation (20 - 50 and. 50 - 80 dog and cat have chylothorax or serosanguinous discharge persisting)

Omentalisation

Pericardectomy (80 % cats respond)

Pleuroperitoneal shunting

Pleural port

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109
Q

When to place chest drain in pneumothorax?

A

Severe > 1l air or >3 taps req in 24h

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110
Q

What helps to seal lung after traumatic pneumo?

A

High pulm thromboblastin

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111
Q

Breeds for spontaneous pneumo?

A

Deep chested, husky, gret

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112
Q

Secondary pneumothorax other than traumatic?

A

Dog - neoplasia PTE pneumonia

Cat - heartworm airway dz

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113
Q

What would you use blood patching for?

A

Pneumothorax - fresh whole blood

114
Q

Pulmonary consequences of PTE?

A

Bronchoconstriction, VQ mismatch, hypoxia, hyperventilation, regional loss of surfactant, pulmonary infarction

Atelectasis, oedema and effusion

115
Q

What is oligemia?

A

Hypoperfused lung, best identified on DV/VD XR

116
Q

Pleural effusion in PTE?

A

Not common, cat > dog

117
Q

Radioscintigraphic perfusion scan pulmonary?

A

V sens for PTE but not specific

Selective pulmonary angiography = gold standard

118
Q

Benefit of O2 supp in PTE?

A

Relieve hypoxaemia, dilate pulm vessels, reduce pulmonary hypertension, improve RV function

Need to optimise perfusion also

119
Q

Difference in factor suppression UFH versus LMWH?

A

1:1 and 4:1 anti-10 anti-2 ratio respectively

Latter more bioavailable and has prolonged half life, decreased protein binding, renal clearance

Less effects plt function and vascular permeability so less haemorrhage events

120
Q

How to prevent PTE?

A

Minimise vascular stasis by optimising perfusion and mobility

Minimise vascular injury with IV Cath management

Alter haemostat system with antithrombotic drugs

121
Q

Why low dose aspirin?

A

Inhibit thromboxane synth and spares prostacyclin

122
Q

Arrhythmias in pulmonary hypertension?

A

Pronounced sinus arrhythmia, isolated APC/VPC, AFib, AV block

123
Q

What equation is used to calculate a pressure gradient?

A

Bernoulli

124
Q

What should be included in this equation?

A

Theoretically right atrial pressure and RV diastolic pressure

125
Q

Ranges for normal pulmonic/TR regurg?

A

2.5 - 3.5
2 - 2.2

BUT some normal dogs have TR around 3. TR jet present 80 % normal dogs.

126
Q

Severity of PH?

A

< 50 mild
< 80 mod
> 80 severe

127
Q

Correlation Doppler echo with right heart cath?

A

Acceptable but less good if PH less severe (humans)

TR affected by rv contractility and volume overload - underestimate if impaired contractility or high diastolic pressure
Opposite overest
Also underest if incorrect alignment

128
Q

Other echo PH diagnostics?

A

Pulmonary flow profile

129
Q

What other echo changes PH?

A

Eccentric, concentric or mixed hypertrophy in mod to severe PH

Concentric more common congenital

Flatten IV septum, paradoxical septum motion, PA dilation (aortic:pulm < 1)

130
Q

Tx for PH other than sildenafil?

A

Calcium channel blockers

131
Q

What pathways can be targeted in PH?

A

Prostaglandin-cAMP pathway (PGI2//cAMP/PDE3+4/AMP) - PDE3/4 inh (pimobendan)

NO-cGMP pathway (Larginine/NOsynthase/NO/cGMP/PDE5) - sildenafil PDE 5 inh

Endothelin pathway (endothelin converting enzyme/calcium) - ET receptor antagonist

132
Q

Why sildenafil effective in lungs?

A

Lots of PDE5

Also - imp myocardial contractility, decreased vent afterload, facilitate natriuretic peptide, blunt adrenergic stim

133
Q

Negative px indicators in PH?

A

Mod/severe dz, RHS CHF, survive first week

134
Q

CT in idiopathic pulmonary fibrosis?

A

Ground glass opacity, sub pleural and parenchymal bands, peribronchovascular interstitial thickening, traction bronchiectasis

Corr dz severity

135
Q

Concurrent IPF pulm dz?

A

Bronchial/tracheal collapse

136
Q

Scope IPF?

A

Expiratory dynamic airway collapse due to poor lung compliance and high elastic recoil, more likely if bronchotracheomalacia

BAL - one study in westies inflamm (concurrent chronic bronchitis?)

137
Q

What interstitial lung diseases would PH be common in?

A

50 % IPF, not PIE

138
Q

IPF histopath?

A

Patchy extensive alveolar fibrosis, epithelial cell hyperplasia, squamous metaplasia, inflamm

139
Q

Eucoleus Boehmi?

A

Nematode, nose, dogs

Eggs in faeces.

Earthworms transport host?

Golden barrel eggs double plug

Look like Eucoleus aerophilus, eggs ls smaller and pitted shell

140
Q

Mammomonogamus eirei?

A

South Am, cats, nose.

Eggs faeces and nasal flush.

Fenbendazole

141
Q

Blood test for Cuterebra?

A

ELISA IgG ABs

142
Q

Linguatula serrata?

A

Arthropod. Dog. Nose. Europe/Middle East

Eggs nasal secretions, intermediate host ruminant. Dog ingest sheep offal.

143
Q

Oslerus osleri?

A

Granulomatous nodules tracheal bifurcation. Young dogs. US/Aus.

Direct life cycle. Faeces and saliva.

Nodules 10 w post exposure, immature worms in trachea. PPP 12-18w

Spont pneumo reported

Egg/larvae BAL, larvae faecess (less reliable, 33% sens, need zinc sulphate centrifug)

Fenbendazole/ivermectin +/- debulk

144
Q

Oslerus rostratus

A

Cats. US Middle East Southern Europe.

Bronchial submucosa, slug intermediate host.

145
Q

Filaroides hirthi

A

Alveoli/terminal bronchioles. Dogs.

Direct life cycle. PPP 32 - 35 d.

Faecal transmission. Autoinfection. Endemic breeding colonies. Might have no clin signs.

Eggs/larvae BAL/faeces. Latter less sens. Zinc sulphate centrifug again.

Fenebendazole/ivermectin

146
Q

Aelurostrongylus abstrususs

A

Cat. Terminal bronchioles/alveolar duct.

Mollusc intermediate host.

Can be subclin, GA death, occ pneumothorax.

Baermann - larvae, sens 85 - 90 %

Pharyngeal PCR highly sens and spec

147
Q

Crenosoma vulpis?

A

Dogs. Frequent Canada.

Indirect slug/snail intermediate.

Bronchi-bronchioless.

19 - 21 d PPP

BAL larvae 50 - 75 % sens

Baermann more sens zinc sulf

Intermittent shed need 3 sample over 7 d

Milbemycin

148
Q

Eucoleus aerophilus

A

Tracheobronchial mucosa, cats and dogs. Masses.

3-6w PPP

Direct life cycle. Earthworm transport host. Rare human case.

PCR for faeces highly sens spec

Fenbendazole, ivermectin, moxidectin/imidacloprid

149
Q

Paragnominus kellicotti?

A

Trematode. Dogs and cats. US. Snail and crab intermediate host.

Metacertaria infective in crab. Exit GI into peritoneal cavity and go through diaphragm. Pulm cysts right caudal lung lobe.

Spont pneumo reported

Fenbendazole or praziquantel.

150
Q

Histopath soft palate changes in BOAS?

A

Increased stroma, increased salivary tissue, muscle degeneration and necrosis

151
Q

What causes vocal cord granulomas?

A

Excess contact and GERD

152
Q

Norwich terriers?

A

Redundant supra-arytenoid folds, laryngeal collapse, everted saccules, narrowed laryngeal openings

Cartilage failure and degeneration

153
Q

Describe the grades of laryngeal collapse

A

1 - sacules
2 - cuneiform process
3 - corniculate process

154
Q

Name the cartilage components of the larynx

A

Arytenoid
Epiglottis
Cricoid
Thyroid

Nerve - caudal laryngeal
Cricothyroid muscle controlled by CRANIAL laryngeal
Cats no cuneiform/corniculate

155
Q

Prevalence of hypothyroidism in larpar?

A

30 %

156
Q

Area for most pronounced tracheal collapse?

A

Cervicothoracic junction

157
Q

What is cervical lung lobe herniation associated with?

A

Intrathoracic tracheal collapse

158
Q

Factors impacting stent prognosis?

A

Presence of bronchomalacia, concomitant lower airway dz

159
Q

Yorkie specific tracheal collapse presentation?

A

W shaped tracheal ring

160
Q

Exposure to smoke causes chronic bronchitis?

A

No evidence for this

161
Q

Is partial bronchial collapse always a sign of disease?

A

No - can find in healthy ageing dogs

162
Q

How to increase sensitivity for airway inflammation?

A

Brushing instead of BAL might be more sensitive for chronic bronchitis

163
Q

What impact does obesity have on respiratory function?

A

Limits exercise, worsens cough, impairs lung function, increases airway hyperresponsiveness

164
Q

Concurrent signs/problems in EBP?

A

50 % nasal discharge, 60 % peripheral eosinophilia, 50 % bronchiectasis

165
Q

BAL fluid marker for EBP?

A

Procollagen 3 aminoterminal propeptide - fibrotic change?

166
Q

Pathophys primary ciliary dyskinesia?

A

Ineffective or uncoordinated ciliary function and therefore mucous clearance

167
Q

What is Kartagener’s syndrome?

A

Bronchiectasis, situs inverts and chronic rhinosinusitis

168
Q

Genetic PCD?

A

OES

169
Q

Situs invertus?

A

50 % PCD

170
Q

Concurrent issues with PCD dogs?

A

Otitis media, infertility, renal fibrosis, dilation renal tubules

Ciliated epithelia/microtubules

171
Q

Diagnosis of PCD?

A 
OES - Taqman assay
Scintigraphy
TEM (distinguish from secondary?) - ultrastructural changes include absence of dynein arms, radial spoke defects, nexin link defects, axonemal disorganisation, micro tubular transposition
172
Q

Irish wolfhound PCD?

A

No - they get a juvenile rhinosinusitis/bronchopneumonia but no PCD

173
Q

Definition of bronchiectasis?

A

Abnormal, permanent dilation and distortion of subsegmental airways

Chronic inflamm damages elastic bronchi components and bronchial wall

Resp secretions not cleared

174
Q

CFTR and bronchiectasis?

A

Mutations in dogs but not assoc with bronchiectasis

175
Q

What might cause focal bronchiectasis?

A

Obstruction eg FB

176
Q

Aspergillus and bronchiectasis?

A

Localised cavitatary

177
Q

Breeds for bronchiectasis?

A

ACS, mini poodle, husky, ESS, usually > 7yo

178
Q

Gold standard dx bronchiectasis?

A

CT - dilation, lack of tapering, lobar consolidation

Bronchoarterial ratio?

179
Q

Surgery for bronchiectasis?

A

Only if focal

180
Q

What is bronchomalacia and what causes it?

A

Weakness principal/small bronchi walls

Static common brachycephalic.

Dynamic - with tracheal collapse, inflamm/infection

Large breeds often have static and dynamic

NOT associated with cardiomegaly.

Both lungs 50 %, infectious 50 %

181
Q

Peripheral eosinophilia in asthma?

A

Around 20 %, not corr with BAL

182
Q

BAL fluid cytokines in asthmatic versus healthy cats?

A

ET 1 increased exp

NO DIFF IL4/IFgamma/TNFalpha

183
Q

Repeat BAL in treated asthmatics

A

70 % BAL still inflamm despite clin imp

184
Q

What bronchodilator not to use in cats?

A

Racemic mixture albuterol increases airway inflamm experimentally

185
Q

How do you calculate the A-a gradient?

A

((0.21 X 714) - (PaCO2/0.8)) - Pa02

< 15 N, > 20 VQ mismatch

186
Q

Increased A-a gradient?

A

Impaired oxygen diffusion or VQ mismatch

187
Q

Hypoventilation?

A

Increased carbon dioxide, normal A-a gradient

188
Q

Hypoxaemia with normal A-a gradient?

A

Low inspired oxygen

189
Q

What causes dyspnoea with normal XR?

A

Aspiration pneumonia, PTE, ARDS

190
Q

What causes dyspnoea with cranioventral alveolar XR?

A

Bact/asp pneum, haemorrhage

191
Q

What causes dyspnoea with perihilar XR?

A

CHF

192
Q

What causes dyspnoea with caudodorsal/peripheral XR?

A

Mycotic, parasitic, protozoal, rickettsial pneumonitis, noncard pulm oedema, haemorrhage

193
Q

What causes dyspnoea with other alveolar XR?

A

PTE, drowning smoke viral parasitic pneumonia, neoplasia, atelectasis

194
Q

What causes dyspnoea with bronchial XR?

A

Asthma, CB, EBP, peribronchial cuffing oedema and inflammation, bronchial calcification

195
Q

What causes dyspnoea with interstitial XR?

A

Unstructured: IPF, lymphoma,
Structured > unstructured: neoplasia, mets, fungal, eosinophilic pneumonia, FB reaction
Structured: abscess/cyst
Any: haematoma

196
Q

What causes dyspnoea with vascular XR?

A

Heartworm, thromboembolic dz, pulm hypertension, CHF

197
Q

What Angiostrongylus larvae are detected in faeces?

A

L1

198
Q

How often are anaerobes involved in bacterial pneumonia?

A

25 % cases

199
Q

Most common bacteria dog and cat pneumonia?

A

Dog - Strep, E coli, Pasteurella

Cat - Mycoplasma, Pasteurella, Bordetella

200
Q

Predisposing factors for bacterial pneumonia?

A

Recumbency, debilitation, immunosuppression, immunodeficiency, defective respiratory defence, damage to the respiratory epithelium

201
Q

Where would a haematogenous pneumonia XR pattern be?

A

Dorsocaudal

202
Q

ISCAID AB pneumonia recommendation?

A

Empirical approach - ampicillin or clindamycin with a quinolone

Recheck at 14 d and make change depending on clin condition

203
Q

What factors impact the pathogenic potential of aspirated material?

A

pH, bacterial load, particle size, volume, tonicity

Polyethylene glycol particularly bad as draws interstitial fluid into lung

204
Q

Most common XR findings in aspiration pneumonia?

A

25 % only interstitial.

Mostly patchy/focal alveolar.

R mid/cranial, caudal left cranial. > 1 involved in 1/3 cases

205
Q

Respiratory Mycoplasma?

A

M. cynos dogs/cats, common bacterial isolate in combination but not sole pathogen. PCR reasonable sens/spec,

206
Q

Testing for influenza?

A

Haemagglutination - specific subtype

Antigen/virus isolation/PCR - shedding peak 2-3d post inf

207
Q

What immunoglobulin deficiency predisposes which breeds to P carinii?

A

CKCS - IgG

Mini dach/pom - IgA

208
Q

Stain for P carinii?

A

Grocott Gomori methenamine

NOT ZOONOTIC!

209
Q

Why are lungs resistant to oedema?

A

Tight junctions between alveolar epithelial cells, lots of lymphatic drainage (peribronchovascular space)

210
Q

What mediates removal of pulmonary oedema alveolar fluid?

A

Active transport of sodium and chloride provides osmotic gradient

211
Q

What arrhythmia might you see in pulmonary disease?

A

Pronounced sinus arrhythmia (vagal stim)

212
Q

Criteria for ventilation?

A

PaO2 < 60 SpO2 < 90 PaCO2 > 60 with O2 supp

213
Q

Negative prognostic indicators in eosinophilic pneumonia?

A

Hypereosinophilic syndrome, bronchiectasis

214
Q

XR changes in feline IPF?

A

Any - common see in conjunction with neoplasia

215
Q

Steroids, antibiotics after drowning?

A

Steroids don’t improve survival, ABs don’t decrease risk bacterial pneumonia.

Pentoxyfylline could decrease risk of ARDS (nonspecific PDE inhibitor)

216
Q

What does carbon monoxide do?

A

Impairs O2 binding with Hb (carboxyHb) - looks normal on pulse ox

217
Q

Prognostic indicators for smoke inhalation?

A

Imp 1st day = good

Resp deterioration past one day/burns/need for vent = bad

218
Q

What is a pulmonary bleb?

A

Accumulation of air between layers of the visceral pleura

219
Q

Imaging for pulmonary bullae?

A

XR insensitive (5 - 50 %), CT 75 %

220
Q

Causes of emphysema?

A

Distension/rupture of alveolar from lost pulmonary elasticity and lung function.

Congenital lobar emphysema (then affects other lobes)

Idiopathic

Bronchial obstruction

221
Q

Classic emphysema XR?

A

Lobar hyperinflation, vessels extend to edge of lobe

222
Q

Most common lung lobes affected by torsion?

A

R middle, R cranial, R caudal, L caudal

223
Q

How often would pleural fluid culture be positive in lung lobe torsion?

A

Reported around 1/3, Pseudomonas/Ecoli

224
Q

Px lung lobe torsion?

A

60 % recovery, pug good px

Delayed mortality due to pneumo/chylous/torsion other lobes

225
Q

Classification of pulmonary hypertension?

A 
I - pulmonary arterial disease
II - left heart disease/pulmonary venous hypertension
III - pulmonary disease
IV - thromboembolic disease
V - miscellaneous
226
Q

Inducers of pulmonary vasculature vasoconstriction and vasodilation?

A

Constrict - endothelin I (also causes muscle hypertrophy/collagen proliferation), prostaglandin, hypoxaemia, serotonin.
PDGF (hypertrophy smooth muscle)

Dilate - NO, increased oxygen, prostacyclin

227
Q

How do you modify the Bernoulli equation to take into account volume overload?

A

By appearance of right atrium - normal add 5 mmHg, dilated add 10, signs R CHF add 15

Most accurate when added to TR velocity

228
Q

XR predictor of pulm hypertension in small dogs?

A

Short axis vertebral heart score/sternal contact length

229
Q

NT-proBNP and troponin in pulm hypertension?

A

NT proBNP - increased in respiratory disease dogs with pulmonary hypertension versus non-PH counterparts
Increased in MVD with PH but can’t distinguish from MVD without PH
NB decreases when manage MVD with pimobendan
Might corr with peak TR

Troponin - increased in resp disease, can’t distinguish PH

230
Q

How might a PDE5 inhibitor help in pulmonary hypertension?

A

Inhibit breakdown of cGMP, NO pathway

Also decreases remodelling and fibrosis

231
Q

When should a PDEE5 inhibitor be used in pulm hypertension?

A

Moderate if syncope and no CHF or after CHF drugs added

Severe regardless of any other factor

232
Q

Imatinib? Mechanism of action and benefit in pulm hypertension?

A

TKI - might decrease PDGF to decrease remodelling

233
Q

What drug might be useful as a sildenafil alternative?

A

Tadalafil - longer acting

234
Q

Blood gas analysis in PTE?

A

Increased A-a gradient, hypoxaemia with hypercapnia

235
Q

Non-recruitable/trapped lung?

A

Non recruitable - immature fibrin presents reexpansion

Trapped lung - thickening and constriction of the pleura - can’t reexpand even with negative pleural pressure

236
Q

How much fluid/air do you need to remove from pleural space to improve ventilation?

A

5 - 30 ml/kg

237
Q

NT pro BNP use in pleural effusion?

A

Cats - pleural eff NTproBNP v sens/șpec for cardio versus non cardio

238
Q

Evidence of chronic pleural effusion?

A

Rounded lung margins

239
Q

Light’s criteria for pleural effusion?

A

Protein:LDH ratio - increase LDH or ratio > 0.5 = exudate

240
Q

What is the problem with diagnosing cardiac causes of pleural effusion?

A

If moderate pleural effusion (> 17 - 22ml/kg), increase CVP by 4.5 cm H2O (misdx)

241
Q

What does it suggest if ascites is present with right atrial tamponade?

A

Chronic

242
Q

How many chylothorax cases have a cause?

A

50 %

243
Q

What ribs could fracture with resp distress in cats?

A

9 - 13

244
Q

Viral components of canine infectious respiratory disease?

A

Enveloped: Parainfluenza, herpesvirus, coronavirus,

Non env: CAV

Influenza, pneumovirus

245
Q

Prevalence of Bordetella in healthy and acutely coughing dogs?

A

45 and 80 %

246
Q

What toxin does Bordetella produce and what does it do?

A

Tracheal cytotoxin, ciliostasis and loss

Adenylate cyclase inhibits neutrophil phagocytosis

247
Q

Bordetella diagnosis?

A

Culture 50 % PCR 100 % sense

Cytokines- coccobacilli adhere to ciliated cells

248
Q

Diagnosis of VS feline calici?

A

Antigen in liver

249
Q

Dx regular FCV?

A

Virus isolation most sensitive, or RT PCR

250
Q

Where does chlamydia need to be?

A

Intracellular

Dx pcr

Eyes - keratitis/ulcer less common cf FHV

251
Q

How can you decrease brachy anaesthesia risk?

A

Do BOAS surgery - subsequent GAs lower risk

252
Q

IgE in serum feline asthma?

A

Serum allergen specific 78 % of cases, usually polysentitised

Evidence allergic dz, not corr with severity or airway eosinophilia

HOWEVER another study found no diff number of cats with pos serum IgE response in healthy/asthmatic (more pos allergen response in each cat with asthma)

Most common in asthma = mites (storage/dust - no control cat pos)

This is blood allergy testing

253
Q

Raltegravir? What is it and why would you use it?

A

Retroviral integrase inhibitor. Interfere DNA polymerase.

May decrease duration FHV shedding and ameliorate eye and resp signs.

Nucleoside analoges can be used but viral mutation can lead to resistance.

254
Q

Famciclovir? Mechanism and use?

A

Diacetyl 6 deoxy derivative of penciclovir

Acyclic guanosine analogue, inhibits herpesviral DNA polymerases

Variable oral absorption in cats and metabolism to penciclovir saturable (this is rate limiting)

Need high oral dose for tear excretion.

High dose may decrease duration and severity of clin signs in FHV vs low dose

Other studies found no benefit in acute upper resp dz when compared with doxycycline alone, however low number FHV in that study. Might decrease shedding?

255
Q

Tracheal stent outcome?

A

93 % survival discharge
MST 1000d (male/younger longer)
89 % imp goose honk cough/raspy breathing/dyspnoea
Major comp 50 % in follow up

Mainstem bronchial collapse no effect on outcome

Half had malformation (W cartilages). No diff in outcome.

256
Q

Is bronchial wall thickness to pulmonary artery ratio useful for chronic bronchitis dx on CT?

A

No

257
Q

Why do alaskan huskies get congenital laryngeal paralysis?

A

MONOneuropathy recurrent laryngeal nerves - neurological atrophy of cricoarytenoideus dorsals muscle

40 % spontaneously improve

Variable penetrance autosomal recessive

Blue eyes, white facial markings. oral mucosal tags/tissue bands

258
Q

How to treat nasopharyngeal stenosis best?

A

Balloon dilation alone - 0 % dogs 50 % cats
Overall after stent - 78 %

High risk complication

259
Q

Cysterna chyli ablation in cats with chylothorax?

A

No improvement cf thoracic duct lig and pericardectomy alone

260
Q

Risk factors for aspiration pneumonia in larpar?

A

Post surg - mega-o, opioids

NOT pre-op asp pneum, metoclop doesn’t help

Periop cisapride CRI might help

261
Q

What clinical exam finding suggests cardiac dz in cat with pleural eff?

A

Low temp

262
Q

When would mesenchymal stem cells have beneficial effect in feline asthma?

A

Delayed - may decrease airway inflamm, hyperresponsiveness and remodelling

263
Q

Theoretically, why would maropitant be helpful in feline asthma?

A

Tachykinins from sensory nerves and immune cells bind NK1 receptors in the lung and cause neurogenic airway inflamm

However, no decrease eosinophilic inflamm or clin signs in experimental cats

264
Q

What drug predicts survival in pulm hypertension?

A

Sildenafil

265
Q

What is the pulmonary interstitium?

A

Anatomic space lined by endothelium cells and alveolar epithelial cells, with fibrous connective tissue.

NB interstitial lung disease can also involve other parenchyma

266
Q

Drugs associated with interstitial lung dz?

A

TMPS cytarabine bleomycin lomustine. rabacfosadine. nitrosurea inhalant chemo XRT

267
Q

Cytokine changes in IPF WHWTs?

A

TGFbeta1 (signalling protein smad increased in tissue, increased pathways for activating storing and signalling), increased assoc cytokine activin B in BAL

In comparison to healthy westies

Lung - CCL2, 7, 14, IL8, fibroblast activation protein alpha
BAL - CCL2, IL8, ET 1, PIIINP
Serum - CCL2 ET1

Westies in general - increased blood IL8, TGFbeta, KL6

268
Q

Cause of IPF?

A

Risk factors - genetic, poor ventilation, old house, grooming in parlour
Bile acids increased in BALF - micro aspiration?
Pos precipitants, fungal hypersens?

269
Q

Prognostic factors IPF?

A

CT findings predict severity (ground glass mild, focal reticular/mosaic/traction bronchiectasis more severe) and survival time. Serum CCL2 predict survival.

PaO2 and 6min walk test don’t predict

270
Q

IPF same as human dz?

A

No - mixture of usual interstitial pneumonia and non-specific interstitial pneumonia

271
Q

Infectious agents in chronic bronchitis/EBP?

A

No diff number PCR pos for M cynos/canis or Bb

EBP dogs had higher loads of Bb and Bb pos had higher neut counts, also more likely Bb pos if worse severity

272
Q

What brachycephalic dogs have most GI?

A

Poss bulldogs (esp French) > pug

273
Q

What is important about Lingatula serrata?

A

Zoonotic

274
Q

Bronchomalacia in tracheal collapse?

A

45 - 83 % cases, most common right middle/left cranial bronchi

275
Q

Anything different between eosinophilic and neutrophilic airway dz in cats?

A

Eosinophilic might be younger

276
Q

What Mycoplasma species are thought to be pathogenic in canine LRT?

A

Cynos, probably not canis, spumans or edwardii

277
Q

Bile acids in BAL?

A

Increased in IPF Westies and healthy westies, also increased other inflamm pulm dz, versus healthy beagles

278
Q

CRP and SAA in bacterial pneumonia?

A

Increased, decreased with tx, can guide tx (stop 5-7d after normalise - shorten AB duration with no increase relapse). Not corr with severity.

279
Q

Serology for feline Aspergillus?

A

IgG most sens and spec, IgA OK

Combining no value - IgA inferior

280
Q

Most common cause sinonasal/sinoorbital aspergillus?

A

A. fumigatus, A. felis

281
Q

Maropitant in chronic bronchitis?

A

Tachykinin NK1 neurogenic pathway - cough and airway inflamm, substance p sensitise cough receptors?

Decrease cough, no change inflamm

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