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ACVIM Specialty 2023 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Cough can be evoked by stimulation of cough receptors located where?

A

Larynx, tracheal, large bronchi. Cough receptors are not found in the lower airway

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2
Q

Describe the sequence of events in a cough

A

Deep inspiration, rapid expiration against a closed glottis, followed by opening of the glottis, closure of the nasopharynx and forceful expiration through the mouth

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3
Q

Irritation of what structures leads to an expiration reflex?

A

Vocal cords/larynx or upper trachea

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4
Q

Describe the sequence of events in a expiration reflex

A

Forced expiration against a closed glottis, not preceded by a large inspiration (“huffing”)

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5
Q

What is the goal of a cough? Of an expiration reflex?

A

Cough: force clearance of mucus and foreign material from the trachea and bronchi (lower airway disease)
Expiration reflex: prevent entry of noxious material into the airways (upper airway irritation)

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6
Q

Name 4 causes of hemoptysis

A

Lung tumors, bleeding disorders, PTE, heartworm disease, lung worm disease

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7
Q

What is the scientific name of the French heartworm?

A

Angiostrongylus vasorum

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8
Q

What is the scientific name of the cat lungworm?

A

Aelurostrongylus abstrusus

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9
Q

What causes reverse sneezing?

A

Irritation of the nasopharyngeal mucosa leads to spasming of the pharyngeal muscles, leading to obstruction of air passage

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10
Q

Name 4 differentials for reverse sneezing

A

Nasopharyngeal foreign body, nasal mites, viral infection, allergic rhinitis, epiglottic entrapment of the soft palate

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11
Q

Stertor occurs from obstruction of airflow in what location?

A

Nasopharynx - resolves with open mouth breathing

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12
Q

Central chemoreceptors measure what in the arterial blood?

A

Carbon dioxide levels

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13
Q

Peripheral chemoreceptors measure what in the arterial blood?

A

Both carbon dioxide and oxygen levels

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14
Q

List 6 causes of hypoxemia

A

Decreased FiO2, hypoventilation, diffusion impairment, VQ mismatch, right to left cardiovascular shunting, hemoglobin abnormalities

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15
Q

Increased inspiratory effort localizes disease to what portion of the respiratory tract?

A

Upper airways: nasal passages, pharynx, larynx, extra thoracic trachea

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16
Q

Increased expiratory effort localizes disease to what portion of the respiratory tract?

A

Intrathoracic trachea, large bronchi, lower airways

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17
Q

A restrictive breathing pattern localizes disease to what portion of the respiratory tract?

A

Pulmonary parenchyma or pleural space disease

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18
Q

Blood pressure must fall by at least ___% for a minimum of ____ seconds to induce syncope

A

50% for 10-30 seconds

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19
Q

What are the causes of cardiogenic syncope?

A

Bradyarrhythmias that result in asystole (sick sinus syndrome, high degree 2nd or 3rd degree AV block). Rapid, sustained ventricular tachycardia.

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20
Q

Define central cyanosis vs peripheral cyanosis

A

Central = systemic deoxygenation of arterial blood
Peripheral = localized reduction in oxygenated hemoglobin

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21
Q

Name 4 causes of ventilation-perfusion mismatch

A

PTE, pulmonary infiltration: pneumonia, edema, neoplasia, hemorrhage, fibrosis

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22
Q

Name 3 causes of hypoventilation

A

Elevated pleural pressure (pleural effusion or pneumothorax), depressed respiratory drive (neurologic disease, toxin) and respiratory muscle failure

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23
Q

A young animal presents with differential cyanosis (cyanosis on the caudal half of the body only). What is your differential diagnosis?

A

Right to left PDA

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24
Q

Name two oxidants that can result in methemoglobinemia

A

Acetominophen, benzocaine, nitrites, nitrates

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25
Q

Cyanosis will not improve with supplemental oxygen therapy when it is due to what conditions?

A

Right to left shunting, methemoglobinemia

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26
Q

Name two treatments of methemoglobinemia

A

Methylene blue, N-acetylcysteine

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27
Q

What muscle is responsible for opening the glottis by causing external rotation and abduction of the arytenoid cartilages?

A

Cricoarytenoideus dorsalis muscle

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28
Q

Autosomal dominant, congenital laryngeal paralysis is described in what breed?

A

Bouviers des Flandres

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29
Q

What anesthetic agents are the best choice for a functional laryngeal exam?

A

Propofol +/- alfaxalone

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30
Q

What drug can be administered during a functional airway exam to increase respiratory rate and effort?

A

Doxapram

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31
Q

What is the most commonly used surgical technique to correct laryngeal paralysis?

A

Unilateral arytenoid lateralization

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32
Q

Aspiration pneumonia occurs post-operatively in what percent of dogs surgically treated for laryngeal paralysis?

A

10-21%

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33
Q

In cats, laryngeal paralysis is more commonly unilateral. What side is more commonly affected?

A

Left

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34
Q

Name 3 causes of laryngeal paralysis in cats

A

Neoplastic invasion, trauma, iatrogenic damage from thyroidectomy

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35
Q

What are the components of Norwich Terrier airway syndrome?

A

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

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36
Q

Laryngeal collapse most commonly occurs secondary to what condition?

A

BOAS or other chronic upper airway obstruction

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37
Q

What defines stage I laryngeal collapse?

A

Eversion of the laryngeal saccules into the glottis. The tissue is then exposed to turbulent airflow, resulting in edema and inflammation

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38
Q

What defines stage II laryngeal collapse?

A

Cuneiform processes of the arytenoid cartilages lose rigidity and collapse into the laryngeal lumen. Aryepiglottic folds also collapse ventromedially

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39
Q

What defines stage III laryngeal collapse?

A

Corniculate processes of the arytenoid cartilage collapse toward midline (complete collapse)

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40
Q

How is laryngeal collapse treated?

A

Removal of everted laryngeal saccules, correction of any upper airway obstruction (stenotic nares, long palate, etc). Can try unilateral arytenoid lateralization or tracheostomy

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41
Q

What nerve innervates the muscles of the larynx

A

Recurrent laryngeal nerve: cranial portion goes to the cricothyroideus. Caudal goes to all other muscles

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42
Q

Autosomal recessive congenital laryngeal paralysis occurs in what breed and is associated with mono neuropathy of the recurrent laryngeal nerve?

A

Alaskan Huskies

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43
Q

Congenital laryngeal paralysis in Alaskan Huskies is associated with what other phenotypes?

A

Blue eyes (92%), white facial markings (76%), oral mucosal tags or tissue bands

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44
Q

Congenital laryngeal paralysis and polyneuropathy in Black Russian Terriers and Rottweilers has been associated with what gene mutation?

A

RAB3ABP1

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45
Q

Juvenile onset polyneuropathy (motor and sensory involvement) in Americal Staffordshire Terriers was associated with laryngeal paralysis in how many cases?

A

10/14 (71%)

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46
Q

Dogs with laryngeal paralysis had more abnormal swallowing studies than age matched controls. What phase of the swallowing study was most abnormal?

A

Liquid phase, worse in cervical and cranial thoracic esophagus

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47
Q

What nerve innervates the cranial esophagus and may be involved in esophageal dysmotility in GOLPP dogs?

A

Pararecurrent laryngeal nerves

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48
Q

Name 2 risk factors for the development of aspiration pneumonia following unilateral arytenoid lateralization

A

Administration of opioids, post-operative megaesophagus

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49
Q

What percent of dogs presenting for chronic cough alone (no upper respiratory signs) displayed evidence of laryngeal hyperemia? Laryngeal dysfunction?

A

Hyperemia in 73%, dysfunction in 19%

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50
Q

In a randomized, controlled clinical trial, did doxepin improved QOL in Labradors with GOLPP?

A

No. Not at all. Haha

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51
Q

Does Carol Reinero occasionally apply medicinal leeches to sublingual hematomas?

A

Yes. Yes she does.

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52
Q

Owners reports that the majority of Norwich Terriers with upper airway syndrome have what kind of QOL?

A

Excellent (81% with QOL scores <3 out of 40)

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53
Q

Vocal fold granulomas have been identified in what type of dog and are thought to result from what processes?

A

Brachycephalics. Thought to arise from chronic inspiratory effort/air turbulence or GERD => chronic laryngeal inflammation

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54
Q

Describe epiglottic retroversion

A

Intermittent, spontaneous, epiglottic retroflexion during inspiration, resulting in obstruction of the rim glottis

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55
Q

Dogs with epiglottic retroversion typically present with what clinical signs? What is the typical signalment?

A

Stridor, dyspnea. Older, small breed dogs, female > male

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56
Q

What percent of dogs with epiglottic retroversion have concurrent upper airway disease?

A

79%

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57
Q

Surgical correction of epiglottic retroversion decreases respiratory crisis from 62.5% to what?

A

25%

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58
Q

The two most common laryngeal neoplasms in cats are:

A

Lymphoma, squamous cell carcinoma

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59
Q

How does the larynx of cats differ from dogs?

A

The arytenoid cartilages lack cuneiform and corniculate processes, no aryepiglottic folds or laryngeal saccules

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60
Q

What breed is most commonly affected by acquired laryngeal paralysis?

A

Labradors

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61
Q

Why are clinical signs of laryngeal paralysis worsened by heavy exercise, hot or humid temperatures?

A

Increased respiratory rate leads to inflammation and edema of the mucosa covering the arytenoids

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62
Q

30% of dogs with laryngeal paralysis have what concurrent disease?

A

Hypothyroidism (causal link not determined)

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63
Q

In a study of more than 400 cats, what was the most common diagnosis on nasal biopsy?

A

Rhinitis (53%), followed by neoplasia (33%), followed by polyps (20%)

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64
Q

In a study of more than 400 cats, what was the median age at the time of diagnosis of nasal neoplasia?

A

11 years

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65
Q

In a study of more than 400 cats, what were the most common nasal tumors

A

Lymphoma (51%), adenocarcinoma (38%)

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66
Q

In a study of more than 400 cats, polyps were more common in cats with what signalment?

A

Young male cats

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67
Q

Name 5 systemic diseases that result in nasal signs

A

Coagulopathies, severe hypertension, hyperviscosity syndromes (multiple myeloma, Ehrlichiosis), systemic infections (Distemper, Ehrlichiosis, Leishmaniasis), Dysautonomia, Vomiting/regurgitation

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68
Q

Dolichocephalic breeds are ____ times more likely to develop nasal neoplasia than mixed breed dogs

A

2.5

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69
Q

What are the most commonly identified canine nasal tumors?

A

Adenocarcinoma, undifferentiated carcinoma, chondrosarcoma, squamous cell carcinoma

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70
Q

What bacteria has been identified in cats with chronic rhinitis, but not control cats, suggesting it may be pathogenic?

A

Mycoplasma

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71
Q

If using antibiotics to treat cats with chronic rhinitis, how long should the antibiotic course be?

A

6-8 weeks

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72
Q

Is famciclovir virostatic or virocidal?

A

Virostatic

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73
Q

How does lysine exert an anti-viral effect?

A

Competes for arginine, an essential animo acid for viral replication

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74
Q

In a study of 42 dogs with nasal foreign bodies, what was the signalment of the dogs?

A

Young (76% less than 7 years) and large breed (BW 22kg). Mainly presented for sneezing

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75
Q

In a study of 42 dogs with nasal foreign bodies, what was the most common foreign body?

A

Grass awns (90%)

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76
Q

In a study of 25 dogs with chronic idiopathic lymphocytic rhinitis, how many had endoscopic gastrointestinal lesions?

A

22 (88%)

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77
Q

Name 4 symptoms of aural inflammatory polyps in cats

A

Chronic otitis externa, head tilt, otorrhea, Horner’s syndrome, ataxia, nystagmus, circling, facial paralysis

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78
Q

Name 4 potential complications after polyp removal

A

Horner’s syndrome, vestibular symptoms, facial nerve paralysis, chronic otitis media/interna. Can be temporary or permanent

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79
Q

What percent of cats develop Horner’s after removing a polyp via traction avulsion?

A

43%

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80
Q

What percent of polyps recur after removal? What is the typical time frame for recurrence?

A

33-57%. 19 days to 46 months later (anytime, really haha)

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81
Q

What is a feline nasal chondromesenchymal hamartoma?

A

Inflammatory polyp of the nasal turbinates

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82
Q

What is the most common cause of nasopharyngeal stenosis in dogs?

A

Aspiration after an anesthetic event

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83
Q

What are the most common causes of nasopharyngeal stenosis in cats?

A

Chronic inflammatory disease, viral infections, congenital scar tissue development

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84
Q

In cats with a perforate NPS, balloon dilation alone is effective what percent of the time?

A

50%

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85
Q

Balloon dilation of an imperforate NPS alone has what rate of recurrence?

A

95%

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86
Q

What substance can be instilled into the region of the NPS after balloon dilation to try prevent recurrence?

A

0.1% Mitomycin C

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87
Q

If no stent is being placed, what size should be the balloon be for dilation of a NPS?

A

1mm larger than the measurement of the “normal” nasopharynx

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88
Q

If a stent is being placed, what size should be the balloon be for dilation of a NPS?

A

50-60% of the diameter of the “normal nasopharynx on CT scan

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89
Q

What is are most common complications with NPS stent placement?

A

Tissue ingrowth (33% of open stents), chronic infections (23% of open, 54% of closed stents), oronasal fistulas (20%), stent fracture

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90
Q

What percent of patients with a nasopharyngeal stent will develop a complication?

A

68%

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91
Q

What is the most common form of aspergillosis in cats?

A

Sino-orbital form - invasive form

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92
Q

In cats, what facial conformation is more predisposed to Aspergillosis infections?

A

Brachycephalic (> 1/3 cases)

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93
Q

What arm of the immune system is responsible for clearance of fungal infections?

A

CD4+ Th1 cells, phagocytes

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94
Q

Many cats with sino-nasal aspergillosis present for what clinical sign? How often are nasal signs present?

A

Ocular signs are most common (unilateral exophthalmos, conjunctival hyperemia, third eyelid prolapse). Nasal signs absent in 40%

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95
Q

What is the treatment for feline Sino-orbital aspergillosis

A

Posaconazole (most A. viridinutans resistant to others)

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96
Q

What adverse effects have been described in cats given voriconazole?

A

Severe neurologic effects - hindlimb paraplegia, blindness

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97
Q

Name 4 clinical signs of Aspergillus fumigatus infection in dogs

A

Chronic mucopurulent nasal discharge, nasal pain, ulceration and depigmentation of the nasal planum, epistaxis

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98
Q

In dogs treated with debridement of Aspergillus plaques and instillation of clotrimazole cream, what percent were cured after one treatment? Overall?

A

68% after one treatment, 94% overall cure rate

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99
Q

Does topical clotrimazole result in neurologic signs in dogs with cribriform plate lysis?

A

No

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100
Q

What oral drugs have been shown to be effective in the treatment of refractory canine sino-nasal aspergillosis?

A

Posaconazole, voriconazole, terbinafine

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101
Q

ELISA testing for Aspergillosis antibodies have what sensitivity and specificity for sinonasal disease?

A

High specificity (97-98%) but moderate to low sensitivity (30-70%) - so a negative test does not rule out the disease

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102
Q

How much more at risk for aspiration pneumonia are brachycephalic breeds compared to non-brachycephalic breeds?

A

3.77x increased risk

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103
Q

What is the typical age of onset of aspiration pneumonia in Frechies/Bulldogs compared to pugs?

A

Frenchies/Bulldogs are young (6-8 months), Pugs older (83 months = 6 years)

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104
Q

What is the most commonly identified risk factor for aspiration pneumonia in brachycephalics?

A

History of GI signs

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105
Q

What lower airway abnormality has been identified in brachycephalics? Which breed is most affected?

A

Fixed bronchial collapse (left cranial bronchus most affected). Most common in Pugs

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106
Q

The odds of a brachycephalic dog needing a temporary tracheostomy tube after BOAS surgery increases by what percent with each year of age?

A

30% (OR 1.3)

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107
Q

Using whole body plethysmography, what was decreased in brachycephalic dogs compared to controls?

A

Minute volume

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108
Q

In dogs with tracheal collapse, softening of the cartilage rings is secondary to a reduction in what content?

A

Glycosaminoglycans, chondroitin sulfate

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109
Q

West Highland White terriers have been shown to develop tracheal collapse due to increased pressure from what disease process?

A

Idiopathic pulmonary fibrosis leading to decreased lung compliance

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110
Q

Name 3 clinical signs of tracheoesophageal or bronchoesophageal fistulas

A

Chronic cough, recurrent respiratory infections, gas accumulation in the GI tract

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111
Q

Name two canine lungworms capable of causing tracheal granulomas

A

Oslerus osleri, Filaroides osleri

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112
Q

What parasite has been found in the trachea of cats?

A

Cuterebra

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113
Q

Cytology of an airway wash in a dog with chronic bronchitis would reveal what abnormalities?

A

Epithelial hyperplasia, increased numbers of neutrophils, macrophages, and goblet cells

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114
Q

Concurrent administration of what drug with theophylline can lead to theophylline toxicosis?

A

Fluoroquinolones

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115
Q

What is the characterization of the immune response in eosinophilic bronchopneumonopathy?

A

Infiltration of eosinophils and CD4+ Th2 cells (likely a hypersensitivity reaction)

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116
Q

What breeds are primarily affected by eosinophilic bronchopneumonopathy?

A

Siberian Huskies and Malamutes

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117
Q

Name 3 clinical signs of eosinophilic bronchopneumonopathy

A

Cough, gagging, and retching. Nasal discharge in 50%

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118
Q

How often do dogs with eosinophilic bronchopneumonopathy have a peripheral eosinophilia?

A

60% of the time

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119
Q

Angiostronglyus vasorum is spread through what intermediate hosts?

A

Snails, slugs

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120
Q

Name 3 clinical signs of angiostronglyus vasorum infection

A

Respiratory signs (eosinophilic pneumonitis), bleeding tendencies, neurologic signs

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121
Q

What are the thoracic radiographic findings with Angiostronglyus vasorum infection?

A

Bronchointerstitial or alveolarintersitial pattern, worse on the peripheral or caudodorsal lungs

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122
Q

What is Kartagener’s syndrome?

A

Primary ciliary dyskinesia leading to bronchiectasis, complete left-right transposition of viscera, and chronic rhinosinusitis

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123
Q

Autosomal recessive primary ciliary dyskinesia has been identified in many breeds. What breed has a mutation in CCDC39 causing the disease?

A

Old English Sheepdogs

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124
Q

Other than respiratory disease, name 3 diseases that can be caused by primary ciliary dyskinesia

A

Otitis media, decreased sperm motility, hydrocephalus, renal fibrosis or dilation of the renal tubules

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125
Q

What are the hallmark respiratory features of primary ciliary dyskinesia?

A

Recurrent bilateral nasal discharge, repeated episodes of bronchitis or bronchopneumonia since birth

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126
Q

How is primary ciliary dyskinesia diagnosed?

A

Scintigraphy to demonstrate decreased mucociliary clearance. Electron microscopy of cilia

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127
Q

Primary ciliary dyskinesia is associated with defects in what part of the cilia?

A

Inner or outer dynein arms

128
Q

A rhinitis/bronchopneumonia syndrome (similar to primary ciliary dyskinesia) has been identified in what breed?

A

Irish Wolfhounds

129
Q

The most widely used CT criteria for diagnosing bronchiectasis is the bronchoarterial ratio. Healthy dogs have a ratio up to what number?

A

Up to 2

130
Q

What is the difference in etiology between feline chronic bronchitis and feline asthma?

A

Chronic bronchitis arises from prior insult resulting in permeant airway damage. Asthma is allergic in origin

131
Q

Name 3 hallmark features of asthma

A

Reversible airway inflammation, consequent airway obstruction/airflow limitation, airway hyper responsive and changes (smooth muscle hypertrophy, excess mucus production, bronchial wall edema)

132
Q

What percent of asthmatic cats have a peripheral eosinophilia?

A

20%

133
Q

What percent of asthmatic cats have hyperglobulinemia?

A

14-50%, depending on the study

134
Q

In healthy feline airways, what should the eosinophil percentage be in BALF?

A

<5%

135
Q

Name 4 parasites that can cause feline bronchial disease?

A

Aerulostrongylus abstrusus, Eucoleus aerophilus, Dirofilaria immitus, Wolbachia, Toxocara cati

136
Q

What is the most common cause of spontaneous pneumothorax in cats?

A

Feline asthma

137
Q

A recent study examining fluticasone use in feline asthmatics found that what dose is most effective?

A

44mcg q12 (as effective as 220 mcg)

138
Q

Daily albuterol use has been shown to cause what in asthmatic cats?

A

Increased severity of airway inflammation

139
Q

Nebulization is not beneficial in cats due to what?

A

Bronchospastic reactions

140
Q

What is the equation for determining the A-a gradient?

A

150 - (PaO2 + PaCO2) as determined by ABG

141
Q

What is a normal A-a gradient? What indicates a V-Q mismatch?

A

<10 is normal. >20 is a V-Q mismatch

142
Q

What is the function of brain natriuretic peptide (BNP) in the body?

A

Promotes natriuresis, increases GFR, causes vasodilation, antagonizes renin system

143
Q

What causes BNP to increase?

A

Volume overload, pulmonary hypertension, cardiac dysfunction/heart failure - all things that turn on RAAS and lead to increased fluid

144
Q

What is NT-proBNP and why is it used as a diagnostic marker instead of BNP?

A

The prohormone is cleaved into NT-proBNP and active BNP. NT-proBNP has a longer half-life, so more useful diagnostically

145
Q

NT-proBNP concentrations can increase with what non-cardiac disease?

A

Azotemia

146
Q

What two intestinal parasites migrate to the lungs before reaching the intestines and can cause respiratory signs with massive migrations?

A

Toxocara (roundworms) and Ancylostoma (hookworms)

147
Q

What is the treatment for lungworms

A

High dose fenbendazole (50mg/kg PO q24) for 10-14 days

148
Q

What is a side effect of albendazole that is typically not seen with fenbendazole?

A

Bone marrow toxicosis

149
Q

What is the scientific name for the lung fluke in dogs and cats?

A

Paragonimus kellicotti

150
Q

What is the intermediate host for Paragonimus kellicotti?

A

Crayfish

151
Q

What radiographic changes can be observed with Paragonimus kellicotti infection? What are the clinical consequences of these structures?

A

Pulmonary bullae and cysts - rupture can lead to hemoptysis or pneumothorax

152
Q

How is Paragonimus kellicotti detected?

A

Fecal sedimentation or airway wash

153
Q

What lung parasite resides in the alveolar space and terminal bronchioles and is transmitted by the direct fecal-oral route?

A

Filaroides

154
Q

Most lungworms can be detected on what fecal test?

A

Baermann

155
Q

What bacteria causes hemorrhagic, necrotizing pneumonia in dogs?

A

Streptococcus equi subspecies zooepidemicus

156
Q

Any coughing cat in the western US should be isolated and tested for what disease?

A

Plague - Yersinia Pestis

157
Q

How are cats infected with Yersinia Pestis?

A

Ingestion of a reservoir host - rodents, rabbits, or flea bite

158
Q

What is the most common first sign of Yersinia Pestis infection in cats?

A

Suppurative lymphadenitis (buboes) in the submandibular and cervical lymph nodes

159
Q

The bubonic form of plague can then spread into one of two forms. Name them

A

Septicemic plague or pneumonic plague

160
Q

Cytologic examination of exudate or LN aspirates in a cat with Yersinia Pestis should reveal what?

A

Bipolar, safety-pin shaped, gram negative rods

161
Q

What is the treatment for Yersinia Pestis?

A

Aminoglycosides, fluoroquinolone, tetracyclines, or chloramphenicol

162
Q

What influenza viruses have caused outbreaks among dogs?

A

H3N8 (Greyhound kennel outbreak, likely equine origin), H3N2 (avian origin)

163
Q

What fungal disease is found in young, presumably immunocompromised Miniature Dachshunds and Cavalier King Charles Spaniels?

A

Pneumocystis carinii

164
Q

What is the treatment for Pneumocystis carinii?

A

Potentiated sulfonamides

165
Q

How does the pathophysiology of cardiogenic and non-cardiogenic pulmonary edema differ?

A

Cardiogenic edema develops from increased hydrostatic pressure. Non-cardiogenic edema develops from increased vascular permeability +/- epithelial damage

166
Q

What is the cause of hypoxemia secondary to pulmonary edema?

A

V-Q mismatch

167
Q

How do interstitial lung diseases result in respiratory signs?

A

Restrict effective lung volume and decrease lung compliance

168
Q

Eosinophilic pneumonia of undetermined origin is more common with what signalment?

A

Young, female Siberian Husky, Alaskan Malamute, Rottweiler

169
Q

What are the radiographic findings with eosinophilic pneumonia of undetermined origin?

A

Dense bronchointerstitial pattern with dense infiltrates that can be mistaken for nodules

170
Q

What is one of the most common diseases associated with bronchiectasis in dogs?

A

Eosinophilic pneumonia of undetermined origin

171
Q

How does pneumocyte injury lead to endogenous lipid pneumonia?

A

Damaged pneumocytes release cholesterol and overproduce cholesterol-rich surfactant. Lipids are then phagocytose by pulmonary macrophages, which accumulate in the alveoli

172
Q

What dog breeds are predisposed to idiopathic pulmonary fibrosis?

A

West Highland White Terriers, Staffordshire Bull Terriers

173
Q

What is the median survival time of dogs with idiopathic pulmonary fibrosis? Cats?

A

Dogs: 32 months
Cats: days to weeks :(

174
Q

Explain the pathogenesis of interstitial lung disease

A

An initial injury to the distal lung parenchyma occurs (hematogenous or inhaled). In response, resident cells recruit and activate inflammatory cells. With persistent injury, pro inflammatory and profibrotic cytokines lead to pathologic inflammation and fibrosis

175
Q

Name 3 CT findings consistent with pulmonary fibrosis

A

Multifocal ground glass opacities, sub pleural honeycombing, traction bronchiectasis, subpleural thickening

176
Q

Fibrotic interstitial lung disease represents the end stage of progressive damage and reparative processes from diverse causes. It culminates with what common clinical phenotype?

A

Restrictive lung disease

177
Q

What is a common co-morbid condition with fibrotic interstitial lung disease?

A

Pulmonary hypertension

178
Q

A familial form of acute respiratory distress syndrome caused by mutations in an aniline actin binding protein has been found in what dog breed?

A

Dalmatians

179
Q

Name two chemotherapeutic agents that can lead to acute lung injury and fibrosis

A

Cytarabine and rabacfosadine

180
Q

What antibiotic can result in pneumonitis and drug-induced interstitial lung disease?

A

Potentiated sulfonamides

181
Q

Immune mediated interstitial pneumonitis has been described with what systemic infection?

A

Leishmania

182
Q

What is hypereosinophilic syndrome (HES)?

A

Multisystemic, idiopathic disorder of infiltrating mature eosinophils into organs, commonly including the lungs

183
Q

What breeds are predisposed to hypereosinophilic syndrome (HES)?

A

Rottweilers +/- Boxers

184
Q

Bile acid concentrations were higher in the BALF of what dogs compared to healthy Beagles?

A

West Highland White Terriers (both healthy and with pulmonary fibrosis) and dogs with chronic bronchitis

185
Q

What metalloproteinases may be useful biomarkers of idiopathic pulmonary fibrosis in Westies?

A

Serum MMP-7, BALF MMP-2 and -9

186
Q

Indoor air pollution (high particulate matter levels) was significantly associated with respiratory disease in what species?

A

Cats

187
Q

Endogenous lipid pneumonia has been identified in 3 dogs with what other pulmonary disease?

A

Neoplasia - 2 adenocarcinoma, 1 squam

188
Q

Polyethylene glycol can induce what condition if inhaled?

A

Pulmonary edema (osmotic pull of water into the alveoli)

189
Q

Dogs with solitary lymphocytosis on BALF were more likely to have what other abnormality on bronchoscopy?

A

Airway collapse

190
Q

What was the final diagnosis in dogs with bronchiectasis?

A

Pneumonia (52%), inflammatory airway disease (36%), eosinophilic bronchopneumonopathy (12%)

191
Q

Which inhalation method resulted in higher respiratory tract deposition of fluticasone in dogs?

A

Nebulizer (4.2%); inhaler was 2.3%

192
Q

What percent of samples obtained by transtracheal wash and endotracheal wash are contaminated by oral bacteria?

A

Approximately 20% for both

193
Q

What was the effect of maropitant in dogs with chronic bronchitis?

A

Decreased cough frequency, but did not decrease inflammation on BAL

194
Q

What are eosinophilic granulomas?

A

Intraluminal airway lesions that appear similar to fungal granulomas, but cause is unknown

195
Q

What is the radiographic or CT appearance of eosinophilic granulomas?

A

Severe saccular dilation of the bronchi with a large amount of soft tissue attenuating material obstrucing the lumen

196
Q

What is the bronchoscopic appearance of eosinophilic bronchopneumonopathy?

A

Yellow-green mucus, bronchiectasis, bronchial collapse, nodular epithelial change

197
Q

Spirometry can be used to evaluate what conditions in veterinary medicine?

A

Tracheal collapse, BOAS, feline lower airway disease

198
Q

Spirometry is capable of measuring what parameters?

A

Inspiratory/expiratory time and flow rates, tidal volume

199
Q

Flow volume loops are used to identify what?

A

Airway obstruction

200
Q

Flow volume loops are created by what instrument?

A

Pneumotachograph

201
Q

On a flow volume loop, which direction is inhalation? Exhalation?

A

Inhalation is in the negative direction, expiration is in the positive direction

202
Q

A fixed airflow obstruction (laryngeal mass, etc) will display what on a flow volume loop?

A

Flattening of BOTH the inspiratory and expiratory curves

203
Q

A dynamic airflow obstruction will display what changes on a flow volume loop?

A

Flattening of only the inspiratory phase (upper airway obstruction - tracheal collapse, etc) or only the expiratory phase (lower airway obstruction - chronic bronchitis, etc)

204
Q

What is lung compliance?

A

Measure of the distensibility of elastic lung tissue: the change in lung volume for a given change in airway pressure

205
Q

How can lung compliance be measured?

A

During positive pressure ventilation

206
Q

What is lung resistance?

A

A measure of the amount of pressure requried to deliver a given gas flow. Test of potency of the small bronchi

207
Q

What does whole body plethysmography measure?

A

Absolute lung volume and airway resistance - gold standard to determining lung volumes in cases of airway obstruction

208
Q

How is whole body plethysmography performed?

A

Animal is placed in a sealed chamber with present air inflow and outlets. The change in barometric pressure caused by inhalation and exhalation is measured to estimate flow rates and lung volume

209
Q

What is Penh?

A

Enhanced pause - used to approximate airway resistance. Has a formula that I refuse to memorize

210
Q

Hypoxemia is defined as a PaO2 lower than ____?

A

80 mmHg

211
Q

What is the equation for minute ventilation?

A

Tidal volume x RR

212
Q

Carbon dioxide is ____ times more soluble than oxygen?

A

20x

213
Q

In a normal animal breathing room air, what is the expected PaO2/FIO2 ratio (PF ratio)?

A

400 to 500

214
Q

What is the FiO2 at room air?

A

0.21

215
Q

A pulse oximeter reading of >95% is considered normal. What PaO2 does this correspond to?

A

80-120 mmHg

216
Q

A pulse oximeter reading of 90% corresponds to what PaO2?

A

60 mmHg - below this = severe hypoxemia

217
Q

What is tidal volume?

A

The volume of air inspired and expired during normal inspiration

218
Q

What is functional residual capacity?

A

The volume of air left in the lung after normal expiration

219
Q

What is residual volume?

A

The volume of air left in the lung after maximal expiration

220
Q

What is vital capacity?

A

The volume of maximal inspiration and expiration

221
Q

What is the primary phospholipid that makes up surfactant?

A

Dipalmitoyl phosphatidyl choline

222
Q

What cell produces surfactant?

A

Type II alveolar cell

223
Q

What is the most common inciting cause of ARDS in dogs/cats?

A

SIRS in one study, pulmonary disease (pneumonia) in another study

224
Q

How often do patients with ALI or ARDS require mechanical ventilation?

A

Frequently - one study: 50% (dogs), 80% (cats); another study, recommended in 86%

225
Q

What is the survival rate for ALI/ARDS?

A

Very poor - 10-14%

226
Q

What are the four criteria used in the diagnosis of ARDS?

A
  1. Acute onset respiratory distress
  2. Presence of known risk factors
  3. Evidence of pulmonary capillary leak without increased pulmonary capillary pressure (bilateral infiltrates in imaging)
  4. Evidence of inefficient gas exchange
227
Q

Point of care lung ultrasound with a total B lines score >10 and the presence of >2 sites was indicative of what diagnosis?

A

Cardiogenic pulmonary edema - 92% sensitive and 94% specific

228
Q

What is pulmonary lobar emphysema?

A

Hyperinflation of 1 or more lung lobes due to bronchial obstruction and air trapping. Results in distension of the affected lobe and compression of adjacent structures

229
Q

What is the common signalment for patients with pulmonary lobar emphysema?

A

Young animals - suspected congenital or old animals - neoplasia

230
Q

What lung lobe is most commonly affected in pulmonary lobar emphysema?

A

Right middle

231
Q

What is the recommended flow rate for high flow nasal oxygen?

A

1-2 L/kg/min (higher not well tolerated)

232
Q

What is an advantage of high flow vs traditional oxygen delivery?

A

High flow provides continuous positive airway pressure, which improves oxygenation by recruiting alveoli, allowing for more efficient gas exchange, and lessening the work of breathing

233
Q

The use of high flow oxygen resulted in what benefits in dogs failing traditional oxygen therapy?

A

Deceased respiratory rate, decreased dyspnea score, and increased SpO2

234
Q

Virtually all cats with feline herpesvirus infections develop latent infections. Where does latency occur?

A

Trigeminal ganglion

235
Q

Reactivation of herpes virus occurs in half of cats. When does it occur and how long does shedding last?

A

4-12 days after a stressful event. Shedding lasts around 7 days (up to 14 days)

236
Q

In a study of dogs with aspiration pneumonia, what was the most commonly identified bacteria? Groups of bacteria?

A

E coli. Gram negative aerobes and anaerobes most common

237
Q

In one study of dogs with tracheal collapse, what was the most common opportunistic infection?

A

Pseudomonas

238
Q

What are the most common bacteria identified in feline pyothorax?

A

Pasteurella, anaerobes

239
Q

What lung function parameters are changed in obese cats compared to healthy weight cats?

A

Decreased tidal volume, minute volume, and peak inspiratory/expiratory flows. No change in Penh (airway resistance)

240
Q

What is the most common complication with bronchoscopy in cats? What factors can be used to reduce this complication?

A

Desaturation (30% of cats). Desaturation is decreased by using an endotracheal tube or laryngeal mask airway vs tracheal catheter. Also decreased by administering terbutaline

241
Q

What is the sensitivity and specificity of NTpro-BNP as a screening test in healthy cats?

A

Specificity 96%, sensitivity 43% (improved to 71% with heart murmur). So a positive result = heart disease, but a negative result does not exclude heart disease

242
Q

Dyspneic cats presenting with these clinical signs are more likely to have cardiac disease as cause of dyspnea

A

Hypothermia, tachycardia, gallop sounds, profound tachypnea (>80 brpm)

243
Q

What is pulmonary Langerhans cell histiocytosis in cats?

A

Pulmonary parenchymal infiltration with Langerhans cells, leading to progressive respiratory insufficiency

244
Q

What is feline progressive histiocytosis?

A

Most common histiocytic disease in cats. Skin nodules, papules, or plaques. Can invade and affect internal organs

245
Q

What is the cause of heartworm associated respiratory disease in cats?

A

Death of immature L5 larvae in the pulmonary arteries => eosinophilic inflammation. Adult worms not required for the disease to occur

246
Q

Cats with suspected heartworm associated respiratory disease should be treated for what other organism and why?

A

Wolbachia - can contribute to bronchial hypersensitivity. Give doxycycline

247
Q

Why does chronic, daily use of albuterol result in worsening inflammation and bronchoconstriction?

A

Albuterol is a racemic mix of R and S enantiomers. The S enantiomer has slower metabolism/clearance and will accumulate in the lung with repeated use. This one has proinflammatory effects

248
Q

How do omega-3 polyunsaturated fatty acids act as anti-inflammatory agents?

A

Reduce the availability of arachiodonic acid in cell membranes for the production of inflammatory eicosanoids

249
Q

What were the effects of omega-3 fatty acids in asthmatic cats?

A

Reduced airway hyperresponsiveness but did not reduce airway eosinophilia

250
Q

Is maropitant effective in reducing airway hyperresponsiveness or inflammation in asthmatic cats?

A

No. No it’s not

251
Q

What is constrictive bronchiolitis obliterans?

A

Subepithelial and peribronchiolar fibrosis and inflammation that surrounds and narrows or obliterates the lumen of the bronchioles

252
Q

What cases of feline upper respiratory tract disease should not be treated with antibiotics?

A

Acute onset (<10 days), serous nasal discharge - likely uncomplicated viral infection

253
Q

In cats or dogs with acute upper respiratory disease and mucopurulent nasal discharge, antimicrobials are only recommended in the first 10 days if which clinical signs are present?

A

Fever, lethargy, or anorexia. Otherwise, wait 10 days to see if signs resolve

254
Q

If antimicrobials are prescribed to a cat or dog with an acute upper respiratory disease, what antibiotic is the first line choice? How long should you treat for?

A

Doxycycline - 7-10 days

255
Q

What infectious agents cause acute upper respiratory infection in cats and are treated with doxycycline?

A

Bordetella, C. felis, Mycoplasma

256
Q

What two antibiotics can cause drug-induced esophagitis and strictures in cats?

A

Doxycycline and clindamycin

257
Q

Other than doxycycline, what is an acceptable alternative first line antibiotic for cats or dogs with acute upper respiratory tract infections?

A

Amoxicillin - if Mycoplasma or C. felis are not suspected

258
Q

In cats with upper respiratory tract signs lasting longer than 10 days, what is recommended?

A

Diagnostic workup: CT, rhinoscopy, nasal tissue biopsy for histopathology/culture, Mycoplasma PCR, fungal culture

259
Q

In cats with chronic upper respiratory tract infections, what antibiotic is recommended and for how long?

A

Based on culture/sensitivity if at all possible. Treat for 7 days - if a positive effect is seen, continue the drug as long as there is clinical improvement and for at least 1 week past clinical resolution of nasal disease

260
Q

In cats with relapsing chronic upper respiratory tract infections, what antibiotic should be used?

A

The previously effective antibiotic should be tried for 48 hours. If no improvement, switch drug classes or to a more active drug in the same class

261
Q

What virus should always be considered in younger dogs with mucopurulent nasal and ocular discharge?

A

Distemper

262
Q

What two organisms may be identified on BAL culture due to endoscope contamination?

A

Serratia, Stenotrophomonas

263
Q

If a dog or cat with pneumonia is too unstable for airway sampling, what other test may be performed for bacterial culture?

A

Blood cultures

264
Q

In dogs/cats with pneumonia, what route of treatment is recommended in hospital?

A

Parenteral, regardless of disease severity

265
Q

In dogs or cats with mild pneumonia (no fever, lethargy, respiratory distress) that is suspected to be due to Bordetella or Mycoplasma, what empiric antibiotic is recommended?

A

Doxycycline

266
Q

In dogs with suspected aspiration pneumonia, what empiric antibiotic is recommended?

A

Ampicillin, Unasyn, or first generation cephalosporins (cefazolin)

267
Q

In dogs/cats with pneumonia and signs of sepsis, what antibiotics are recommended?

A

Fluoroquinolone + ampicillin or clindamycin

268
Q

How long should dogs/cats with pneumonia be treated with antibiotics?

A

Repeat PE and thoracic radiographs recommended at 10-14 days; make decision to extend treatment based on results

269
Q

How should pyothorax in dogs/cats be treated?

A

Fluoroquinolone + penicillin or clindamycin combined with therapeutic drainage of the pleural space +/- lavage

270
Q

How long should cats/dogs with pyothorax be treated?

A

Minimum of 3 weeks, ideally 4-6 weeks

271
Q

What is the passive slow expiratory technique?

A

A type of physiotherapy performed with the dog in lateral recumbency. One hand is on the chest, the other on the abdomen. As the dog start to expire, continuous pressure is applied to help increase expiration.

272
Q

The passive slow expiratory technique improved what parameters in dogs with acute dyspnea due to airway fluid accumulation?

A

Improved P/F ratio, increased O2 free time by 46%), and decreased mortality (13% vs 44%)

273
Q

How do CRP concentrations differ between dogs with Bordetella pneumonia and aspiration pneumonia?

A

CRP is much higher in dogs with aspiration pneumonia (118 vs 20)

274
Q

When antibiotic therapy is discontinued based on a decrease in serum CRP, how much shorter is the treatment duration? How many dogs with pneumonia relapsed?

A

21 days vs 35 days; none relapsed

275
Q

If using CRP to montior recovery from pneumonia, how long should antibiotic therapy be continued?

A

5-7 days after CRP normalizes

276
Q

Dogs vaccinated with intranasal adenovirus 2, Bordetella, and parainfluenza vaccines tested positive for these organisms on molecular diagnostics for how many days after vaccination?

A

28 days (highest on days 3-10)

277
Q

Aerosolized delivery of what antibiotic can be used for Bordetella infections? Clinical response is better with what formulation and in what population of dogs?

A

Gentamicin - undiluted better than diluted with saline. Dogs with less than 1000 cells /uL in lavage more likely to be cured at 3-4 weeks

278
Q

How long should dogs with influenza (H3N2) be isolated?

A

> 21 days, even if clinical signs resolve, can still shed virus

279
Q

What is the mechanism of action for famciclovir?

A

Prodrug of penciclovir, which is a nucleoside deoxyguanosine analog

280
Q

In cats treated with low dose (40mg/kg) vs high dose (90mg/kg) famciclovir, the high dose cats showed…

A

Significantly greater improvement in clinical signs and shorter treatment courses

281
Q

What are the most common side effects of famciclovir?

A

GI upset (diarrhea, vomiting, anorexia, polydipsia)

282
Q

Feline calicivirus is more likely to be detected on swabs from what location?

A

Oropharynx

283
Q

What species of Mycoplasma is significantly associated with lower respiratory tract disease? Which ones are not?

A

M. cynos is
M. canis, M. edwardii are not

284
Q

Cats with outdoor access are ___ fold more likely to test positive for heartworm antigens

A

3 fold

285
Q

What is the seroprevalence of heartworm disease in cats with respiratory clinical sign?

A

1% (overall seroprevalence 0.4%)

286
Q

What is involved in the pathogenesis of Angiostrongylus vasorum induced bleeding? How should they be treated?

A

Hyperfibrinolysis and hypofibrinogenemia - treat with transexamic acid and plasma transfusions

287
Q

What cardiac changes are associated with decreased bronchial diameter and cough?

A

Increased left atrial size and VHS

288
Q

What are the potential complications with tracheal stent placement and how often do they occur?

A

Overall complication rate 47%. Stent fracture (25%), infection (58%), tissue ingrowth (20%), progressive tracheal collapse (12%)

289
Q

What percent of dogs show improvement in clinical signs after tracheal stenting?

A

Improvement in goose honking or raspy breathing - 89%, improved dyspnea 84%

290
Q

In one study of 75 dogs, what was the rate of survival to discharge and median survival time of dogs with tracheal stents?

A

93% survival to discharge, MST 1000 days

291
Q

Does the presence of mainstem bronchial collapse at the time of tracheal stent placement affect outcome?

A

Not in the Weisse JAVMA study

292
Q

What stage of Dirofilaria do microfilariae represent?

A

L1 larvae

293
Q

What stage of Dirofilaria larvae infect dogs/cats after a mosquito bite?

A

L3

294
Q

In dogs, how long does it take for L3 Dirofilaria larvae to develop to adults? In cats?

A

Dogs: 4-6 months
Cats: 7-9 months

295
Q

Dirofilaria repens causes infection where?

A

Subcutaneous tissues

296
Q

In cats, early or end-stage death of Dirofilaria can lead to what clinical consequences?

A

PTE, eosinophilic inflammatory response in the lungs - acute-onset dyspnea and interstitial pattern on rads

297
Q

The presence of large quantities of Dirofilaria antigens from dead parasites can lead to what in cats?

A

Systemic anaphylaxis and sudden death

298
Q

Aberrant Dirofilaria migration is more common in cats than dogs and cause cause what signs?

A

Body cavity effusions, neurologic signs (blindness, ataxia, paraparesis, seizures)

299
Q

What tests for Dirofilaria (commonly used in dogs) have low sensitivity in cats?

A

Microscopic detection of microfilaria and antigen tests

300
Q

What sex of Dirofilaria adult worms is detected by antigen testing?

A

Females

301
Q

Why does heat pretreatment improve the sensitivity of heartworm antigen tests?

A

Released antigens blocked within circulating immune complexes - increases antigen available for detection

302
Q

What changes are seen on thoracic radiographs in cats with heartworm disease?

A

Vascular changes - enlargement, loss of tapering, tortuosity of the right or both caudal pulmonary arteries on VD
Patchy infiltrates around the caudal lobar arteries

303
Q

In cats infected with Dirofilaria, a self cure occurs in most cases within what time frame?

A

18-48 months

304
Q

Why is adulticide (melarsomine) not used in cats?

A

High risk of triggering PTE or anaphylaxis due to parasite death

305
Q

What is the recommended treatment for feline heartworm?

A

Monthly heartworm preventative drugs, prednisone (2mg/kg PO q24 then taper)

306
Q

Monthly heart worm preventatives kill what stage of the worm?

A

L3-L4 larvae

307
Q

The earliest heartworm antigen and microfilariae can be detected post-infection in dogs is?

A

5 and 6 months, respectively

308
Q

Heartworm antigenemia may be suppressed until how many months post-infection in dogs receiving preventatives?

A

9 months

309
Q

All positive heartworm antigen tests should be confirmed by?

A

Microfilariae testing (modified Knott’s test), a different type of antigen test, echocardiograph

310
Q

What are 3 factors that influence the probability of post-adulticide thromboembolic complications?

A

1) Activity level of the dog
2) Extent of concurrent pulmonary vascular disease
3) Severity of infection (high vs low worm burden)

311
Q

Melarsomine has been shown to have activity against what stage of worm?

A

Immature worms between 2-4 months of age

312
Q

What is the recommended dosing protocol for melarsomine? What is the success rate?

A

One injection (2.5mg/kg) when one month later, two injections 24 hours apart. Kills 98% of worms

313
Q

Doxycycline should be administered for how long before melarsomine?

A

Treat with doxycycline for 1 month, then wait one month before melarsomine

314
Q

A macrocyclic lactone preventative should be administered for how long before melarsomine?

A

2 months

315
Q

What is caval syndrome?

A

When adult heartworms partially obstruct blood flow through the tricuspid valve and interfere with valve closure

316
Q

What are characteristic clinical signs of caval syndrome?

A

Sudden onset lethargy, dyspnea, pale mucous membranes, hemoglobinemia/uria, severe passive congestion of the liver, coarse tricuspid valve murmur, jugular pulsations

ACVIM Specialty 2023 (38 decks)

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