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Auburn ECC > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What nerve can be damaged during a tracheostomy?

A

Recurrent laryngeal nerve

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2
Q

What muscle must be separated at midline during tracheostomy?

A

Sternohyoid muscle

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3
Q

Risk factors associated with aspiration pneumonia

A

GI: refractory vomiting, pancreatitis, intussusception, FB, ileus Anesthesia Esophageal disease: megaesophagus, motility dz, hiatal hernia, stricture, esophagitis Neuro: polyneuropathy, myasthenia gravis, seizures, prolonged recumbency Cricopharyngeal dyssynchrony Muscular dystrophy Oropharyngeal dysphagia Laryngeal disease

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4
Q

Causes of lobar alveolar consolidation

A

aspiration pneumonia lung lobe torsion atelectasis secondary to mucus plugging

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5
Q

Causes of focal alveolar consolidation

A

Airway foreign body Primary pulmonary neoplasia Metastatic neoplasia NCPE

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6
Q

Causes of diffuse alveolar pattern

A

ARDS CHF Fluid overload Eosinophilic bronchopneumopathy Coagulopathy Metastatic neoplasia

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7
Q

Causes of diffuse or focal interstitial pattern

A

early bacteria pneumonia Imminent CHF Pneumocystitis carinii infection Inhalant Toxicity Viral pneumonia

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8
Q

Bacteria commonly isolated from airway samples of canine pneumonia patients

A

B bronchiseptica (22-49%) E coli (11-17%) Klebsiella pneumoniae (2-6%) Pasteurella (3-21%) Mycoplasma (30-70%) Streptococcus (6-13%) Staphylococcus (14%) Anaerobes (5-17%)

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9
Q

Reasons to AVOID bronchodilators

A

May worsen V/Q mismatch May allow exudates to spread Inotropic/vasodilator effects may increase perfusion to poorly ventilated units May prevent hypoxic vasoconstriction may suppress cough reflex

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10
Q

Reasons to GIVE bronchodilators

A

Antiinflammatory -inhibit mast cell degranulation -decrease microvascular permeability and leak -increase mucociliary transport speed Respiratory stimulant Increase diaphragm contractility Increase resistance of diaphragm fatigue

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11
Q

5 classification of pulmonary hypertension

A
  1. pulmonary arterial hypertension 2. left-sided heart disease 3. lung disease and/or hypoxemia 4. chronic thrombotic/embolic disease 5. Miscellaneous
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12
Q

For canine pyothorax, what are the most common OBLIGATE ANAEROBES?

A

peptostreptococcus, bacteroides, fuesobacterium, prevotella, porphyromonas

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13
Q

For canine pyothorax, what are the most common AEROBES?

A

Pasteurella, e. coli, actinomyces, streptococcus (S. canis), and staphylococcus

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14
Q

MOA of doxapram

A

General CNS stimulant - direct stimulation of medullary respiratory center possibly through reflex activation of carotid and aortic chemoreceptors

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15
Q

Paradoxical laryngeal motion is defined as?

A

INward movement of the arytenoids secondary to negative pressure generated upon inspiration

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16
Q

How much resistance to airflow during inspiration is from the nose in normal dogs?

A

80%

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17
Q

What is the most important aspect of surgery for brachycephalic airway syndrome?

A

widening of the nares

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18
Q

What is a possible alternative to permanent tracheostomy in dogs with tracheal COLLAPSE

A

cricoarytenoid lateralization with thyroarytenoid caudolateralization

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19
Q

What % of cats with nasopharyngeal disease have nasopharyngeal polyps?

A

28%

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20
Q

Traction-avulsion is the most simple way to remove nasopharyngeal polyps, but is associated with what recurrence rate?

A

40 to 50%

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21
Q

What is the recommended treatment for nasopharyngeal polyps?

A

ventral bulla osteotomy

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22
Q

Radiographs misdiagnosed the location of tracheal collapse in what % of dogs?

A

44%

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23
Q

what bacteria may be cultured from the airway of normal dogs?

A

pasteurella, staphylococcus, streptococcus, klebsiella

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24
Q

What are the most common bacteria associated with tracheal collapse?

A

pseudomonas, pasteurella, e coli, staphyloccoci

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25
Q

Common nasal neoplasia in dogs vs cats?

A

Dogs: carcinomas or sarcomas Cats: lymphoma most common

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26
Q

Describe the airway changes seen in allergic airway disease

A

Bronchial or alveolar inflammatory changes, submucosal wall edema, increased bronchial secretions, smooth muscle hypertrophy, smooth muscle constriction of bronchioles and small bronchi

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27
Q

Name diseases that included in small animal allergic airway disease

A

canine allergic bronchitis (eosinophilic bronchopneumopathy), parasitic larval migration, pulmonary infiltrate with eosinophils, feline asthma

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28
Q

Describe the pathogenesis in human asthma

A

IgE ab cross link to mast cells in submucosa of bronchi and bronchioles of lungs, causing mast cell degranulation. Leads to release of inflammatory mediators that cause airway constriction

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29
Q

Name the inflammatory mediators involved in human asthma

A

Leukotrienes, histamine, eosinophilic chemotactic factor, bradykinin

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30
Q

Common parasites implicated in inflammatory pulmonary disease?

A

Ancylostoma, Toxocara (both primary intestinal that migrate through lung), Paragonimus, Crenosoma, Filaroides, Capillaria, Aelurostrongylus

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31
Q

Pathophysiology of parasites in lungs?

A

Type I hypersensitivity reaction that leads to bronchoconstriction and inflammation

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32
Q

Define and give causes of pulmonary infiltrates with eosinophils (PIE)

A

Umbrella term that describes several diseases that cause eosinophilic airway inflammation. Includes heartworms, drugs, parasites, inhaled allergens

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33
Q

Pathogenesis of feline bronchopulmonary disease?

A

Cellular inflammatory response, lower airway hyperreactivity (ease with which airways narrow in response to stimuli)

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34
Q

Most common cause of coughing in cats?

A

Feline bronchopulmonary disease

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35
Q

What % of cats with bronchopulmonary disease do not have coughing in history or PE findings?

A

16%

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36
Q

Breed of cat that is over-represented in cats with lower airway disease?

A

Siamese

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37
Q

Tests that should be performed in cats with suspected bronchopulmonary disease?

A

Fecal, heartworm antigen/antibody testing, radiographs, CBC, Chem, UA

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38
Q

Describe the radiographic appearance of feline bronchopulmonary disease

A

increase in bronchial densities (doughnuts, tram lines, train tracks), increased interstitial markings, alveolar pattern, hyperinflation of lung fields, flattening of diaphragm

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39
Q

What % of cats with bronchopulmonary disease have consolidation and alveolar infiltration of R middle lung lobe?

A

11%

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40
Q

Bronchoscopic findings in cats with bronchopulmonary disease?

A

Thick mucus secretion, hyperemic and edematous mucosa

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41
Q

Which type of diagnostic test (BAL, ETW, TTW) provides samples that are most representative of the lower respiratory cell population?

A

BAL

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42
Q

True or false- The cat’s lower airways are sterile

A

False- normal to have <2000 CFU/ml

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43
Q

T or F: Cats with bronchopulmonary disease are less likely to have mycoplasma colonization?

A

False

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44
Q

Treatment options for allergic airway disease in dogs and feline bronchopulmonary diseaes?

A

Glucocorticoids, bronchodilators, cyclosporine, cyproheptadine, tyrosine kinase inhibitors, leukotriene receptor blockers

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45
Q

How might cyclosporine help in allergic airway disease:?

A

inhibits the T helper cells of the immune system, which are a primary component of the allergic immune response

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46
Q

Two classes of bronchodilators

A

Methylxanthines (theophylline, aminophylline) & B2 receptor agonists (terbutaline or albuterol)

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47
Q

Common types of chest wall neoplasia?

A

Osteosarcoma, fibrosarcoma, lipoma, mast cell tumor, hemangiosarcoma

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48
Q

In what situations should rib fractures be repaired?

A

When they are causing injury to underlying structures or interfering with ventilation

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49
Q

2 main reasons why flail chest causes respiratory distress?

A

1) Pain 2)Underlying diseases such as contusions, pneumo, etc are common with flail chest

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50
Q

How does cervical spinal disease cause hypoventilation?

A

The medullary respiratory center sends information via the reticulospinal tracts to the phrenic nerve and the segemental intercostal nerves. The phrenic nerve leaves the spinal cord between C4-C6 and provides motor innervation to the diaphragm. The segmental intercostal nerves leave the spinal cord between C6-T2.

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51
Q

T/F- Cranial nerve deficits can be seen with botulism?

A

True- coonhound paralysis, on the other hand, does not cause CN deficits

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52
Q

Causes of allergic airway disease

A

Parasitic allergic airway disease, allergic bronchitis, feline asthma, PIE

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53
Q

More specific term for allergic bronchitis

A

Eosinophilic bronchopneumanopathy

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54
Q

Allergic airway diseases characterized by:

A
  1. Sub mucosal wall edema 2. Increased bronchial secretions3. Smooth muscle hypertrophy4. Smooth muscle constriction of bronchioles and small bronchi
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55
Q

Human asthma: IgE antibodies cross link to _______ in the ________ and ________ causing _________.

A

Mast cells, sub mucosa of the bronchi and bronchioles of the lung, mast cell degranulation

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56
Q

In human asthma degranulation of mast cells leads to the release of the following inflammatory mediators:

A

Histamine, leukotrienes, eosinophilic chemo tactic factor, bradykinin

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57
Q

Name 4 airway changes caused by inflammatory mediators in human asthma

A

Pulmonary mucosal edema, smooth muscle hypertrophy of bronchi and bronchioles, accumulation of pulmonary secretions, airway narrowing

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58
Q

Most common migratory parasite to cause allergic response in canine lungs

A

Toxocara canis

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59
Q

True/False: Ancylostoma caninum is a known cause of feline parasitic allergic airway disease

A

False…causes disease in dogs only

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60
Q

List 6 causes of canine parasitic allergic airway disease

A
  1. Capillaria aerophilia2. Filaroides hirthi3. Crenosoma vulpis4. Paragonimus kellicotti5. Intestinal parasite migration6. Dirofilaria immitis
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61
Q

List 4 causes of feline parasitic allergic airway disease

A
  1. Aelurostrongylus abstrusus2. Capillaria aerophila3. Paragonimus kellicotti4. Dirofilaria immitis
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62
Q

Distribution of Aelurostrongylus abstrusus

A

Southern US and worldwide

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63
Q

Distribution of Filaroides hirthi

A

North America, Japan, Europe

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64
Q

Distribution of Paragonimus kellicotti

A

Great Lakes, Midwest, Southern US

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65
Q

How does dirofilaria immitis cause an allergic inflammatory response?

A

Large numbers of antimicrofilarial antibodies entrap microfilariae within the pulmonary capillaries

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66
Q

Signalment of dogs with allergic bronchitis?

A

Younger, Siberian Huskies and Alaskan Malamutes over represented

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67
Q

Most common radiographic finding with canine allergic bronchitis

A

Diffuse, prominent bronchointerstitial pattern. Alveolar infiltrates (40%), and bronchiectasis (26%) also seen

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68
Q

Expected bronchoscope findings with canine allergic airway disease

A

Abundant yellow/green mucous, thickening with irregularities or polyploid changes to mucosa, exaggerated airway closure during expiration

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69
Q

Expected airway sampling findings in dogs with allergic bronchitis

A

More than 50% eosinophils (87% of dogs), 20-50% eosinophils (remaining 13% of dogs)

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70
Q

Causes of PIE

A

Pulmonary or migrating parasitesHeartworms (65% of cases)DrugsInhaled allergens

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71
Q

Difference between PIE and allergic bronchitis?

A

PIE is a pulmonary parenchymal disease, allergic bronchitis is lower airway

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72
Q

Radiographic changes expected with PIE?

A

Diffuse interstitial, bronchial, or alveolar pattern, many have hilar lymphadenopathy

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73
Q

Most common cause of coughing in cats?

A

Feline bronchopulmonary disease

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74
Q

What breed is over-represented in feline bronchopulmonary disease?

A

Siamese

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75
Q

T/F: a peripheral eosinophilia is common in feline bronchopulmonary disease

A

False- only 9% of cats with peripheral eosinophilia had this disease

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76
Q

Most common and persistent radiographic finding in feline heart worm disease

A

Bronchointerstitial pattern even without changes in the pulmonary vasculature

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77
Q

Common radiographic signs of feline bronchopulmonary disease

A
  1. Increase in bronchial densities2. Increase in interstitial markings3. Alveolar pattern4. Hyper inflated lungs with flattening of diaphragm5. Alveolar infiltrate with right middle lung lobe consolidation
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78
Q

Rare radiographic consequences of feline bronchopulmonary disease:

A
  1. Pneumothorax2. Lung lobe torsion3. Bronchiectasis
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79
Q

Common bronchoscope findings with feline bronchopulmonary disease

A

Thick mucous secretions in lower airways, hyperemic and edematous mucosa

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80
Q

Most predominant cell types in bronchial washings of cats with bronchopulmonary disease

A

Neutrophils (33% of cats) and eosinophils (24% of cats); mast cells found infrequently (up to 8% of cells), macrophages (22% of cats)….mixed cell population in 21% of cats

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81
Q

Mainstays of emergency therapy for allergic airway disease

A

Steroids, bronchodilators, oxygen

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82
Q

2 classes of bronchodilators for allergic airway disease

A

Methylxanthines, Beta 2 agonists

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83
Q

Which class of bronchodilators preferred for long term therapy? Why?

A

Methylxanthines - tolerance to Beta agonists may occur which then decreases efficacy in emergency situations

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84
Q

List 3 miscellaneous drugs to treat feline asthma

A
  1. Cyclosporine - inhibits helper T cells2. Cyproheptadine inhibits feline airway smooth muscle contraction in vitro3. Masitinib tyrosine kinase inhibitor may decrease airway eosinophilia and improve pulmonary mechanics in feline asthma
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85
Q

NCPE PCWP?

A
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86
Q

Categories of NCPE

A

Post obstructive, neoruogenic, ALI/ARDS, drowning, smoke inhalation, adverse drug effects, anaphylaxis, oxygen toxicity, pulmonary embolus

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87
Q

Possible source of ARDS (NCPE review, compendium 2012)

A

SIRS, sepsis, panc, pneumonia, neoplasia, uremia, parvovirus

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88
Q

Respiratory interstitial space contains

A

Connective tissue, fibroblasts, macrophages, small arteries, veins, lymphatic channels

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89
Q

As lymph drains from alveoli to hilus of the lungs, net hydrostatic pressure in the pulmonary interstitium __________ and the potential space for fluid accumulation __________.

A

Decreases, increases

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90
Q

Landis Pappenheimer formula does what?

A

Calculates COP: COP = 2.1TP + [0.16TP^2] + [0.009TP^3]

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91
Q

Diseases of the chest wall include…

A

Congenital anomalies, neoplasia, trauma (rib fx, flail chest, penetrating wounds), cervical spine dz, and neuromuscular dz

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92
Q

List the 2 main functions of the chest wall

A
  1. Protect internal thoracic structures2. Muscles and nerves necessary for normal respiration
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93
Q

What blood gas abnormality is most common with chest wall disease?

A

Hypoventilation/increased PCO2

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94
Q

What breathing pattern expected with chest wall disease?

A

Paradoxical…abdomen moves in on inspiration instead of out

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95
Q

Most common congenital chest wall abnormality?

A

Pectus excavatum…inward concavity of sternum and costal cartilages.

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96
Q

How does respiratory distress occur with pectus excavatum?

A

Restrictive ventilation or paradoxical movement of the deformity during inspiration

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97
Q

Pectus excavatum should always be surgically corrected T/F?

A

False…only corrected if significant respiratory impairment

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98
Q

List the 6 most common chest wall masses

A

Lipoma, chrondrosarcoma, fibrosarcoma, osteosarcoma, MCT, hemangiosarcoma

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99
Q

Define flail chest

A

Fracture of several adjoining ribs resulting in a segment of the thoracic wall that has lost continuity with the rest of the hemithorax…fractured segment moves paradoxically throughout respiration

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100
Q

What are the 2 main reasons patients with flail chest have respiratory distress?

A
  1. Hypoventilation secondary to pain2. Hypoxemia from other injuries such as pneumothorax, hemothorax, pulmonary contusions, diaphragmatic hernia
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101
Q

List 3 causes of non-traumatic rib fractures in cats

A

Chronic respiratory disease (asthma, pneumonia, upper airway obstructions), CRD, neoplasia

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102
Q

Where are non traumatic rib fractures typically located?

A

Mid rib, caudal aspect of the rib cage

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103
Q

In cats what is the proposed mechanism of Hypoventilation with cervical spine dz?

A

Afferent tracts to respiratory center may be damaged in cervical spinal Sx

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104
Q

How does cervical spinal dz cause Hypoventilation in dogs?

A

Unknown; postulated that medullary respiratory center sends info via reticulospinal tracts to phrenic nerve and segmental intercostal nerves. If these pathways are interrupted can cause ventilatory failure.

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105
Q

The ________leaves the spinal cord between the 4th and 6th vertebral bodies and provides ______________ to the diaphragm

A

Phrenic nerve; motor innervation

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106
Q

The ___________ innervate the intercostal muscles and leave the spinal cord between ______ and ______.

A

Segmental intercostal nerves; C6 , T2

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107
Q

Tick paralysis induced when female tick secretes______ that ______ or _______.

A

Neurotoxin, inhibits depolarization of motor nerves or blocks release of acetylcholine

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108
Q

List 2 ticks most commonly responsible for tick paralysis in US

A

American dog tick (Dermacenter variabilis), Rocky Mountain wood tick (Dermacenter andersoni)

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109
Q

When do signs develop in tick paralysis?

A

1 week after attachment of tick

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110
Q

Tick paralysis in Australia most common from what tick?

A

Ixodes holocyclus

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111
Q

How is tick paralysis different in Australia vs US?

A

Australia more severe, most require vent (median 23 hours), hospitalization 3-4 days. Vent due to Hypoventilation good (90% survived), not as good with hypoxemia (53% survive)

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112
Q

What things were found to be improved in a patient with biologically active ventilation compared to standard ventilation?

A

improved arterial oxygenation, lung mechanics, degree of lung edema, redistribution of pulmonary blood flow, proinflammatory cytokine production, histologic damage

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113
Q

What are the 3 fundamental settings for assist control ventilation?

A

RR, tidal volume, inspiratory flow rate

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114
Q

what is the only part of the breathing cycle that is variable with assist controlled ventilation (and is only variable when the patient triggers the breath)

A

expiratory time

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115
Q

Things that can be adjusted bedside during assist controlled ventilation?

A

inspired O2 concentration, trigger sensitivity, resp rate, tidal volume, insp flow rate, end insp pause, external PEEP

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116
Q

T/F- achieving normocapnea is a goal of mechanical ventilation?

A

false

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117
Q

in what disease state is achieving normocapnea VERY important?

A

brain disease

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118
Q

Heavy sedation can cause what disturbance with assist control ventilation?

A

ineffective triggering

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119
Q

Define hypoxia

A

Decrease in level of oxygen supplied to tissues

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120
Q

Define hypoxemia

A

Inadequate oxygenation of arterial blood and is defined as PaO2<80 mm Hg (at sea level)

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121
Q

DO2 =

A

CO x CaO2

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122
Q

List 5 causes of hypoxemia

A

HypoventilationVQ mismatchDiffusion impairmentDecreased FiO2Intrapulmonary shunt

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123
Q

Which of the 5 causes of hypoxemia do not respond to oxygen supplementation?

A

Intrapulmonary shunt

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124
Q

When is supplemental oxygen indicated?

A

SpO2< 93%

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125
Q

Arterial oxygen content formula

A

[1.34 (ml O2/g) x SaO2 (%) x Hb (g/dL)] + [0.003 (ml O2/dl/mmHg) x PaO2 (mm Hg)]

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126
Q

Risks of using non-humidified oxygen:

A
  1. Drying and dehydration of nasal mucosa2. Respiratory epithelial degeneration3. Impaired mucociliary clearance4. Increased risk of infection
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127
Q

What is hyperbaric oxygen

A

100% oxygen under supraatmospheric pressures (>760 mm Hg) to increase the percent dissolved oxygen in bloodstream by 10-20%

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128
Q

Phases of oxygen toxicity

A
  1. Initiation: 24-72h of exposure to 100% O2; ROS damage2. Inflammatory phase: pulmonary epithelial lining destroyed and inflammatory cells recruited, massive release of inflammatory mediators results in increased tissue permeability and pulmonary edema3. Destruction: severe local destruction, many die4. Proliferation: type 2 pneumocytes and monocytes recruited5. Fibrosis: collagen deposition and interstitial fibrosis
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129
Q

Correlation b/t PaO2 and SaO2

A

PaO2 500 = 100% SaO2

PaO2 125 = 99% SaO2

PaO2 100 = 98% SaO2

PaO2 80 (hypoxemia) = <90%P50

PaO2 29, SaO2 50

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130
Q

Primary physiologic cause of hypoxemia.

A

Low FiO2Global hypoventilationVenous admixture

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131
Q

Causes of venous admixture

A

Low V/Q regionAtelectasis (no V/Q)Diffusion defectsRight to left shunts (PDA, VSD, intrapulmonary AV shunt)

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132
Q

Thickness of an alveolar wall

A

0.3 um

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133
Q

What is the smallest airway without aveoli?

A

terminal bronchioles

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134
Q

Conducting ariways end with…

A

terminal bronchioles

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135
Q

What is anatomic dead space?

A

Airway w/o alveoli - ends at terminal bronchioles

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136
Q

Define acinus

A

portion of lung distal to terminal bronchiole

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137
Q

External intercostal muscles aid in..

A

Inhalation

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138
Q

Internal intercostal muscles aid in…

A

Forced exhalation

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139
Q

Where does the velocity of gas decrease the most in the?

A

terminal bronchioles (so inhaled particles end up here most)

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140
Q

Weibel diagram

A

Conducting zone = trachea –> bronchi –> bronchioles –> terminal bronchiolesTransitional and respiratory zone –> respiratory bronchioles –> alevolar ducts –> alveolar sac

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141
Q

Respiratory capillary diameter

A

7-10 um

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142
Q

How long does an RBC spend in the capillary network?

A

0.75 s

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143
Q

Bronchial circulation supplies.

A

Conducting zone (trachea to terminal bronchioles)

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144
Q

Surface area of the lungs

A

50-100 meters squared

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145
Q

aveoli in lung

A

500 million

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146
Q

Alveoli diameter

A

0.3 mm

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147
Q

Function of surfactant

A

Decrease surface tension in alveoli

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148
Q

When oxygen moves from the thin side of the blood-gas barrier from the alveolar gas to hemoglobin of the RBC, it traverses the following layers in order:

A

Surfactant, epithelial cell, interstitium, endothelial cell, plasma, red cell membrane

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149
Q

What is the PO2 of inspired gas at Mt. Everest (barometric pressure of 247 mm Hg)?

A

247-47 (water vapor) x 0.21 = 42 mm Hg

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150
Q

What is the predominant mode of gas flow in the alveolar ducts?

A

Difffusion

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151
Q

Define tidal volume

A

volume inspired normally

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152
Q

Devine vital capacity

A

Max inspiration and max expiration = inspiratory reserve volume + tidal volume + expiratory reserve volume

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153
Q

Residual volume

A

gas that remained in lung after maximal expiration

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154
Q

Functional residual capacity

A

volume of gas in lung after a normal expiration = expiratory reserve volume + residual volume

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155
Q

Inspiratory capacity

A

Tidal volume + inspiratory reserve volume

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156
Q

What does Boyle’s law state?

A

Pressure x volume is constant (at constant temperature)PV = K

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157
Q

What is alveolar ventilation?

A

Volume of fresh gas entering the respiratory zone each minute; (tidal volume - dead space) x resp freq

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158
Q

How can you increase alveolar ventilation?

A

increased tidal volume or respiratory frequencyIncreasing tidal volume more effective b/c reduces proportion of each breath occupied by anatomic dead space

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159
Q

What is the alveolar ventilation equation?

A

VA = (VCO2/PCO2) x K

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160
Q

What is anatomic dead space?

A

Volume of the conducting airways

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161
Q

What is the Bohr equation?

A

VD/VT = (PACO2-PECO2)/PACO2VD = dead spaceVT = tidal volumeA = alveolarE = mixed expiredBohr eqn: AEA (my initials:)All of the expired CO2 comes from the alveolar gas and none from the dead space. MEASURES PHYSIOLOGIC DEAD SPACE

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162
Q

What is the normal ratio of dead space:tidal volume during resting breathing?

A

0.2-0.35

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163
Q

What is physiologic dead space?

A

Volume of gas that does not eliminate CO2

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164
Q

T/F. Anatomic dead space increases with many lung diseases

A

F - physiologic dead space increases

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165
Q

T/F. Upper regions of the lung ventilate better than lower regions.

A

F - Lower regions ventilate better than upper zones

166
Q

What lung volumes cannot be measured with a simple spirometer?

A

total lung capacity, functional residual capacity, residual volumeThey can be measured with helium dilution or body plethysomograph

167
Q

T/F. The concentration of CO2 (and therefore its partial pressure) in alveolar gas and arterial blood is inversely related to the alveolar ventilation.

A

T

168
Q

What does Fick’s law state regarding diffuson?

A

The rate of transfer of a gas through a sheet of tissue is proportional to the tissue area and the difference in gas partial pressure between the two sides, and inversely proportional to the tissue thicknessDiffusion rate proportional to partial pressure differenceDiffusion rate proportional to solubility of gas in tissue and inversely propotional to its molecular weight

169
Q

CO2 diffuses ____ times more rapidly than O2 because it ha a higher _____

A

20 xsolubility

170
Q

Transfer of carbon monoxide is….

A

diffusion limited b/t the amt of CO that gets into blood limited by diffusive properties and not amt of blood available

171
Q

What gas is perfusion limited?

A

nitrous oxide (doesn’t bind with Hbg so partial pressure rises rapidly in blood, so blood flow depends on uptake)

172
Q

T/F. Under resting conditions, the capillary PO2 virtually reaches that of alveolar gas when red cell is 1/3rd the way along the capillary.

A

T

173
Q

Diffusion process challenged by:

A

exercise, alveolar hypoxia, thickening of the blood-gas barrier

174
Q

Normal diffusing capacity

A

25 ml/min/mmHgcarbon monoxide used to determineFormula = VCO2/PACO2

175
Q

T/F. Oxygen transfer is normally diffusion limited.

A

F - Perfusion limited

176
Q

Under what circumstances does oxygen transfer become diffusion limited?

A

Intense exercise, thickened blood-gas barrier, alveolar hypoxia

177
Q

What is transmural pressure?

A

Pressure difference between the inside and outside of capillaries

178
Q

What is normal pulmonary vascular resistance?

A

1.7 mm Hg/L/min

179
Q

What are the two mechanisms for why an increase in pulmonary arterial venous or arterial pressure causes the pulmonary vascular resistance to fall?

A

Recruitment (opening of previously closed) and distension (increase caliber of vessels)Recruitment more with increase in arterial pressureDistention more with increase in venous pressure

180
Q

What is hypoxic pulmonary vasoconstriction?

A

Contraction of smooth muscle in the walls of the small arterioles in the hypoxic region. PAO2 of pulmonary gas determines this reaction. When PAO2 < 70 mm Hg, marked vasoconstriction occurs.

181
Q

What is the primary constituent of pulmonary surfactant?

A

dipamlitoyl phosphatidylcholine

182
Q

Ratio of total systemic vascular resistance to pulmonary vascular resistance

A

10:1

183
Q

What two wave wavelengths do pulse oximeters use?

A

660 and 940 mm

184
Q

What are the 4 causes of venous admixture?

A

low VQ regions, small airway and alveolar collapse (atelectasis), diffusion defects, anatomic right to left shunts

185
Q

T/F Cats have a right shift oxygemoglobin dissociation curve compared to dogs

A

T

186
Q

What are examples of diffusion defects for venous admixture?

A

Oxygen toxicity, smoke inhalation, ARDS

187
Q

T/F. Oxygen concentration is lower at higher altitudes

A

F - Still 21%, barometric pressure is lower so PatmO2 is lower

188
Q

What gas is highest in the alveoli?

A

nitrogen (560 mm Hg)

189
Q

T/F. Hypoventilation is a cause of hypoxemia in patients breathing room air but not in patients breathing enriched oxygen mixtures

A

T - With 100% oxygen, nitrogen is decreases to nearly 0 and oxygen increases to 665, alveolar CO2 could theoretically rise to 550 mm Hg before the alveolar oxygen decreased to a level that would lead to hypoxemia (PaO2 <80)

190
Q

What is the difference between a physiologic shunt and a true or anatomic shunt?

A

physiologic: blood flowing past nonfxnal alveolitrue: blood completely bypasses alveoli (be they fxnal or not)

191
Q

What cell proliferation is responsible for diffusion defect?

A

cuboidal, type 2 pneumocytes (normal is flat type 1)

192
Q

What is the normal A-a gradient?

A

20 mm Hg = venous admixture

193
Q

What is minute ventilation?

A

TV x RRalveolar and dead space ventilation

194
Q

What are causes of hypercapnia?

A

hypoventilation, increase in dead space ventilation, increased CO2 production, increased inspired CO2

195
Q

Fowler’s method measures what?

A

Anatomic dead spaceMeasures concentration of a tracer gas (nitrogen) over time

196
Q

Bohr’s method measures what?

A

Physiologic dead spaceVolume of lung that does not eliminate CO2

197
Q

What is the conclusion from the alveolar ventilation equation (VA = (VCO2/PaCO2) x K)

A

The only physiologic reason for increased PaCO2 is level of alveolar ventilation that is inadequate for the amount of CO2 produced by tissues

198
Q

Normal dog PaCO2

A

30-42 mm Hg

199
Q

Normal cat PaCO2

A

25-36 mm Hg

200
Q

Venous CO2 is usually ___ higher than arterial CO2

A

3-6 mm Hg

201
Q

What are the 3 neurons involved in the respiratory control center in medulla and pons?

A
  1. medullary respiratory center2. apneustic center3. pneumotaxic center
202
Q

The medullary respiratory center is split into ….

A

Dorsal and ventral respiratory group

203
Q

What is special about the dorsal respiratory group?

A

Located in region of nucleus tractus solitarius, where visceral afferents from cranial nerves IX and X terminateresponsible primarily for INSPIRATION (intrinsic periodic firing)

204
Q

What are the 4 nuclei in the ventral respiratory group of the medullary resp center?

A
  1. Nucleus retrroambiguus2. Nucleus para-ambiguus3. Nucleus retrofacialis4. pre-Botzinger complex
205
Q

What is the job of the ventral resp group of medullary resp center?

A

Controls voluntary forced exhalation and acts to increase the force of inspiration

206
Q

What does the apneustic center do?

A

coordinates the speed of inhalation and exhalation; can be over ridden by pneumotaxic center

207
Q

Where is the apneustic center?

A

lower (ventral) pons

208
Q

Where is the pneumotaxic center and what does it do?

A

upper (dorsal) ponsSends inhibitory impulses to the inspiratory center, terminating inspiration, and regulates inspiratory volume and RR

209
Q

The descending automatic pathways (in anterolateral white matter of cord) are where…

A

paramedian reticular formation of the medullary and pontine tegmentum and laterally in the high cervical cord in close proximity with the spinothalamic tract

210
Q

The descending voluntary pathways are where…

A

associated with the corticospinal tracts in brainstem and upper cervical cord

211
Q

Phrenic motor neurons are where?

A

C3-C5

212
Q

Intercostal motor neurons were where?

A

T2-12

213
Q

Where are central chemoreceptors found?

A

medulla

214
Q

Where are peripheral chemoreceptors found?

A

carotid and aortic bodies

215
Q

Central chemoreceptors responsible for ___% of resp response to CO2

A

85%

216
Q

What happens to CO2 that diffuses into brain?

A

Hydrated to carbonic acid –> dissociates to H+ and HCO3-; so the H+ is what actually stimulates respiration

217
Q

Peripheral chemoreceptors respond to these 4 things to increase ventilation

A

Decreased pH, decreased PaO2, increased PaCO2, hypoperfusion

218
Q

Peripheral chemoreceptors are exclusively responsible for the increased ventilation secondary to _____

A

hypoxemia

219
Q

What is the Hering-Breuer inflation reflex?

A

pulmonary stretch receptors in SM respond to excessive stretch with large inspiration by sending action potentials thru large myelinated fibers of the vagus nerve to inspiratory area of medualla and apneustic center in pons; inhibits inspiratory dischargemain effect = slowing respiratory frequency by increasing expiratory time

220
Q

Where are “irritant receptors” and what do they do?

A

Between airway epithelial cells, stimulated by noxious gases, cold, and inhaled dust; send AP via vagus causing BRONCHOCONSTRICTION AND INCREASED RR

221
Q

What are “J” receptors and what do they do?

A

juxtacapillary receptors in alveolar walls close to capillariesrespond rapidly to chemicals in pulm circulation, distension of capillary walls, and accumulation of interstitial fluid to cause rapid, shallow breathing

222
Q

How are arterial baroreceptors involved in ventilation?

A

Low blood pressure - hyperventilationLarge increase BP - hypoventilation

223
Q

Strength of muscle contraction to inspire must overcome two main sources of impedance:

A
  1. elastic recoil of lungs and chest wall2. resistance to gas flow (upper airways)
224
Q

Carbon dioxide narcosis

A

PaCO2 > 90mmHg

225
Q

What accounts for the normal v-a CO2 difference?

A

10% dissolved CO2 and 90% bound CO2 in RBC as bicarbonate from tissues back to lungs

226
Q

What 3 things affect venous CO2?

A

PaCO2, de novo tissue CO2 production, tissue blood flow

227
Q

What does Henry’s law say?

A

The amount of dissolved gas if proportional to the partial pressure

228
Q

What is oxygen capacity?

A

Maximum number of O2 that can combine with HbNormal is 20.8 ml O2/dL blood

229
Q

What is oxygen saturation?

A

Percentage of available binding sites that have oxygen attached.O2 combined with Hb / O2 capacity x 100

230
Q

What are the conformational changes to hemoglobin in respect to oxygenation of Hb?

A

R (relaxed) state with oxygenatedT (tense) state when deoxygenated

231
Q

What shifts the oxygen dissociation curve to the right?

A

Increased temperature, 2,3-DPG, PCO2, hydrogen ionsRemember exercising muscle is hot, acidotic, hypercarbic and needs more oxygen in tissues

232
Q

T/F. A right shift on the oxygen dissociation curve means the affinity of oxygen to hemoglobin is stronger.

A

F - means it is weaker so more O2 can be unloaded to tissues for the same given PO2

233
Q

What is 2,3 DPG?

A

2,3-diphosphoglycerate = end product of red cell metabolism. This increased in chronic hypoxia and high altitudes. In stored RBC, 2,3-DPG reduced, so may not be that great at offloading oxygen.

234
Q

A small addition of carbon monoxide to blood causes a left or right shift to O2 dissociation curve?

A

Left

235
Q

Carbon monoxide affinity for Hb is ___ times greater than oxygen’s affinity for Hb

A

240Means same amt of CO with bind with Hb when partial pressure of CO is 240 times lower than oxygen’s PP

236
Q

What is the Bohr effect?

A

The effect of pCO2 shifting curve to right because of it’s action on H+ ions

237
Q

Where is carbonic anhydrase highest?

A

RBC

238
Q

What is the chloride shift?

A

In the RBC, CO2 + H2O –> carbonic acid –> HCO3 and H. The bicarb diffuses out, but H can’t b/c cell membrane impermeable to + cations; so ensure a happy RBC, chloride shifts in to make it a neutral ground againGibbs-Donnan equilibrium

239
Q

What is the Haldane effect?

A

Deoxygenated blood increases its ability to carry CO2…..why….because reduce Hb is less acidic and can take on a proton; so reduced Hb in periphery makes it easier to load CO2, and oxygenation in the lungs, makes it easier to unload CO2

240
Q

How is CO2 removed from tissues?

A

10% dissolved, 60% HCO3, 30% carbaminoHb

241
Q

Normally PETCO2 underestimates PaCO2 by __ mm Hg

A

2-6

242
Q

What are the 3 mechanisms for oxygen induced hypercapnia in patients with chronic hypoventilation?

A
  1. Depression of formerly hypoxic-driven peripheral chemoreceptors causing worsening of hypovenilation2. Relief of hypoxic pulmonary vasoconstriction in poorly ventilated lung regions that further reduces the ability of these units to eliminate CO2 as local perfusion increases w/o increase in ventilation3. Better saturation of Hgb so that previously buffered protons on deoxyhemoglobin are released with subsequent generation of CO2 from stores (Haldane effect)
243
Q

List respiratory stimulants

A

Doxopram, theophylline/aminophylline, caffeine, progesterone

244
Q

What is orthopnea?

A

Extension of the head and neck while breathing

245
Q

Where is 80% of the resistance to airflow during inspiration in the dog?

A

nose

246
Q

Nasal turbinates protruding into the nasopharynx has been documented in __% of dogs with BAS, with the ___% being in Pugs.

A

20%, 80%

247
Q

___ % of dogs with BAS has some degree of bronchoscopically detectable collapse or stenosis and that worsened degree of bronchial collapse was associated with ______ collapse.

A

87%, laryngeal

248
Q

Esophagitis, gastritis, reflux, hiatal hernia, and pyloric stenosis reported in ____ % of dogs with BAS.

A

80% - worsened their resp signs

249
Q

T/F. cTnI increased and CRP and haptoglobin normal in BAS dogs

A

T

250
Q

What is the most important part of BAS surgery?

A

A good nose job!!! Imparts the most airway resistance.

251
Q

T/F Tracheal hypoplasia and bronchial collapse means outcome worse with BAS surgical treatment.

A

F

252
Q

What is the surgical procedure to fix a collapsed larynx?

A

Cricoarytenoid lateralization combined with thyroarytenoid caudolateralization (arytenoid laryngoplasty)

253
Q

Which cell makes surfactant?

A

type 2 pneumocyte

254
Q

What is the main substance of surfactant?

A

Dipalmitoyl phosphatidylcholine

255
Q

___% of cats with nasopharyngeal disease have polyps.

A

28%

256
Q

Traction avulsion of NP polyps in cats ass’d with ___% recurrence.

A

40-50%, esp if from auditory canal

257
Q

If NP polyp from auditory tube or middle ear dz present, recommendation should be…

A

VBO

258
Q

Horner’s syndrome VBO vs. traction avulsion

A

57% vs. 43%

259
Q

Larynx accounts for ___% of resistance to airflow during nasal breathing

A

6

260
Q

Causes of lar par

A

congenital denvervation, traumatic, iatrogenic, idiopathic, neoplastic, diffuse NM dz (MG and hypoT4)

261
Q

Breeds associated with congenital lar par

A

Bouvier des Flandres, Rotties, Dalmations, Siberian Huskies (and mixes), Bull Terriers, Pyrenean Mountain Dogs, Leonbergers

262
Q

T/F. Liquid phase esophagram better predicts post op aspiration than neuro status with lar par.

A

T

263
Q

What are surgical techniques to fix lar par

A
  1. widen dorsal glottis (unilateral or bilateral arytenoid lateralization)2. widen ventral glottis (focal fold resection, partial laryngectomy, modified castellated laryngofissure)3. widen both (castellated laryngofissue and bilateral arytenoid lateralization)
264
Q

Incidence of aspiration after lar par sx

A

8-33%

265
Q

T/F. Cats with lar par are older or younger than dogs.

A

Older (8-16y)

266
Q

Radiographs misdiagnosed the location of tracheal collapse in ___% of dogs, and failed to diagnose tracheal collapse in ___% of dogs when compared to fluorscopy.

A

44%, 8%

267
Q

___% of dogs with cervical tracheal collapse also had concurrent bronchial collapse.

A

83%

268
Q

Lar par diagnosed in ___% of dogs with tracheal collapse.

A

30% (vet surg, 1982)

269
Q

Pathogens that can be cultured from normal dog lungs

A

Pasteurella, Staph, Strept, Klebsiella

270
Q

Most common isolated bacteria from dogs with tracheal collapse.

A

Pseudomonas, Pasteurella, E.coli, Staph

271
Q

T/F Bronchoscopic removal of trach foreign bodies has better success in cats vs dogs

A

F. Dogs 86%, cats 40%

272
Q

Most common nasal tumors in dogs vs. cats.

A

Dogs - carcinoma/sarcoma, cats- LSA

273
Q

Most common laryngeal tumor in dogs?

A

osteochondroma (usually young dogs < 2y)

274
Q

Most common laryngeal tumor in cats?

A

LSA

275
Q

Median age of laryngeal tumors?

A

9 y (exception, dogs osteochondroma < 2 y)

276
Q

Sleep study in Bulldogs showed what?

A

5 bulldogs had SpO2<90% during 32% of time in REM, no control had this. Mean REM sleep SpO2 Bulldogs (78+/-5%) and controls (95 +/-2%)

277
Q

What is a staphlectomy?

A

Resection of the soft palate

278
Q

Laryngeal collapse in BDs has been correlated with the severity of ____.

A

Bronchial collapse.

279
Q

__ % of BDs had GI abnormalites (endoscopic and biopsies)

A

97%

280
Q

What is the Precision Flow?

A

Device that provides high flow (40 L/min) of humidified, warmed oxygen to help support airway patency

281
Q

What was the conclusion of the NTT study in brachycephalics?

A

5 dogs w/o NTT oxygen developed resp distress, no dog with NTT oxygen developed resp distress; 4 dogs with NTT had to have it removed d/t vomiting, regurg, or coughing

282
Q

T/F BDs have lower PaO2 and higher PaCO2

A

T

283
Q

What kind of endotracheal tube has been assc’d with tearing of the dorsal tracheal membrane in cats?

A

low volume,high pressure cuffs

284
Q

How much of the trachea can be resected in dogs?

A

20% yound dog, 25-50% older dog

285
Q

What is the most appropriate way to re-anastomose tracheal rings from traumatic trachea tears in medium to large dogs?

A

Split cartilage technique - tracheal cartilage at the proximal and distal ends of the anastomosis is split circumferentially using an 11 blade, then prepalced sutures (8-12 of them) with 3/0 or 4/0 monofilament material around the opposite cartilage halves and thru the dorsal tracheal membrane on either side of the anastomosis; less risk of luminal stenosis than annular ligament and cartilage technique; doesn’t work in small patients

286
Q

What is the most appropriate sx technique to re-anastomose the trachea in smaller animals?

A

cartilage technique; resect annular ligament on each side and suture the two cartilages together with preplaced suturessplit cartilage technique doesn’t work b/c cartilages fragment due to size

287
Q

In cats with trach tears secondary to intubation, where was the most common site?

A

Thoracic inlet on the dorsolateral aspect of the trachea at the jxn of the tracheal rings and trachealis muscle

288
Q

Surgical approach for an intrathoracic tracheal tear?

A

Right lateral thoracotomy (3rd-4th intercostal space)

289
Q

Minimum volume of air in high volume, low pressure cuff to create an airtight seal in cats.

A

0-3 mm

290
Q

Cuff pressures (measured with pressure manometer attached to endotrach cuff) should be kept within ___ and ____ mm Hg to provide sufficient seal without compromising tracheal mucosal perfusion.

A

20-30 mm Hg

291
Q

Most common parasite to cause allergic response in canine lungs?

A

Toxocara canis

292
Q

T/F. Strongyloides stercoralis migrates through cat lungs only, not dogs.

A

F - both

293
Q

List 4 primary lung parasites

A

Paragonimus kellicotti (both)Aelurostrongylus abstrusus (cats only)Capillaria aerophila (both)Filaroides hirthi (dogs only)

294
Q

What is canine allergic bronchitis (eosinophilic bronchopneumopathy)

A

a. Eosinophilic infiltration of lung and bronchial mucosab. Younger (3.3 +/- 2y)c. Siberian Huskies and Alaskan malamutes overrepresentedd. Prominent bronchointerstitial pattern on rads i. 40% alveolar pattern d/t secondary pneumonia ii. 26% bronchiectasise. Peripheral eosinophilia 60%f. BAL cytology i. >50% eos in 87% dogs ii. 20-50% eos in 13% dogs

295
Q

What is PIE (pulm infiltrates with eos)

A

a. Type I hypersensitivityb. Possible stimuli: pulmonary or migrating parasites, HWD, drugs, inhaled allergensc. 65% d/t HWDd. Pulmonary parenchymal dz – signs rapid, shallow breathing, cyanosise. Rads: diffuse interstitial, bronchial, or alveolar pattern +/- hilar lymphadenopathyf. Cytology: predominance eos in airways

296
Q

What are the two classes of bronchodilators?

A

Methylxanthines (aminophylline, theophylline)B2 agonists (albuterol, terbutalline)

297
Q

What is the reflection coefficient (sigma)

A

relative permeability of the membrane to protein; 1 = 100% impermeable so the protein is 100% reflected

298
Q

What is the filtration coefficient (K)

A

measure of the overall flow from the vasculature of specific tissues and is dependent on capillary surface area and hydraulic conductivity

299
Q

What are the two types of pulmonary edema?

A

High-pressure edemaIncreased permeability edema

300
Q

T/F. The filtration coefficient is reduced when increased permeability edema

A

F - reflection coefficient reduced, memebrane more permeable to protein

301
Q

Pulmonary edema fluid is largely cleared by…

A

Bronchial circulation

302
Q

____ % of cats with left sided CHF have no cardiac auscultable abnormalities

A

20

303
Q

What are risk factors for ALI/ARDS (Dorothoy Russell Havemeyer)

A

inflammationinfectionsepsisSIRSsevere trauma (long bone fx, head injury, pulm contusion)multiple transfusionssmoke inhalationsubmersion injuryaspiration of stomach contentsingestion of drugs and toxins

304
Q

What are some causes of increased permeability edema?

A

ALI/ARDSPTEVALIinhaled toxins (hydrocarbons)

305
Q

What are causes of mixed high-pressure and increased permeability edema?

A

neurogenic pulmonary edema (seizure, shock, TBI)negative pressure pulmonary edema (airway obst)

306
Q

Particle smaller than __ microns bypass the upper resp tract defenses and are deposited in the alveoli.

A

3 um

307
Q

What antibiotics penetrate the lung tissue?

A

chloramphenicol, doxycycline, enrofloxacin, TMS, clindamycin

308
Q

What are the risks/benefits or using bronchodilators to treat pneumonia?

A

Risks: suppress cough, worsen VQ mismatch, spread exudates to other areas of lungBenefits: increase airflow, improve mucokinetics, methylxanthings may increase speed of mucociliary transpor, inhibit degranulation of mast cells, and decrease microvascular permeability and lead; aminophylline is also a resp stimulant and increases strength of diaphragmatic contraction

309
Q

How does NAC fxn as a mucolytic?

A

Breaks disulfide bonds in thick airway mucus; inhaled can cause bronchoconstriction in pets

310
Q

Nebulizer particle size has to be < or = to…

A

3 microns

311
Q

___ % of cats have no signs of pneumonia

A

36%

312
Q

____% of dogs with pneumonia have concurrent predisposing disorder

A

36-57%

313
Q

___% of cats with pneumonia cough; compared with ___% of dogs

A

8%, 47%

314
Q

What should be done after a lung aspirate?

A

Place patient on aspirate side down for 30-60 min

315
Q

Common bacteria in pneumonia?

A

Pasteurella (22-28%), E.coli (17-46%), Staph (10-16%), Strept (14-21%), Bordetella (49%, mostly puppies), anaerobic (10-20%), mycoplasma (sole inf 8%, mixed 62%)

316
Q

What is the cause of an emerging a syndrome of acute, hemorrhagic, fatal pneumonia in dogs from shelters?

A

Strept equi subspp zooepidemicus (Lancefield Group C)

317
Q

List the criteria for ALI/ARDS accoring to the Dorothy Russell Havameyer criteria.

A
  1. Acute onset2. Risk factors3. Evidence of increased transcapillary leak w/o increased pulm cap pressure pressure4. Evidence inefficient gas exchange5. Diffuse pulmonary inflammation (optional)
318
Q

List the risk factors for Vet ALI and ARDS.

A

InflammationInfectionSepsisSIRSTrauma (long bone fx, pulmonary contusions, head trauma)Multiple transfusionsSmoke inhalationNear-drowningAspiration stomach contentsDrugs/toxins

319
Q

Kelmer, JAVMA, 2009. What were the findings from the study on nasal catheter ETCO2 compared with PaCO2 in critically ill dogs?

A

Mean diff 3.95 +/- 4.9 w/o supplemental oxygenMean diff 6.87 +/- 6.4 w/ supplemental oxygenMean diff w/ resp disease (9+/-5) much higher than w/o resp disease (3+/-3)Good correlation (r=0.833)Cath size, ventilatory status, and outcome no sig assc’d with diff b/t ET and Pa CO2

320
Q

Kogan, JAVMA, 2008. Which breed were more likely to have aspiration pneumonia?

A

Goldens, Cockers, English Springers, Pugs

321
Q

Rice, Chest, 2007. SF ratio of <200 (ARDS)

A

85, 85

322
Q

Rice, Chest, 2007. FS ratio of < 315 was ___ senstiive and __ specific for detecting PF < 300 (ALI)

A

91%, 56%

323
Q

Aspiration pneumonitis can be caused by inhalation of the following…

A

gastric contents, freshwater, saltwater, hydrocarbons

324
Q

Severity of injury after aspiration of gastric content depends on…

A

pH, volume, osmolality, presence of particulate matter

325
Q

What percent of aspiration pneumonia cases reported to be complications of anesthesia?

A

5-26%

326
Q

What is the most common risk factor for aspiration pneumonia?

A

GI disorders (60%), followed by neuro (18%), laryngeal dz (13%)

327
Q

Reported survival rate after aspiration pneumonia?

A

77-82%

328
Q

Effect of pH on severity of lung injury after aspiration?

A

2.4 minimal unless particulate matter present

329
Q

What is the biphasic pathogenesis of acid-induced lung injury?

A

Initial (peaks at 1-2 h): caustic effects of acid damage bronchial and alveolar epithelium and pulm cap endothelium, stimulates substance P immunoreactive neurons involved in control of bronchial SM tone and vascular permeability. Stimulation of subP neurons induces tachykinin, peuropeptidase release, causing neurogenic inflammation, bronchoconstriction, vasodilation, and increased vascular permeability. Histologically, epithelial and endothelial degeneration, type I cell necrosis, intraalveolar hemorrhage.Second (4-6h): larger inc pulm cap permeability and protein extravasation, edema, VQ mismatch, reduced compliance, chemotactic mediates (IL-8, TNF-alpha, macrophage inflammatory protein 2) attracts neutrophils which increase ROS, proteinases, and complement proteins. Complement induced mast cell release can cause damage to contralateral lung.

330
Q

T/F - Particular matter (w/o acid) aspiration causes severe pulmonary edema.

A

F - inflammation, no edema

331
Q

Sensitivity of TTW to diagnose bacterial pneumonia.

A

45-70%

332
Q

Thoracic trauma reported in ___ % dogs and ___% cats that sustain limb fractures from road accidents.

A

34-57%, 17%

333
Q

What is the spalling effect in relation to pulmonary contusions?

A

A shearing or bursting phenomenon that occurs at gas-liquid interfaces and may disrupt the alveolus at the point of initial contact with shock wave.

334
Q

What is the inertial effect in relation to pulmonary contusions?

A

Occurs when low-density alveolar tissue is stripped from heavier hilar structures as they accelerate at different rates resulting in both mechanical tearing and laceration of the lungs

335
Q

What is the implosion effect relating to pulmonary contusions?

A

Rebound or overexpansion of gas bubbles after a pressure wave passes, which can lead to tearing of pulmonary parenchyma from excess distension

336
Q

What does Henry’s Law say?

A

The amount of gas which dissolves in a unit volume of a liquid at a given temperature is directly proportional to the partial pressure of the gas in the equilibrium phaseCO2:O2 = 24:1Solubility coefficient

337
Q

Rate of oxygen diffusion dependent on…

A

FiO2, alveolar ventilation, pulmonary capillary blood flow, oxygenation of hemoglobin

338
Q

Factors that cause contraction and increase in RV pressure:

A

Noradrenaline, adrenalinedopamine, PGF2alpha, TXA2, histamine (H1), serotonin, angiotensin II

339
Q

Factors that cause dilation and decrease RV pressure.

A

isoproterenol, aminophylline, ganglion blcokers, PGE1, PGI2, histamine (H2), acetylcholine, bradykinin

340
Q

What causes the normal physiological shunt?

A

Coronary blood enters LV via thebesian veins; some bronchial artery blood enters the pulmonary veins

341
Q

What can increase the A-a gradient?

A

Pulmonary collapse/consolidationNeoplasiaInfectionAlveolar destructionDrugsHormonesExtrapulmonary shuntingvenous admixturealveolar PAO2Cardiac outputOxygen consumpationAnemiaP50 dissociation curveAlveolar ventilation

342
Q

What is the Bohr effect?

A

Increased CO2 produces a pH independent shift of curve to right with decreased affinity for oxygen

343
Q

T/F Normal adult hemoglobin has iron in the ferrous state Fe++

A

TIf oxidized to Fe+++ forms metHb

344
Q

How do you treat methemoglobinemia?

A

methylene blue

345
Q

What is the Haldane effect?

A

Deoxy Hb is more basic than oxy Hb and accepts H+ more readilyso…reducing the PO2 and Hb saturation increases the CO2 carrying capacity of the blood

346
Q

What causes reduced compliance of lungs with pleural space disease?

A

reduced FRC which forces lung to operate on a less compliant portion of the compliance curve

347
Q

Sigrist, JVECC, 2011. Pleural space disease was significnantly associated with what type of breathing pattern?

A

Costoabdominal breathing (exaggerated abd component) and asynchronous breathing (outward mvmt chest and inward mvmt abd during inspiration)

348
Q

Sigrist, JVECC, 2011. Asynchronous breathing was * assc’d with…in cats.

A

Pleural effusion and chest wall localization

349
Q

Sigrist, JVECC, 2011. Inspiratory dyspnea (prolonged insp, short exp) was associated with upper airway dz in bth dogs and cats.

A

F - only dogs

350
Q

In dogs, what muscles elevate the ribs during inspiration?

A

External intercostals and the internal intercartilagenous intercostal muscles

351
Q

Sigrist, JVECC, 2011. Animals (dogs and cats) with pleural space disease showed predominantly ______ breathing. SE and SP for animals with pleural space dz showing an asynchronous or inverse breathing type in combination with decreased lung sounds on auscultation was ___ and ____, respectively.

A

asynchronous, 99%, 40%

352
Q

What is the expected compensatory response in PaCO2 from metabolic acidosis?

A

Decrease in PaCO2 by 0.7 mm Hg per every 1 mEq/L decrease in plasma bicarb

353
Q

Hypoxemia becomes the primary stimulation for ventilation when the PaO2 drops below…

A

50 mm Hg

354
Q

Causes of hypoglycemia in animals (can cause diminished resp muscle fxn):

A

Excess insulin (iatrogenic, insulinoma)Severe liver dz (PSS, glycogen storage, failure)Insulinlike hormone secreting tumors (hepatic carcinoma, HSA, leiomyoma)Metabolic dz (Addisons, GH deficiency)Neonatal and juvenile hypoglycemiaToxicosis (xylitol, ethanol)SepsisPregnancy toxemiaPolycythemiaHunting dog hypoglycemia

355
Q

How do you reverse nondepolarizing paralytic agents (atracurium, vecuronium, pancuronium)?

A

Wait - 30-45 minutes; or…give anticholinesterase (edrophoium, physostigmine, neostigmine) and an anticholinergic (atropine, glyco)

356
Q

What are the 3 types of ventilator breaths?

A

Spontaneous: patient determines RR and TVAssisted: patient determines RR, machine sets TVControlled: machine sets RR and TV

357
Q

How is PEEP helpful?

A

recruiting previously collapsed alveoli, preventing further alveolar collapse, reducing ventilator induced lung injury

358
Q

List some differentials for patient-ventilator asynchrony.

A

hypoxemia, hypercapnia, pneumothorax, hyperthermia inappropriate ventilator settings, full urinary bladder or colon, inadequate depth of anesthesia

359
Q

What are some indications of pneumothorax in the PPV patient?

A

Rapidly climbing PCO2, falling PaO2, decreased compliance

360
Q

List ddx of decreases in oxygenation in the PPV patient.

A

Loss of O2 supply, machine or circuit malfxn, worsening of underlying lung dz, new lung dz (pneumothorax, VAP, VALI, ARDS)

361
Q

List ddx of hypercapnia in the PPV patient.

A
  1. pneumothorax2. bronchoconstriction3. ET or TT obstruction4. Vent circuit issues (leak, exhale obstruction)5. Increased dead space (pulm)6. Inadequate vent settings
362
Q

List endotracheal techniques

A

LaryngoscopicFiberoptic-assistedDigital palpationNasal intubationRetrograde intubationTransilluminationSurgical technique (cricothyroidotomy)Cricoid pressure

363
Q

What is a needle cricothyroidotomy?

A

Pass large bore catheter thru cricothyroid membrane to supply oxygen until can get a tube in; jet ventilation indication

364
Q

Complications of endotracheal intubation.

A

kinking of tubepressure induced tracheal necrosisbronchial intubationincreased ICPincreased IOPhypertensiontachycardia

365
Q

Indications for temp trach.

A

UA obstructionoral/pharyngeal sxlong term ventilationremoval of tracheal FBs

366
Q

How big should trach tube be?

A

As big as will fit in trachea, measure on lateral cervical radiograph

367
Q

Describe the surgical technique for temp trach

A

GA, orotrach tube in place, dorsal recumbency, ventral cervical midline incision from cricoid cartilage to sternum, separate sternohyoid muscles along midline with blunt dissection and retract laterally, remove pertracheal connect tissue, transverse, vertical or box trach

368
Q

What needs to be avoided for temp trach?

A

recurrent laryngeal and tracheal blood supply

369
Q

Where do you make incision for transverse temp trach?

A

3-5 trach rings

370
Q

How is vertical temp trach done?

A

vertical incision thru 2-4 trach rings

371
Q

Trach tube care protocol

A
  1. Clean inner canula2. Humidify airway for 20 minutes before suctioning3. Always preoxygenate4. Sterile technique for suctioning, circular motion5. 100% O2 x 3 min after suction6. Suction 2-4 times (patient dependent)7. Replace cannula (q24h)8. Clean incision and ensure ties secure
372
Q

How is cyproheptadine thought to be helpful in feline asthma?

A

serotonin receptor antagoist that inhibits feline airway smooth muscle contraction

373
Q

Define spalling effect (pulm contusion).

A

lung injured directly by increase pressure, a shearing or bursting phenomenon that occurs at gas liguid interfaces and may disrupt alveolus at point of initial contact with shock waves

374
Q

Define inertial effec (pulm contusion)

A

occurs whn low density alveolar tissue stripped from heavier hilar structures as the accelerate at different rates

375
Q

Define implosion effect (pulm contusion)

A

Rebound or overexpansion of gas bubbles after a pressure wave passes, can lead to tearing of the pulm parenchyma fro excess distension

376
Q

Angiostrongylus vasorum

A

middle aged dog, parasitic infection, causes hemoptysis and pulm hemorrhage

377
Q

Define volutrauma

A

alveolar overdistension

378
Q

Define barotrauma

A

mechanical disruption of pulmonary tissues as result of pressure

379
Q

Define atelectrauma

A

Repetitive alveolar opening and collapse of alveoli

380
Q

Difference b/t VILI and VALI

A

Induced vs associatedVILI based on histopath, research settingVALI clinical syndrome, live patients

381
Q

Why start heparin 3-4 d before warfarin?

A

Avoid hypercoagulable state thru inactivation of protein C with warfarin therapy

382
Q

Carboxyhemoglobin shifts OD curve to….

A

left

383
Q

Binding affinity of CO to Hgb

A

240X greater than oxygen

384
Q

3 possible outcomes from CO poisoning

A
  1. Complete recovery with transient hearing loss2. Recovery with permanent CNS effects3. Death
385
Q

Hydrogen cyanide gas effects

A

nonirritant but interferes with utilization of oxygen by cellular cytochrome oxidase, causing histotoxic hypoxia

386
Q

What gases can be inhaled during fire?

A

COShort-chain aldehydes (convert to acid in resp tract - oxides of sulfur and nitrogen)Water soluble (ammonia, HCl)benzene (from plastics)

387
Q

What reduces lung compliance from smoke inhalation?

A

alveolar atelectasispulmonary edema

388
Q

DDx for hyperemia in smoke inhalation

A
  1. carboxyHgb2. cyanide toxicosis3. systemic vasodilation4. local vasodilation from mucosal injury
389
Q

Reduction in a-v oxygen gradient may be suggestive of… (in smoke inhalation)

A

HCN toxicity

390
Q

Excessively high plasma lactate levels at admission are a sensitive indicator of ___ toxicity in humans (smoke inhalation)

A

HCN

391
Q

The half life of CO is about ___ minutes in patients with normal respiraotry exchange on room air, but is reduced to ___ to ___ minutes with an FiO2 of 100%

A

250 minutes25-150 minutes

392
Q

How do you treat HCN toxicity?

A

IV sodium nitrite followed by IV sodium THIOSULFATESodium nitrite may not be great for smoke inhalation b/c causes methemoglobinemia which will worsen O2 carrying capacity

393
Q

3 mechanisms for atelectasis

A

compression, oxygen adsorption, depletion of surfactant

394
Q

What is the primary collapsing force on the alveoli?

A

surface tension

395
Q

What are the four opposing distending forces of the alveoli?

A

transpulmonary pressuretethering effect of surrounding structuressurfactantgaseous nitrogen skeleton

396
Q

Why does adsorption atelectasis occur more rapidly in patients breathing oxygen enriched air?

A

Nitrogen skeleton is diminished or absent; the nitrogen skeleton usually provides support preventing collapse

397
Q

What lung lobes are thought to be more at risk of atelectasis based on higher pleural surface to volume ratio?

A

right middle, left upper lobe

398
Q

VAP definition

A

Pneumonia developed > 48 h after initiation of IPPV

399
Q

Sumner, JVECC, 2011. Deep oral swabs for pneumonia….findings.

A

No good for puppy pneumonia, community acquired pneumonia, 40-50% agreement with hospital acquired pneumonia.

400
Q

Compliance equals =

A

change in volume over change in pressure

401
Q

What are the 4 types of PV dyssynchrony?

A

triggerflowcycle (breath termination)expiratory

402
Q

List the 4 types of hypoxia

A

hypoxic, anemic, stagnant, histotoxic

403
Q

Canine influenza strain

A

H3N8 - Greyhounds - FloridaDiagnosis difficult b/t viral shedding peaks during incubation 2-5 days, but when dogs become sick, not enough time for antibodies and viral isolation may be minimal b/c shedding decreased at this time

404
Q

Sepsis and SIRS cats, JAVMA, 2011, DeClue, findings:

A
  1. Sepsis: high bands, eosinopenia, hyponatremia, hypochloremia, hypoalbuminemia, hypocalcemia, hyperbilirubinemia2. When sepsis/SIRS compared = only * diff were bands and albumin3. Cats with sepsis * higher TNF than healthy cats and more likely to have detectable IL-6 than SIRS or healthy cats4. CXCL-8 not detectable in most cats5. No diff in mortality b/t sepsis or SIRS6. Variables correlated with nonsurvival in sepsis: IL-1B, IL-6, chloride7. Cats with SIRS had higher ALP8. # SIRS criteria fulfilled not associated with outcome
405
Q

DeClue, What mediators prominent in early vs. maintenance inflammatory phase?

A

TNF-a and IL-1B (early)IL-6 and CXCL-8 (maintenance)

406
Q

SIRS criteria cats.

A

T103.5HR 225RR >40WBC 19.5, or >5% bands

407
Q

Effect of oxyglobin in hypotensive cats, JAVMA, 2011, Wehausen.

A

SAP increased >80 mm Hg in 75% cats; increased >20 mm Hg above baseline in 29/33 cats, mean SAP during CRI 92

408
Q

Adverse effects oxyglobin hypotensive cats, JAVMA, 2011

A

respiratory changes, vomiting, pigmented urine (30/33 cats)

409
Q

Was NT-proBNP able to differentiate b/t CHF and nonCHF for moderate to severe pleural effusion in cats? Hassdenteufel, JVECC, 2013

A

Yes, cutoff 258 pmol/L

410
Q

What is airway pressure release ventilation?

A

Open lung ventilation, high CPAP maintained and patient allowed to breath spontaneously

411
Q

Most common causes of pneumomediastinum in cats (most common to least common)?JVECC, 2013

A
  1. Endotracheal intubation and PPV2. Spontaneous3. Trauma4. Tracheal FB50% had pneumothorax and pneumoretroperitoneum22% had pleural effusion

Auburn ECC (26 decks)

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