Respiratory AI Flashcards
1
Q
What are some of the diseases/problems that can lead to the accumulation of protein-rich fluid in the alveoli?
A
Some of the diseases/problems that can lead to the accumulation of protein-rich fluid in the alveoli include aspiration of gastric content, severe upper-airway obstruction, electric shock, seizures, pancreatitis, smoke inhalation, and DIC.
2
Q
What is the difference between cardiogenic and non-cardiogenic pulmonary edema in dogs?
A
Cardiogenic edema is typically seen in the perihilar region while non-cardiogenic edema is more frequent in the caudodorsal regions or, if due to aspiration, in the cranioventral regions.
3
Q
What is the recommended treatment for non-cardiogenic pulmonary edema (NCPE)?
A
Control of the underlying disease/cause is essential in the process of trying to tackle NCPE. Supportive therapy, including oxygen supplementation, is indicated. There is limited evidence that other drugs such as diuretics, inotropes or corticosteroids work. In more severe cases, mechanical ventilation might be necessary.
4
Q
What is acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) associated with?
A
ALI and ARDS are associated with inflammation and changes in alveolocapillary membrane, leading to the accumulation of protein-rich fluid in the alveoli.
5
Q
What is the treatment for pulmonary haemorrhage or contusion?
A
Treatment is largely supportive with oxygen supplementation (minimizing stress as much as possible), analgesia, judicious fluid therapy +/- others as needed on a case-by-case basis. Antibiotic use is not routinely recommended unless there is a bacterial pneumonia associated with the contusion.
6
Q
What are some causes of non-traumatic pulmonary hemorrhage?
A
Some causes of non-traumatic pulmonary hemorrhage include infectious causes (leptospirosis and Angiostrongylus infection), coagulation anomalies, pulmonary hypertension, neoplasia, lung lobe torsion, vigorous exercise in racing dogs, and iatrogenic (e.g. lung mass aspiration).
7
Q
What are the common presenting signs for both primary and metastatic neoplasia in the lung?
A
Coughing is a common presenting sign for both primary and metastatic neoplasia. Older animals are more frequently affected and usually have other chronic non-respiratory systemic signs such as reduced appetite and weight loss.
8
Q
What are the radiographic findings of metastatic pulmonary disease in dogs and cats?
A
In dogs, metastatic pulmonary disease is often seen as multiple, discrete nodules of variable sizes or alternatively a diffuse interstitial pattern. In cats, the findings can range from ill-defined nodules to a diffuse alveolar pattern. Pleural effusion may be present concurrently.
9
Q
What are some possible causes of unilateral nasal discharge in dogs?
A
Possible causes of unilateral nasal discharge in dogs include foreign body, trauma, tooth root abscess, early fungal infection, neoplasia, and coagulopathy.
10
Q
How can nasal airflow be assessed in dogs?
A
Nasal airflow in dogs can be assessed by holding a refrigerated microscope slide in front of each nostril to check for fogging of the glass or by placing a wisp of cotton from a cotton ball in front of each nostril to observe movement.
11
Q
What is a specific feature of canine sinonasal aspergillosis?
A
Nasal depigmentation is a relatively specific feature of canine sinonasal aspergillosis, occurring in about 40% of the cases due to the toxins produced by Aspergillus.
12
Q
Why is it important to evaluate the dental arcade and teeth during a physical examination?
A
Evaluating the dental arcade and teeth is important because dental-related nasal disease is usually related to the canine or carnassial teeth. Tooth root disease can be present without external evidence of it.
13
Q
What is dyspnoea and how is it clinically observed in our patients?
A
Dyspnoea is the feeling of shortness of breath or breathlessness. Clinically, respiratory distress is observed in patients with dyspnoea. Patients in respiratory distress may refuse to lie down, stand with abducted elbows, have extended necks, and exhibit marked flaring of the nares.
14
Q
What is the importance of minimal restraint and avoiding head and neck manipulation in dyspnoeic patients?
A
Minimal restraint and avoiding head and neck manipulation are critical in dyspnoeic patients as they are fragile and stressful handling, especially in cats, can lead to cardiopulmonary arrest.
15
Q
What should be done immediately when faced with a patient in respiratory distress?
A
When faced with a patient in respiratory distress, immediate oxygen supplementation should be started while assessment is underway.
16
Q
What should be considered when assessing respiratory patterns and lung sounds in cats?
A
When assessing respiratory patterns and lung sounds in cats, it should be noted that they are more subtle compared to dogs. Cats can mask significant changes despite significant disease and decompensate quickly when handled.
17
Q
Define chronic bronchitis.
A
Chronic bronchitis is defined as an inflammatory disorder of the lower airways that causes a daily cough and for which other causes have been excluded.
18
Q
Define asthma.
A
Asthma is defined as a disease of the lower airways that causes airflow limitation (usually a combination of airway inflammation, accumulation of airway mucus, and smooth muscle contraction), which can resolve spontaneously or in response to treatment.
19
Q
What is the postulated hypersensitivity type responsible for asthma and chronic bronchitis?
A
The changes seen in asthma and chronic bronchitis are postulated to result from a type I hypersensitivity reaction within the airways.
20
Q
What are some clinical signs of asthma and chronic bronchitis?
A
Some clinical signs of asthma and chronic bronchitis include chronic coughing, wheezes, tachypnea, and acute respiratory distress.
21
Q
What are some radiographic changes associated with asthma and chronic bronchitis?
A
Radiographic changes associated with asthma and chronic bronchitis include a bronchial pattern, alveolar pattern areas, lung hyperinflation, and evidence of hyperinflation (presence of the diaphragmatic crus at the level of L1-L2).
22
Q
What should be considered as a potential differential prior to diagnosing chronic lower airway disease?
A
Parasitic disease should be considered as a potential differential prior to diagnosing chronic lower airway disease.
23
Q
What is the recommended treatment for cats with frequent clinical signs (1-2 times per week) of chronic bronchitis?
A
Prednisolone has traditionally been the treatment of choice for cats with frequent clinical signs (1-2 times per week) of chronic bronchitis.
24
Q
What are some potential side effects of long-term treatment with prednisolone?
A
Potential side effects of long-term treatment with prednisolone include weight gain, possible diabetes mellitus, or iatrogenic hyperadrenocorticism.
25
What are the three stages of laryngeal collapse?
Stage 1 involves laryngeal cartilage fatigue and degeneration, leading to partial laryngeal collapse. Stage 2 includes further reduction of the lumen of the larynx, and Stage 3 is the most advanced stage with complete laryngeal collapse.
26
What is the controversial treatment for laryngeal collapse?
The removal of the laryngeal saccules is controversial, as it has been associated with increased pre-operative complications and should be considered on a case-by-case approach.
27
What is the most common type of neoplasia in the larynx of dogs and cats?
Squamous cell carcinoma and lymphoma are the most common types of neoplasia in the larynx of dogs and cats.
28
What is the group of abnormalities that result in upper airway obstruction known as?
The group of abnormalities that result in upper airway obstruction is known as brachycephalic obstructive airway syndrome (BOAS).
29
What are some of the congenital abnormalities associated with brachycephalic syndrome?
Some of the congenital abnormalities associated with brachycephalic syndrome are stenotic nares, shortening and flattening of the nasal cavity and pharynx, elongation and thickening of the soft palate, and possible tracheal hypoplasia.
30
What are some acquired abnormalities that can occur in cases of brachycephalic obstructive airway syndrome?
Acquired abnormalities that can occur in cases of brachycephalic obstructive airway syndrome include oedema and further thickening of the soft palate, eversion of the laryngeal saccules, oedema of the pharyngeal and laryngeal mucosa, enlargement of the tonsils, and progressive laryngeal dysfunction that can culminate in laryngeal collapse.
31
Which breeds are most commonly affected by brachycephalic obstructive airway syndrome?
English Bulldog, Pug, Boston Terrier, Shih Tzu, and Persians are breeds most commonly affected by brachycephalic obstructive airway syndrome, although it can occur in other breeds as well.
32
What surgical treatments are recommended for brachycephalic obstructive airway syndrome?
Surgical treatment includes correction of stenotic nares, resection and thinning of the soft palate, and resection of the everted laryngeal saccules.
33
What is the most common disease in the group of lung diseases mentioned in the course notes?
Eosinophilic bronchopneumopathy (EBP)
34
What are the clinical signs exhibited by patients with Eosinophilic bronchopneumopathy?
Coughing, retching, increased respiratory effort, and dyspnoea
35
What imaging findings are reported in cases with Eosinophilic bronchopneumopathy?
Moderate to severe diffuse bronchoalveolar pattern, alveolar pattern, bronchiectasis, peribronchial cuffing, nodular pattern, and bronchial obstruction with fluid or tissue
36
What is the main differential diagnosis for Eosinophilic bronchopneumopathy?
Angiostrongylus infection, Dirofilaria infection pulmonary migration of parasites, and eosinophilic bronchopneumopathy
37
What is the treatment for Eosinophilic bronchopneumopathy?
Corticosteroid treatment, with the clinical signs usually disappearing within 1 week. In some cases, low-dose long-term medication may be necessary.
38
What is the most common interstitial lung disease mentioned in the course notes?
Idiopathic pulmonary fibrosis (IPF)
39
What are the clinical signs exhibited by patients with Idiopathic pulmonary fibrosis?
Chronic history of coughing, exercise intolerance, tachypnea, and sometimes a right-sided systolic murmur if secondary pulmonary hypertension developed
40
What are the treatment options for Idiopathic pulmonary fibrosis?
Treatment options are limited, and if there is secondary pulmonary hypertension, treatment should be initiated. Prognosis is guarded.
41
What is Pulmonary thromboembolism (PTE) and how can it occur?
PTE is a condition in which a blood clot obstructs the pulmonary artery or its branches. It can occur if there is at least one of the three key elements of Virchow's triad: blood stasis, hypercoagulability, or vascular wall injury.
42
What are some common diseases causing upper airway disease?
Some common diseases causing upper airway disease include laryngeal paralysis, tracheal collapse, and brachycephalic syndrome.
43
What are the major methods of thermoregulation, especially in dogs?
The major method of thermoregulation, especially in dogs, is panting.
44
Which drug is commonly used in patients with respiratory distress?
Butorphanol is the most commonly used drug in patients with respiratory distress.
45
When should rapid induction for endotracheal intubation or tracheostomy be performed?
Rapid induction for endotracheal intubation or tracheostomy should be performed if anti-anxiety medication and supportive treatment doesn't improve/resolve respiratory distress or if the patient is thought to be at risk of imminent arrest.
46
What are some abnormalities in the pleural cavity?
Some abnormalities in the pleural cavity include pleural effusion, pneumothorax, and space-occupying lesions such as neoplasia or diaphragmatic rupture.
47
What are the signs of pleural space disease?
Patients with pleural space disease typically have restrictive breathing (short, rapid, shallow breathing).
48
What are the diagnostic uses of thoracocentesis in cases with pleural effusion?
Thoracocentesis is not only therapeutic but also of diagnostic use in cases with pleural effusion as fluid analysis can help narrow down the differential diagnoses.
49
What should be performed as soon as possible to stabilize a patient suspected of having pleural effusion or pneumothorax?
Thoracocentesis should be performed as soon as possible to stabilize a patient suspected of having pleural effusion or pneumothorax.
50
What are some immediate complications of temporary tracheostomy?
Immediate complications of temporary tracheostomy can include plugging of the tube, patient removal of the tube, gagging, coughing, subcutaneous emphysema, pneumomediastinum, pneumothorax, infection, and respiratory distress.
51
Why is the rate of complications higher in cats compared to dogs after temporary tracheostomy?
The rate of complications is higher in cats (87%) compared to dogs due to cats forming more mucus than dogs, which can lead to more severe complications.
52
What is the most significant long-term complication of temporary tracheostomy?
The most significant long-term complication of temporary tracheostomy is the development of stenosis of either the site of the stoma, the site of the cuff, or the tube tip.
53
What is the average decrease in luminal area reported in dogs at 60 days after tube removal?
A study in dogs reported an average decrease in luminal area of 25% at 60 days after tube removal.
54
When can sedation be used in animals with respiratory distress?
Sedation can be used to improve the dynamic component of upper respiratory obstruction in conditions such as tracheal collapse, brachycephalic syndrome, and laryngeal paralysis.
55
What should be considered when administering sedation to animals with respiratory distress secondary to congestive heart failure?
The benefits vs side-effects must be weighed carefully when administering sedation to animals with respiratory distress secondary to congestive heart failure.
56
What is one commonly used drug for sedation in animals with respiratory distress?
Butorphanol is one of the drugs most commonly used for sedation in animals with respiratory distress.
57
How should hyperthermia be controlled in animals with respiratory distress?
Hyperthermia in animals with respiratory distress should be controlled through active cooling with room temperature fluid therapy, fans, and cool towels around the body.
58
What is the recommended treatment for patients diagnosed with laryngeal paralysis and hypothyroidism?
Patients diagnosed with laryngeal paralysis and hypothyroidism should be treated with thyroxine, although this does not usually improve the clinical signs associated with laryngeal paralysis.
59
What is the definitive diagnostic method for laryngeal paralysis?
The definitive diagnosis of laryngeal paralysis most commonly requires visual assessment of the larynx.
60
How can false positives due to anesthesia be ruled out during laryngeal paralysis diagnosis?
To rule out false positives due to anesthesia, it is important to have an assistant help identify the phase of the breathing cycle and avoid false positives caused by paradoxical movement of the arytenoid cartilages.
61
What emergency management measures should be taken for dogs in respiratory distress?
Emergency management of dogs in respiratory distress includes supplemental oxygen, sedation, and active cooling of hyperthermic patients.
62
When should a temporary tracheostomy tube be used in the treatment of laryngeal paralysis?
Placement of a temporary tracheostomy tube should be avoided unless it is not possible to successfully extubate the patient, as it is associated with higher post-surgical complication rates.
63
What are the goals of surgery for laryngeal paralysis?
The goals of surgery for laryngeal paralysis are to improve the size of the rima glottis to prevent severe respiratory distress and reduce stridor, although the patient is likely to continue coughing.
64
What percentage of dogs may experience post-operative aspiration pneumonia following laryngeal paralysis surgery?
Post-operative aspiration pneumonia has been reported in 8-19% of dogs who have undergone laryngeal paralysis surgery.
65
Why should dogs with laryngeal paralysis not go swimming?
Dogs with laryngeal paralysis should not go swimming because there is a risk of aspiration.
66
What were the types of heart disease observed in the cats referred for cardiac evaluation?
Most of the cats had some form of cardiomyopathy but some had other forms of heart disease (e.g., congenital heart disease).
67
What were the sensitivity and specificity values for the test used to identify cats with moderate-severe subclinical HCM?
The test was found to be 84% sensitive and 83% specific (accuracy 83%).
68
When can the NT-proBNP test be used?
The NT-proBNP test can be used to help strengthen (or weaken) other diagnostic findings, but should never be evaluated in isolation.
69
What are the types of drugs commonly used for treatment without achieving a definitive diagnosis?
The types of drugs commonly used are antibiotics, diuretics, bronchodilators, vasodilators, and glucocorticoids.
70
What are the potential complications associated with excessive use of diuretics?
Excessive use of diuretics can be associated with severe dehydration, electrolyte abnormalities (hypokalaemia, hyponatremia, and metabolic alkalosis), and pre-renal azotaemia.
71
What is the role of Pimobendan in treating congestive heart failure?
Pimobendan has inotropic and vasodilator properties and can help stabilize patients with congestive heart failure.
72
What are the bronchodilators commonly used for respiratory diseases?
Theophylline, terbutaline, and salbutamol are commonly used bronchodilators.
73
What should be considered for patients in severe respiratory distress that fail to respond to supportive treatment?
Intubation and IPPV (Intermittent Positive Pressure Ventilation) should be considered.
74
What are some points to inquire about when assessing a respiratory patient?
#NAME?
75
What are some physical examination points specifically relevant to the respiratory system?
#NAME?
76
How is respiratory effort classified?
Respiratory effort can be classified as inspiration, expiratory, or mixed.
77
What is stertor and what does it indicate?
Stertor is a low-pitched snoring sound generally associated with obstructive diseases affecting the nasal passages and nasopharynx. It is frequently encountered in brachycephalic breeds.
78
What is stridor and when is it heard?
Stridor is a high-pitched noise heard during inspiration, as there is rapid flow of air past a rigid obstruction. It is heard frequently with diseases affecting the larynx, laryngeal paralysis, laryngeal collapse, cervical tracheal collapse, and nasopharyngeal stenosis.
79
What is cyanosis and when is it visible?
Cyanosis is the greyish to purplish color of tissues that occurs due to the presence of deoxygenated hemoglobin. It is a late sign of hypoxemia and is visible when the amount of deoxygenated hemoglobin is above 3-5g/dL.
80
Why is auscultation essential in assessing patients?
Auscultation is essential in assessing patients as it allows for the evaluation of breath sounds and can provide important information about the condition of the respiratory system.
81
What is the purpose of using tubing held adjacent to or within 2cm of the patient's nostrils in an emergency?
The purpose is to provide oxygen supplementation to the patient during triage and assessment.
82
What is the recommended oxygen flow rate for delivering oxygen through a tight-fitting face mask?
The recommended oxygen flow rate is 2-5L/min.
83
What is one disadvantage of using oxygen hoods made in the hospital using cling film, tape, and a rigid Elizabethan collar?
One disadvantage is that incorrectly built collars can lead to carbon dioxide accumulation and hyperthermia.
84
How can oxygen concentration, humidity, and temperature be controlled for oxygen administration in cats?
Oxygen cages are available commercially and allow control over these parameters.
85
What is one potential problem with using oxygen cages?
Whenever the cage door is opened, the FiO2 quickly decreases.
86
When should placement of a nasal or nasopharyngeal catheter be considered for oxygen supplementation?
It should be considered when oxygen supplementation is needed for more than 24 hours.
87
What is the advantage of placing a catheter directly into the trachea (trans-tracheal oxygen supplementation)?
It is an effective means of administering increased FiO2 to patients that are intolerant to nasal or hood oxygen, and have upper airway obstruction.
88
How can a catheter be connected to a humidified source of oxygen during trans-tracheal oxygen supplementation?
It can be connected using a cut-off of a 1ml syringe or a Xmas tree.
89
What is the main function of the respiratory system?
The main function of the respiratory system is to supply oxygen to the cells in the body for aerobic respiration and remove carbon dioxide.
90
What are the structures that air passes through in the respiratory system?
Air passes through the nares, nasal cavity, pharynx, larynx, trachea, bronchi, and bronchioles.
91
What is the role of the pleural fluid?
The pleural fluid allows the visceral pleura and parietal pleura to slide over each other without friction, linking the thorax with the lungs.
92
Which muscle is the main inspiratory muscle?
The main inspiratory muscle is the diaphragm.
93
How does inspiration occur?
During inspiration, the diaphragm contracts and pulls caudally, increasing the intra-abdominal pressure, enlarging the thoracic cavity, and creating a negative pressure for air to move into the lungs.
94
What is the total arterial blood oxygen content dependent on?
The total arterial blood oxygen content is dependent on the concentration of hemoglobin, its degree of saturation, and the amount of oxygen dissolved in the blood.
95
What is hypoxia and hypoxemia?
Hypoxia is a decrease in the level of oxygen supply to the body tissues, while hypoxemia is the inadequate oxygenation of the arterial blood.
96
What are methods for evaluating the ability of the lungs to oxygenate arterial blood?
Arterial blood gas analysis and pulse oximetry are methods for evaluating the ability of the lungs to oxygenate arterial blood.
97
What are some common causes of Pulmonary Thromboembolism (PTE) in dogs?
Some common causes of PTE in dogs are immune-mediated haemolytic anaemia, sepsis, hyperadrenocorticism, and cardiomyopathy.
98
What are the most frequent culprits of PTE in cats?
In cats, neoplasia and cardiomyopathy are the most frequent culprits of PTE.
99
What are some features of the underlying disease often encountered on physical examination in patients with PTE?
Some features of the underlying disease often encountered on physical examination in patients with PTE are pale mucous membranes and a pot-bellied appearance.
100
What radiographic patterns can be seen in PTE?
In PTE, it is possible to see an alveolar pattern or blunting of the pulmonary vessels on radiographs.
101
What diagnostic technique is preferred for confirming a PTE diagnosis?
Thromboelastography is preferred for confirming a PTE diagnosis.
102
What is the preferred imaging technique for diagnosing PTE?
CT angiography is the technique of choice for diagnosing PTE, although it is rarely performed for this purpose in veterinary medicine.
103
What is the recommended treatment for PTE?
Treatment of PTE is largely supportive with medication to try to prevent further thromboembolic disease (e.g. low-molecular weight heparin or anti-platelet drugs) while also addressing the underlying cause.
104
When should prophylactic treatment for PTE be started?
Prophylactic treatment for PTE should be started if a patient is diagnosed with a disease that predisposes to it, as the prognosis for PTE is guarded.
105
What is the recommended rate of fluid administration in ml/kg/min?
The recommended rate of fluid administration is 50-100mls/Kg/min.
106
How should the catheter be secured to the neck?
The catheter should be secured to the neck with lengths of white tape.
107
What technique can be used to keep excess skin out of the way during catheter placement?
Horizontal mattress sutures can be used to keep excess skin out of the way during catheter placement.
108
What is the range of achievable inspired oxygen (in %) for an oxygen cage?
The achievable inspired oxygen for an oxygen cage ranges from 21% to 60%.
109
What is the mean FiO2 achieved with positive pressure ventilation?
The mean FiO2 achieved with positive pressure ventilation is 21-100%.
110
Why is a FiO2 below 50% usually chosen for patients that require oxygen supplementation for a reasonable period of time?
A FiO2 below 50% is usually chosen to avoid oxygen toxicity.
111
What should be performed if clearing the airway is not possible for patients with upper airway obstruction?
If clearing the airway is not possible, endotracheal intubation should be performed to secure the airway and ventilation.
112
What factors are considered when selecting an antibiotic for a patient?
The patient's overall health status is usually considered when selecting an antibiotic.
113
Which antibiotics may be adequate for cases of mild disease?
Oral trimethoprim/sulphonamide, doxycycline, cephalexin, or potentiated amoxicillin may be adequate for cases of mild disease.
114
What type of treatment is recommended for patients with severe disease?
Patients with severe disease would benefit from intravenous antibiotics and other supportive treatment.
115
When should the simultaneous use of 2 or more antibiotics be reserved?
The simultaneous use of 2 or more antibiotics should be reserved for individual selected cases where there is very severe disease, especially when culture and sensitivity is not possible.
116
What is the minimum period of treatment for most cases?
The minimum period of treatment should be 10 days, although a much longer course is advisable in most cases.
117
How long should patients with recurrent pneumonia or a known underlying disorder be treated?
Patients with recurrent pneumonia or a known underlying disorder should be treated for 4 to 6 weeks as a minimum.
118
When should antibiotic therapy ideally be discontinued?
Antibiotic therapy should be discontinued based on documentation of radiographic resolution of the problem; continue antibiotics for 1 to 2 weeks after Xrays back to normal.
119
What treatment is usually not indicated for patients with bacterial pneumonia?
The use of mucolytics (e.g. N-acetylcysteine) is usually not indicated for patients with bacterial pneumonia.
120
What is the stress caused by thoracic radiographs in patients with respiratory distress?
Stressful procedure that can cause significant decompensation.
121
How many views of the thorax should be obtained in a patient who is stabilized?
At least two views, ideally three views.
122
What does TFAST stand for?
Thoracic focused assessment with sonography for trauma.
123
What are the 5 points used for TFAST3 exam?
Chest tube site (CTS) right, Chest tube site (CTS) left, Pericardial site (PCS) right, Pericardial site (PCS) left, Diaphragmatico-hepatic site (DH).
124
What is the best use of CTS views in TFAST3?
Ruling out pneumothorax and surveying for possible lung pathology.
125
What does DH assess in TFAST context?
Presence of pleural fluid, pericardial fluid, and diaphragmatic rupture.
126
What is VetBLUE used for?
Extending thoracic ultrasound to non-trauma patients with extra points of assessment of the thorax.
127
Why is the placement of an intravenous catheter important in dyspnoeic patients?
Allows administration of IV medication and a route to administer fast acting drugs if necessary.
128
What is the purpose of performing a thoracic focused assessment with sonography in trauma (TFAST)?
It can provide valuable information about the patient's condition.
129
When should a TFAST be performed?
It can be performed with the patient in sternal recumbency or standing, but training and experience are needed to use it effectively.
130
What should be done if further diagnostics are not deemed safe for an unstable patient?
Empirical treatment should be instituted.
131
When can diagnostic tests be performed?
They can be performed when the patient is stable to help achieve a diagnosis or confirm clinical suspicion.
132
Why is it important to observe the breathing pattern in dyspnoeic patients?
Observing the breathing pattern can aid in localizing the pathology and help select a more targeted treatment.
133
What is the normal respiratory rate in a patient?
The normal respiratory rate is 10-30 breaths per minute with expiration being slightly longer than inspiration (ratio inspiration:expiration of 1:1.3).
134
What are the obstructive and restrictive breathing patterns seen in dyspnoeic patients?
Obstructive breathing patterns are slower and deeper breaths, while restrictive patterns are short, rapid, and shallow breaths.
135
What is paradoxical breathing and what conditions is it associated with?
Paradoxical breathing is the decreased chest wall movement and inward movement of the abdomen during inspiration. It is most frequently seen in patients with pleural disease and thoracic wall disease.
136
Why is pain management important in patients with hypoventilation?
Pain has a significant impact on the ventilation status.
137
What is the term used to describe when an animal with flail chest has a segment of the hemithorax moving paradoxically during breathing?
Flail chest
138
What are the common signs seen in patients with small airway disease?
Marked expiratory effort, wheezes and/or crackles on auscultation.
139
What are the treatment options for patients with small airway disease?
Bronchodilators (terbutaline IV or SC) and short-acting corticosteroids.
140
What types of diseases affect the pulmonary parenchyma?
Problems affecting the alveolar ducts, the alveoli, the pulmonary vasculature, and the pulmonary interstitium.
141
How can imaging help in diagnosing the cause of respiratory distress in a stable patient?
Imaging can help dramatically narrow down the potential cause.
142
What are the most common causes of pulmonary parenchymal disease?
A. Pneumonia (bacterial, viral, parasitic, etc) B. Cardiogenic pulmonary edema C. Non-cardiogenic pulmonary edema
143
What treatment should be started if cardiogenic pulmonary edema is suspected?
Treatment with diuretics, pimobendan +/- other drugs.
144
What is the name of the curve that plots the relationship between SpO2 and PaO2?
The curve is named the oxygen-haemoglobin dissociation curve.
145
What shape does the oxygen-haemoglobin dissociation curve have?
The curve has a sigmoid shape.
146
What important characteristic does the right side of the oxygen-haemoglobin dissociation curve have?
Small changes in SpO2 are associated with large changes in PaO2 on the right side of the curve.
147
What is the approximate SpO2 value when PaO2 is around 60mmHg?
The SpO2 is still around 90%.
148
Can SpO2 measurements discriminate PaO2 values above 100?
No, SpO2 measurements can't discriminate PaO2 values above 100.
149
What is the gold-standard for assessing arterial carbon dioxide (PaCO2)?
Arterial blood gases are the gold-standard for assessing PaCO2.
150
What is the expected difference between venous PCO2 and PaCO2?
The venous PCO2 is expected to be 3-6mmHg higher than PaCO2.
151
What concentration of PaCO2 is defined as hypercapnia in a cat?
Hypercapnia is defined as a PaCO2 >36mmHg in a cat.
152
What is a potential treatment option for reducing eosinophilic inflammation in experimental studies?
Cyproheptadine
153
In which situations can cyproheptadine be effective?
When combined with prednisolone
154
What is the current recommendation for monotherapy with cyproheptadine?
It cannot be recommended
155
What is the reported effectiveness of cyclosporin for treating eosinophilic inflammation?
Conflicting results
156
What methods have been assessed experimentally for allergen-specific immunotherapy?
Intradermal skin testing and allergen-specific serum IgE
157
What is the limitation of intradermal skin testing for airway hypersensitivity?
High sensitivity but lower specificity
158
How should a fragile cat with an acute asthmatic crisis be handled?
Minimal handling is important
159
What supplementary treatment should be provided to a cat with an acute asthmatic crisis?
Supplemental oxygen
160
What are adventitious lung sounds?
Adventitious lung sounds are wheezes and crackles.
161
What can adventitious lung sounds indicate?
Adventitious lung sounds can indicate the presence of disease.
162
How are wheezes defined?
Wheezes are defined as musical sounds generated by airway narrowing, stenosis, or obstructions.
163
How are crackles defined?
Crackles are defined as short, explosive, non-musical sounds produced by a delayed opening of small airways.
164
What can cause crackles?
Crackles can be caused by pneumonia, pulmonary edema, and bronchitis.
165
Does the presence of a heart murmur always indicate cardiac disease?
No, the presence of a heart murmur doesn't necessarily mean coughing is secondary to cardiac disease.
166
What does the absence of a heart murmur not rule out?
The absence of a heart murmur does not rule out significant cardiac disease, especially in cats.
167
What does a gallop rhythm indicate?
A gallop rhythm should increase suspicion of significant cardiac disease.
168
What are the signs that are not consistent with congestive heart failure in coughing small breed dogs with a heart murmur?
The signs that are not consistent with congestive heart failure in coughing small breed dogs with a heart murmur are bright, alert, not dyspnoeic, and present an obvious sinus arrhythmia.
169
Why should cardiac disease in dogs with a heart murmur not be ignored?
Cardiac disease in dogs with a heart murmur should not be ignored because it is a potential risk factor for anesthesia, which is almost invariably necessary to continue the investigation of respiratory causes of coughing.
170
Is coughing a feature seen in cardiac disease in cats?
No, coughing is not a feature seen in cardiac disease in cats.
171
According to the course notes, what approach does the author prefer when listing the causes of coughing in dogs and cats?
According to the course notes, the author prefers to start with a more anatomy-based approach when listing the causes of coughing in dogs and cats.
172
What factors should be taken into account when considering the duration of clinical signs in coughing dogs and cats?
When considering the duration of clinical signs in coughing dogs and cats, the factors that should be taken into account are the differential diagnosis for acute coughing (less extensive) and chronic coughing (more extensive).
173
What are the most common causes of acute coughing in dogs and cats?
The most common causes of acute coughing in dogs and cats are kennel cough, laryngeal or tracheal trauma, acute non-infectious tracheitis, foreign body in the upper airway, lower airway disease, pulmonary parenchyma diseases (such as aspiration pneumonia, infectious pneumonia, non-cardiac pulmonary edema), and exacerbation of chronic 'compensated' cardiac or respiratory disease.
174
What causes stimulate the cough receptors in dogs and cats with chronic coughing?
The causes that stimulate the cough receptors in dogs and cats with chronic coughing include inflammatory, infectious, or neoplastic processes in the respiratory areas mentioned earlier.
175
What are the initial steps of the investigation of coughing in patients?
The initial steps of the investigation of coughing in patients include anamnesis (patient history), physical examination, and direct visual inspection of the pharynx to assess for the presence of changes (e.g., inflammation and masses) in all structures including the tonsils.
176
Where is the urinary catheter inserted during bronchoalveolar lavage?
The urinary catheter is inserted into the trachea at the level of the crycothyroid ligament and fed down to the level of the carina.
177
What type of fluid is used for infusion and aspiration during bronchoalveolar lavage?
Warm sterile 0.9% saline is used for infusion and aspiration during bronchoalveolar lavage.
178
What are the possible causes of eosinophilic inflammation in bronchoalveolar lavage samples?
Eosinophilic inflammation in bronchoalveolar lavage samples may suggest allergic bronchitis, parasitic disease, or eosinophilic lung disease.
179
What complications can be associated with fine needle aspiration (FNA) of the pulmonary parenchyma?
Complications associated with fine needle aspiration (FNA) of the pulmonary parenchyma include pneumothorax and haemothorax.
180
Which technique is often used for obtaining biopsies of intra-thoracic organs?
Thoracotomy is often used for obtaining biopsies of intra-thoracic organs.
181
What is the cause of tracheal collapse?
The cause of tracheal collapse is unknown but is thought to involve both a primary cartilage abnormality and secondary factors.
182
What happens to the tracheal lumen in tracheal collapse?
Tracheal collapse usually results in dorsoventral flattening of the tracheal lumen.
183
What is the purpose of bronchoscopy?
The purpose of bronchoscopy is to perform an endoscopic examination of the respiratory system for diagnostic purposes.
184
Why is general anesthesia required for bronchoscopy?
General anesthesia is required for bronchoscopy to ensure patient comfort and cooperation during the procedure.
185
What is the main landmark used for orientation during bronchoscopy?
The dorsal tracheal membrane is the main landmark used for orientation during bronchoscopy.
186
What is the significance of using a side connector (Cobb connector) during bronchoscopy?
Using a side connector (Cobb connector) helps provide the patient with oxygen and maintain anesthesia with volatile agents during bronchoscopy.
187
What should be inspected during bronchoscopy?
During bronchoscopy, the airways should be inspected for changes in mucosal color, secretions, masses, foreign bodies, and the presence of collapse.
188
What is the recommended technique for sampling the intra-thoracic respiratory tract?
Bronchoscopy-assisted BALs (bronchoalveolar lavage) are the best routine technique for sampling the intra-thoracic respiratory tract.
189
What complications can arise during or after bronchoscopy?
Complications of bronchoscopy can include pneumothorax secondary to airway rupture and potentially life-threatening bronchoconstriction in cases of feline lower airway disease.
190
When is trans-tracheal wash (TTW) performed?
Trans-tracheal wash (TTW) is performed when general anesthesia is contraindicated or endoscopy is not available to obtain fluid washes from the large airways.
191
What are some preparations commonly used to reduce expiratory collapse of the trachea?
The preparations most used are theophylline, terbutaline, and salbutamol.
192
Why should the use of Beta-blockers be considered carefully in patients with concurrent congestive heart failure?
The use of Beta-blockers should be considered carefully in patients with concurrent congestive heart failure due to potential risks and interactions.
193
What is the importance of glucocorticoids in chronic inflammation?
Glucocorticoids can be invaluable in breaking the cycle of chronic inflammation.
194
What are the potential risks of chronic oral treatment with glucocorticoids?
Chronic oral treatment with glucocorticoids can exacerbate bacterial infection, promote tachypnoea, and promote weight gain.
195
When should inhaled fluticasone be considered?
Inhaled fluticasone should be considered if the use of corticosteroids is thought to be needed.
196
What are the considerations for using intra-luminal stents in severe cases of airway collapse?
In cases that are very severe or those where medical treatment fails, the use of intra-luminal stents can be considered. However, the use of stents should be carefully considered on a case-to-case basis, as other airways may also collapse.
197
What long-term complications can occur after surgery and stenting?
Surgery and stenting have relatively high perioperative mortality rates of 5-10% and long-term complications have also been reported.
198
What is the definition of canine chronic bronchitis?
Canine chronic bronchitis is characterized by airway inflammation and results in chronic coughing.
199
What is the purpose of coughing?
Coughing is a protective mechanism to expel secretions from the airways and prevent inhalation of foreign bodies.
200
How can coughing be stimulated?
Coughing can be stimulated by mechanical or chemical irritation of cough receptors located in the pharynx, larynx, trachea, bronchi, and smaller airways.
201
Where are cough receptors located?
Cough receptors are located on the pharynx, larynx, trachea, bronchi, and smaller airways, but not on the more distal airways or alveoli.
202
Which areas have a higher density of cough receptors?
The upper airways have a higher density of cough receptors compared to the lower airways.
203
What are some triggers or worsening factors that can cause coughing?
Triggers or worsening factors for coughing include smokers in the house, fireplace cleaning, carpet changes, significant house renovation, and exposure to irritants like smoke or dust.
204
Why is signalment and history important in diagnosing the nature of the cough?
Signalment and history can help establish the nature of the cough and identify potential triggers or worsening factors.
205
What other clinical signs should be considered for localization of cough?
Other clinical signs relevant to localization of cough include abnormal breathing noises (stertor, stridor, or wheeze), sneezing, reverse sneezing, terminal retching, and increased respiratory rate or effort.
206
How can coughing be elicited in most cases?
In most cases, coughing can be elicited by gently palpating the trachea.
207
What are some clinical signs of feline lungworm infection?
Coughing, dyspnoea, and wheezing
208
How can the presence of Angiostrongylus infection be diagnosed?
By identification of L1 stage larva in the respiratory tract (BAL/TW) or faeces (Baerman)
209
What are the treatment options for Angiostrongylus infection?
Moxidectin (Advocate, Prinovox, Endectrid), milbemycin oxime (Milbemax), or fenbendazole
210
What is the suspected cause of eosinophilic bronchopneumopathy?
Immunologic hypersensitivity
211
Which breeds are commonly affected by eosinophilic bronchopneumopathy?
Nordic breeds such as Siberian Huskies and Alaskan Malamutes
212
What are some clinical signs of eosinophilic bronchopneumopathy?
Coughing, retching, increased respiratory effort, dyspnoea, and possible concurrent nasal discharge
213
How is eosinophilic bronchopneumopathy diagnosed?
Based on diagnostic imaging, bronchoscopic findings, and demonstration of an eosinophilic infiltrate on BAL's after excluding other causes
214
What is the recommended treatment for eosinophilic bronchopneumopathy?
Corticosteroid treatment
215
What is the function of the larynx?
The larynx regulates airflow, helps protect the airways during swallowing, and is involved in the sound of voice.
216
Why is it important to assess the larynx in patients undergoing general anesthesia?
To ensure proper laryngeal function and prevent aspiration during anesthesia.
217
What is the preferred anesthesia plane for assessing laryngeal function?
A light anesthesia plane is preferable as a deep plane paralyzes the intrinsic laryngeal muscles and hinders assessment.
218
What is the significance of arytenoid abduction in dogs with laryngeal paralysis?
Arytenoid abduction is reduced or absent during the inspiratory phase in dogs with laryngeal paralysis.
219
Why is careful examination of arytenoid movement necessary?
Paralyzed vocal folds often show paradoxical movement, where they move apart passively due to expiratory airflow.
220
What imaging technique is recommended to assess the upper airways?
Radiographs, particularly extended inspiratory lateral views of the neck and thoracic radiographs.
221
What is the role of fluoroscopy in diagnosing airway collapse?
Fluoroscopy can assess the presence of airway collapse without using general anesthesia.
222
When is a CT scan recommended in the investigation of intra-thoracic disease?
A CT scan is recommended when more detailed information and surgical planning are required.
223
What does a cough suggest when the trachea is palpated?
Tracheal irritation/inflammation
224
What is the importance of physical examination in coughing patients?
To help determine the appropriate diagnostic tests and the severity of disease
225
What are the common clinical signs to determine the severity of disease in coughing patients?
The presence or absence of tachypnoea, dyspnoea, cyanosis, and pyrexia
226
What are the primary causes of upper airway problems in animals with noisy breathing during inspiration?
Most commonly upper airway problems
227
What is the common pathology in patients with significant expiratory effort?
Intra-thoracic pathology such as chronic bronchitis
228
What can the lack of compressible cranial thorax in a patient raise suspicion of?
The presence of a cranial mediastinal mass
229
Is the presence of a heart murmur conclusive of coughing being secondary to cardiac disease?
No, it doesn't necessarily mean that
230
What can chronic respiratory disease lead to?
Pulmonary hypertension and right-sided heart disease
231
What is the treatment for idiopathic pulmonary fibrosis (IPF)?
There is no effective treatment for IPF.
232
Which animals are over-represented in idiopathic pulmonary fibrosis (IPF)?
West Highland Terriers and Cairn terriers.
233
What are the clinical signs of idiopathic pulmonary fibrosis (IPF)?
Significant tachypnoea or dyspnoea, loud crackles on auscultation, and a radiographic interstitial pulmonary pattern.
234
What is the main differential diagnosis for idiopathic pulmonary fibrosis (IPF)?
Severe chronic bronchitis.
235
What is the role of bronchoscopy in diagnosing idiopathic pulmonary fibrosis (IPF)?
Bronchoscopy can help identify possible concurrent problems.
236
What is the benefit of a CT scan in detecting interstitial changes in idiopathic pulmonary fibrosis (IPF)?
CT scan has increased sensitivity for detection of interstitial changes.
237
Is inhaled medication a long-term management option for all animals with respiratory issues?
No, some animals don’t seem able to be managed long term on inhaled medication.
238
What is the typical treatment approach for respiratory conditions requiring corticosteroids?
Low-dose long-term medication is common and in some cases, it is possible to stop the corticosteroids.
239
What breeds are most commonly affected by tracheal collapse?
Toy Poodles, Yorkshire Terriers, Pugs, Pomeranian, Chihuahua
240
What factors may initiate the clinical syndrome of tracheal collapse?
Obesity, recent endotracheal intubation, cervical trauma, respiratory infection, cardiomegaly, inhalation of irritants/allergens
241
What is the most common clinical sign of tracheal collapse?
Coughing
242
What are potential exacerbating factors for coughing in tracheal collapse patients?
Exercise, excitement, pulling on the lead
243
What are some severe clinical signs that can be observed in tracheal collapse patients?
Tachypnoea, cyanosis, syncope, respiratory distress
244
Where is the area most commonly affected by tracheal collapse?
The thoracic inlet
245
What are some diagnostic methods used to confirm the diagnosis of tracheal collapse?
Endoscopy, fluoroscopy, radiographs, bronchoscopy
246
What are the initial management measures for tracheal collapse?
Weight reduction, treatment of concurrent disease, removal of inhaled allergens/irritants, replacement of collars for harnesses
247
What are some viral pathogens that can be involved in respiratory infections in dogs?
Canine respiratory coronavirus, canine herpesvirus, and canine influenza virus
248
What are the clinical signs associated with respiratory infections in dogs?
Purulent nasal discharge, coughing episodes, lethargy, reduced appetite, and pyrexia
249
What is the most severe form of respiratory disease in dogs?
Co-infection with Parainfluenza virus
250
What is the main method of bacterial persistence in respiratory infections?
Active attachment to cilia and ciliostasis
251
How long can shedding of respiratory pathogens last after infection?
Up to 14 weeks
252
What is the recommended treatment for respiratory infections in dogs?
Antibiotic treatment if systemic signs are present; doxycycline or potentiated amoxicillin are good choices for Bordetella infections
253
What is the duration of protection provided by intranasal vaccination against respiratory infections in dogs?
10-14 months, but in high-risk environments, vaccination every six months may be required
254
Why should the nose of the patient point downwards during the procedure?
The nose of the patient should point downwards to avoid blood migrating into the nasopharynx and possibly the airways.
255
What precaution should be taken to prevent severe bleeding post-biopsy?
Patients should have a mouth-pack placed to prevent severe bleeding post-biopsy.
256
What are some methods used to decrease/stop bleeding?
Some methods used to decrease/stop bleeding include cold-packs, topical adrenalin, or phenylephrine in cotton buds.
257
When is nasal flushing useful?
Nasal flushing is useful for attempting to retrieve a sample for cytology or histopathology and in clearing discharge or flushing out foreign bodies.
258
What species is involved in the vast majority of cases of sinonasal aspergillosis?
Aspergillus fumigatus is the species involved in the vast majority of cases of sinonasal aspergillosis.
259
What are the clinical signs of sinonasal aspergillosis?
Clinical signs of sinonasal aspergillosis include sneezing, profuse nasal discharge, epistaxis, and pain on palpation of the nose.
260
How is the diagnosis of sinonasal aspergillosis confirmed?
The diagnosis of sinonasal aspergillosis is confirmed by documenting the presence of widespread turbinate destruction with a cavernous appearance on rhinoscopy and the presence of off-white to grey colored fungal plaques on the mucosal surface.
261
What can cytology or histology of biopsy samples demonstrate in cases of sinonasal aspergillosis?
Cytology or histology of biopsy samples can demonstrate the presence of branching septated hyphae in cases of sinonasal aspergillosis.
262
What are the subtypes of traumatic pneumothorax?
The subtypes of traumatic pneumothorax are 'closed' and 'open'.
263
How does air enter the pleural cavity in open pneumothorax?
Air enters the pleural cavity in open pneumothorax through an injury in the thoracic wall.
264
What causes closed pneumothorax?
Closed pneumothorax is caused by rapid compression of the thorax against a closed glottis, resulting in alveolar disruption, lung laceration, ruptured bullae or blebs, or pneumomediastinum.
265
What is the treatment approach for pneumothorax where the source of leakage can spontaneously seal?
For pneumothorax where the source of leakage can seal spontaneously within 3 to 5 days, supportive treatment +/- placement of chest drains is needed.
266
What is tension pneumothorax?
Tension pneumothorax occurs when air enters the pleural space during inspiration but cannot exit during expiration, leading to a progressive increase in pneumothorax volume, hypoventilation, and decreased venous return.
267
What should be assumed for all trauma patients until proven otherwise?
All trauma patients should be assumed to have pneumothorax (and pulmonary contusions) until proven otherwise.
268
What is the common cause of diaphragmatic rupture after blunt trauma?
Diaphragmatic rupture is most often recognized after blunt trauma, when there is a rapid compression of the abdomen with force directed cranially.
269
What imaging techniques are commonly used for diagnosing diaphragmatic rupture?
X-rays, ultrasound, and CT scan are commonly used for diagnosing diaphragmatic rupture.
270
What is the definition of pneumomediastinum?
Pneumomediastinum is defined as the accumulation of air in the mediastinal space.
271
What are the possible causes of pneumomediastinum?
Pneumomediastinum can be caused by injury to the upper airways, oesophagus, alveoli, and skin in the cervical region.
272
What are some common causes of pneumomediastinum?
Tracheal injury from endotracheal intubation or overinflation of the cuff and trauma are some common causes of pneumomediastinum.
273
What should be monitored in patients with pneumomediastinum?
Patients with pneumomediastinum should be closely monitored for the development of respiratory distress due to pneumothorax.
274
Can pneumomediastinum lead to clinical signs?
The presence of pneumomediastinum per se doesn’t usually lead to clinical signs, but the patient may exhibit signs associated with the underlying cause and associated complications.
275
What additional condition can pneumomediastinum lead to?
In more marked cases, pneumomediastinum can lead to pneumothorax.
276
Is surgery always necessary for treating pneumomediastinum?
Depending on the cause, surgery may be needed to correct the underlying cause of pneumomediastinum. However, some cases don’t require specific treatment and the air is expected to reabsorb in 10-20 days.
277
What is the most common type of mediastinal neoplasia?
The most common types of mediastinal neoplasia are lymphoma and thymoma.
278
What is the recommended treatment for aspergillosis with erosion of the cribiform plate?
Treatment with topical clotrimazole is contra-indicated if there is erosion of the cribiform plate.
279
What is the reported success rate of topical clotrimazole for treating aspergillosis?
Topical clotrimazole has a reported success rate of around 90% with a single treatment.
280
When may a second treatment of topical clotrimazole be required for aspergillosis?
Some patients may require a second treatment of topical clotrimazole three weeks later.
281
What is the recommended treatment for refractory cases of aspergillosis?
Thorough debridement +/- local deposition of clotrimazole can be successful in refractory cases.
282
Why are systemic anti-fungals not recommended routinely for treating aspergillosis?
Systemic anti-fungals are not recommended routinely as they are not effective and can have significant side effects.
283
In which cases of chronic rhinitis are systemic anti-fungals such as itraconazole, fluconazole, and voriconazole used?
Cases with soft tissue involvement or cribiform plate erosion are candidates for systemic anti-fungal treatment.
284
How is chronic idiopathic rhinitis diagnosed?
Chronic idiopathic rhinitis is diagnosed by exclusion of other disease processes.
285
What are the proposed causes of chronic rhinitis?
Proposed causes of chronic rhinitis include allergy to inhaled substances and hypersensitivity to normal flora.
286
What are the different types of effusion that can result from the same disease process?
The different types of effusion that can result from the same disease process are exudate, modified transudate, and transudate.
287
What are the common causes of a transudate effusion?
The common causes of a transudate effusion are congestive heart failure and hypoalbuminemia.
288
What are the common causes of a modified transudate effusion?
The common causes of a modified transudate effusion are congestive heart failure, neoplasia, diaphragmatic rupture, and lung lobe torsion.
289
What are the common causes of an exudate effusion?
The common causes of an exudate effusion are neoplasia, lung lobe torsion, pyothorax, and Feline Infectious Peritonitis (FIP).
290
How can the presence of fluid in chronic effusions lead to an increase in total protein and nucleated cell count (TNCC)?
The presence of fluid in chronic effusions can lead to an increase in total protein and TNCC due to inflammation.
291
What biochemical tests can be helpful in diagnosing specific conditions related to pleural effusion?
Biochemical tests such as assessing albumin and globulins can help increase suspicion of FIP, while triglycerides can help diagnose chylothorax.
292
What are the characteristics of a pure transudate effusion?
The characteristics of a pure transudate effusion are low protein content (< 25 g/l) and a low nucleated cell count (< 1500/μl). The primary cell types are macrophages, lymphocytes, and mesothelial cells.
293
What are the characteristics of a modified transudate effusion?
The characteristics of a modified transudate effusion are slightly higher protein content (25-35 g/l) and higher cell count (1000-5000/μl). The main cell types seen are macrophages, lymphocytes, neutrophils, and mesothelial cells.
294
How are thymomas classified?
Thymomas can be classified as benign or malignant based on invasiveness and ability to achieve surgical resection.
295
What are some common paraneoplastic syndromes associated with thymomas?
Patients with thymomas commonly have paraneoplastic syndromes such as myasthenia gravis and megaoesophagus.
296
What are the different classes of drugs used to treat respiratory problems?
The drugs used to treat respiratory problems can be divided into different classes: antitussives, bronchodilators, antimicrobials, anti-inflammatories, expectorants, mucolytics, and decongestants.
297
When should antitussives be used in respiratory problems?
Antitussives should not be used as symptomatic treatment in respiratory problems of unknown cause as they can mask clinical signs. In cats, the use of antitussives is very rarely indicated as coughing is usually due to feline lower airway disease.
298
What is the main use of bronchodilators?
The main use of bronchodilators is in feline patients with lower airway disease as bronchoconstriction is a major feature. Dogs with respiratory problems rarely have bronchoconstriction, but bronchodilators can still have beneficial effects beyond bronchodilation.
299
What are the two big groups of bronchodilators?
Bronchodilators can be divided into two big groups: methylxanthines and β-receptor agonists.
300
How do β-receptor agonists work as bronchodilators?
Stimulation of the β-receptors leads to relaxation of the smooth muscle of the bronchial walls and there is also some evidence that it can increase mucociliary clearance in the respiratory tract.
301
What is the preferred drug for bronchodilation?
Terbutaline and salbutamol are the preferred drugs for bronchodilation.
302
What are some possible causes of pyothorax?
Some possible causes of pyothorax include puncture wounds, migrating foreign bodies, ruptured abscesses, or haematogenous spread of pathogens.
303
Which species is pyothorax more common in?
Pyothorax is significantly more frequent in cats than in dogs.
304
What are some signs of a patient with pyothorax?
Patients with pyothorax are often presented systemically ill and frequently with signs of sepsis.
305
What is the recommended action if the patient has a large amount of fluid present and is in respiratory distress?
The removal of pleural fluid should be a priority.
306
What imaging techniques are recommended for identifying structural abnormalities in pyothorax cases?
Thoracic imaging, such as radiographs or preferably CT scans, are recommended for identification of structural abnormalities such as abscesses or foreign bodies.
307
What is the best way to decide upon the appropriate antibiotic to use in pyothorax cases?
Culture and sensitivity should be used to decide upon the best antibiotic to use.
308
How long should antibiotics be continued after the removal of thoracic drains in pyothorax cases?
Antibiotics should be continued for an extra 4 to 6 weeks after the removal of thoracic drains.
309
What are the aims of pleural lavage in pyothorax cases?
The aims of pleural lavage include reduction of effusion viscosity, making drainage of effusion easier, and dilution and reduction of bacteria and inflammatory mediators.
310
What are the clinical signs of feline nasopharyngeal polyps?
The clinical signs of feline nasopharyngeal polyps can be of nasopharyngeal origin (reverse sneezing and stertor) or otic.
311
What is the suggested first option for treating cats with nasopharyngeal polyps?
Traction/avulsion is suggested as a good first option for cats with no radiographic or CT evidence of bulla involvement.
312
What is the recommended treatment after traction of nasopharyngeal polyps?
Treatment with anti-inflammatory doses of prednisolone after traction can reduce the recurrence rate.
313
Why should polyps be submitted for histopathology?
Polyps should be submitted for histopathology to confirm the diagnosis and rule out other differentials such as lymphoma.
314
What are the possible causes of nasopharyngeal stenosis in cats?
The possible causes of nasopharyngeal stenosis in cats include chronic inflammation, infectious diseases, trauma, and congenital abnormalities.
315
What are the common clinical signs of nasal neoplasia?
Common clinical signs of nasal neoplasia include obstruction of airflow, mucopurulent nasal discharge, epistaxis, and sneezing.
316
What are the most common locations of metastasis in nasal neoplasia?
The most common locations of metastasis in nasal neoplasia are the regional lymph nodes and the lungs.
317
What is the treatment of choice for nasal neoplasia?
Radiotherapy is often considered the treatment of choice for nasal neoplasia, as most cases are not responsive to chemotherapy.
318
What are the most common nasal problems in dogs?
The most common nasal problems in dogs are chronic rhinitis, aspergillosis, and neoplasia.
319
What are the most common nasal problems in cats?
The most common nasal problem in cats is chronic rhinosinusitis.
320
What are some common differentials for nasal problems in dogs?
Some common differentials for nasal problems in dogs include foreign bodies, tooth root abscess, and allergic rhinitis.
321
What are some common disease processes affecting the nose and nasopharyngeal region in cats?
Some common disease processes affecting the nose and nasopharyngeal region in cats are foreign bodies, neoplasia, polyps, nasopharyngeal stenosis, and Cryptococcus infection.
322
What causes sneezing in animals?
Sneezing is caused by stimulation of the nasal and nasopharyngeal mucosa.
323
What is reverse sneezing?
Reverse sneezing consists of paroxysmal strong inspiratory efforts made against a close glottis, accompanied by short snoring sounds, neck extension, bulging of the eyes, and abduction of the elbows.
324
What can cause epistaxis (bleeding from the nostrils)?
Epistaxis can be caused by local disease or systemic factors such as haemostatic problems and increased capillary fragility.
325
What tests can be considered in the investigation of nasal disease?
Non-invasive or minimally invasive tests that can be considered in the investigation of nasal disease include serology for Aspergillus, cytology of nasal discharge, cytology of submandibular lymph nodes, and cytology for Cryptococcus and Cryptococcus antigen.
326
What are the potential properties of drugs that relax smooth bronchial muscle?
The potential properties of drugs that relax smooth bronchial muscle are anti-inflammatory effects and improvement of mucociliary clearance.
327
What is the most commonly used medication for relaxing smooth bronchial muscle?
Theophylline is the most commonly used medication for relaxing smooth bronchial muscle.
328
What formulations are available for theophylline?
Theophylline can be obtained as immediate-release and sustained-release formulations.
329
What is the interchangeability between immediate release theophylline and aminophylline?
Immediate release theophylline and aminophylline are interchangeable as aminophylline is 80% theophylline.
330
What is the potent anti-inflammatory effect of corticosteroids on the bronchial mucosa?
Corticosteroids have a potent anti-inflammatory effect on the bronchial mucosa.
331
Which corticosteroid is the most frequently used inhaled corticosteroid?
Fluticasone is the most frequently used inhaled corticosteroid.
332
What is the route of administration of fluticasone?
Fluticasone is administered through inhalation.
333
Are NSAIDs recommended for treating inflammatory airway disease in small animals?
No, NSAIDs are not recommended for treating inflammatory airway disease in small animals.
334
What percentage of instilled fluid is typically recovered in most patients?
Around 75% of the instilled fluid is recovered in most patients.
335
What is the controversy surrounding the addition of heparin to the lavage fluid?
The addition of heparin is controversial as it can reportedly reduce adhesions and promote drainage.
336
Is there evidence to support the addition of antibiotics to the lavage fluid?
There is no evidence that adding antibiotics to the lavage fluid is of benefit and it can also act as an irritant.
337
What is chylothorax?
Chylothorax is the accumulation of chyle in the pleural cavity.
338
What can cause the color of chylothorax fluid to change from milky white to blood-tinged?
If there is a haemorrhagic component, the fluid color of chylothorax can change from milky white to blood-tinged.
339
What is the recommended diagnostic method for chylothorax?
The diagnosis of chylothorax is based on documentation of higher triglycerides in the fluid versus the serum.
340
What diseases are commonly associated with chylothorax?
The most commonly diseases associated with chylothorax are cardiac disease, pericardial disease causing right-sided heart failure, dirofilariasis, pulmonary hypertension, lung lobe torsion, diaphragmatic rupture, neoplasia, and trauma.
341
What is restrictive pleuritis?
Restrictive pleuritis is the development of a fibrotic membrane that surrounds the lungs and restricts lung inflation despite drainage of the effusion.
342
What technique is most useful for assessment of the tympanic bullae?
Views with positioning to avoid superimposition of the hard palate, mandible, tongue, and ET tube.
343
What should be examined in sinonasal radiographs?
Patency of the nasal gas lucency, radiodense foreign bodies, areas of turbinate or bony loss, areas of increased soft tissue/fluid accumulation, and alterations in symmetry.
344
What is essential prior to rhinoscopy and nasal biopsies?
Assessment of platelet count, clotting times, and +/- BMBT.
345
What are the alternatives if rhinoscopy is not available?
Inspect visually the nasopharynx directly or with the help of a dental mirror while pulling the soft palate cranially, or attempt evaluation of the very most cranial part of the nasal cavity with a narrow auroscope under general anesthesia.
346
What should be done before anterograde rhinoscopy to avoid migration of material to distal airways?
Place a mouth-pack and preferably use a cuffed ET-tube.
347
What is recommended to avoid damage to the endoscope during retrograde rhinoscopy?
Use a mouth-gag.
348
What should be assessed during rhinoscopy besides the presence of masses and foreign bodies?
The appearance of the nasal conchae (turbinates).
349
What is important to avoid during nasal biopsies?
Reaching beyond the level of the medial canthus of the eye to avoid possible damage of the cribiform plate.
350
What is the limiting factor for considering euthanasia in patients presenting with epistaxis?
Multiple severe episodes of haemorrhage
351
What are the treatment options for nasal mites (Pneumonyssoides caninum)?
Ivermectin, milbemycin, or selamectin
352
What is the function of the low-protein fluid in the pleural space?
Acts as a lubricant between the parietal and visceral pleura
353
What are the clinical signs of pleural effusion?
Tachypnoea, shallow breathing with a restrictive pattern, muffled lung sounds, and dullness on percussion
354
What are the possible causes of pleural effusion?
Increased capillary hydrostatic pressure, increased capillary permeability, decreased oncotic pressure, or impaired lymphatic drainage
355
What is the diagnostic procedure indicated for patients suspected to have pleural effusion?
Thoracocentesis
356
How can ultrasound be used in cases of pleural effusion?
To confirm thoracic effusion, guide thoracocentesis, and examine thoracic structures for masses and foreign bodies
357
What samples should be collected for analysis in cases of pleural effusion?
Fluid samples for total cell count, cytology, biochemical analysis, and culture
358
What is the next logical step after the initial patient assessment and non-invasive test?
Imaging
359
What information can imaging provide in the investigation of nasal disease?
Information on location and type of changes
360
Which modalities are considered the most advanced in imaging for nasal disease investigation?
CT scan and MRI
361
What are radiographs used for in the investigation of nasal disease?
Routine use by the majority of clinicians
362
What are the advantages of CT scan in nasal disease investigation?
Differentiating between neoplasia, fungal disease, and inflammatory rhinitis
363
What are the advantages of MRI in nasal disease investigation?
Higher accuracy in identifying erosion of the cribiform plate and detecting intracranial changes
364
Why is it important to perform imaging before rhinoscopy or collection of biopsies?
Iatrogenic hemorrhage can interfere with the diagnostic quality of the images
365
Which radiographic views are commonly used for assessing nasal and maxilla structures?
Intra-oral occlusal view, rostro-caudal skylined frontal sinus view, lateral and oblique lateral views
366
What are the classic findings in acute feline upper respiratory tract disease?
Oculo-nasal discharge
367
What are some systemic signs of illness commonly seen in acute feline upper respiratory tract disease?
Fever and other systemic signs of illness
368
What are the ocular manifestations of FHV-1 infection?
Conjunctival hyperemia and corneal disease
369
What oral manifestations can be caused by feline calicivirus?
Oral ulcers
370
Which pathogen is most commonly associated with chemosis?
Chlamydophila
371
What is the suggested treatment for upper respiratory infections in cats?
Supportive care with hydration, nutritional support, humidification of the inhaled air, and lubrication of the ocular surface. Systemic antibiotic therapy can be used if there are secondary bacterial infections.
372
What antibiotics are recommended for Mycoplasma involvement in upper respiratory infections?
Fluoroquinolones or tetracycline
373
How long should doxycycline be used in cases suspected of Chlamydophila infection?
4 to 6 weeks
