Respiratory Disease Flashcards
(149 cards)
1
Q
A dog who is unable to lie down with an extended neck and panting is suffering from what?
A
Dyspnoea
2
Q
What are the clinical signs of a cat suffering from dyspnoea?
A
Sternal recumbency, abducted elbows and abdominal effort during inspiration
3
Q
Does sinus arrhythmia normally indicate cardiac disease or primary respiratory disease?
A
Primary respiratory disease
4
Q
Define the term stridor
A
An abnormal, high-pitched, musical breathing sound, caused by a blockage in the larynx or below
5
Q
Define the term stertor
A
A low-pitched inspiratory noise due to significant upper respiratory obstruction (above the larynx) and subsequent turbulent airflow in the upper airway
6
Q
What relevant history questions should be asked when presented with a patient in respiratory distress?
A
Duration and severity (changing?) of clinical signs
Are they coughing or sneezing, or have tachypnoea or nasal discharge?
On any medication/recent medication?
7
Q
Is a vein or artery blood sample best for blood gas analysis?
A
Artery
8
Q
What does blood gas analysis help you assess?
A
Pulmonary function
Oxygenation
Ventilation
9
Q
How many radiograph views are taken to investigate respiratory issues?
A
3 views - right and left lateral and then VD or DV (taken before the laterals to prevent effects of lung collapse)
10
Q
What imaging would be ideal if you suspect dynamic airway disease?
A
Fluoroscopy
11
Q
During ultrasound for respiratory issues, which 3 structures should you focus on?
A
Lungs
Pleural space
Mediastinum
12
Q
What is tracheobronchoscopy useful for?
A
Visualising airways and collecting fluid samples
13
Q
Name 2 methods of sampling airway fluid
A
Bronchoalveolar lavage (ideally with bronchoscopy)
Trans/Endotracheal wash
14
Q
What should you do with sampled airway fluid?
A
Cytology
Culture
PCR
15
Q
Name the 7 most important things involved in assessment and stabilisation of patients with respiratory emergencies
A
- Respiratory pattern assessment
- Auscultation of heart and thorax
- Pulse oximetry
- Oxygen therapy - possible sedation and caged oxygen
- Sedation - butorphanol IV/IM and acepromazine IV/IM/SC
- IV catheter placement - when stable
- +/- Cooling, emergency intubation and ventilation
16
Q
How can you differentiate between restrictive and obstructive respiratory distress?
A
Restrictive = rapid, shallow breathing
Obstructive = prolonged breathing phase
17
Q
A dog with restrictive breathing and decreased breathing sounds could have which condition?
A
Pleural space disease - inspiratory dyspnoea
18
Q
A dog with restrictive breathing and increased breathing sounds could have which condition?
A
Pulmonary parenchymal disease (alveolar space or pulmonary interstitium)
Can be both inspiratory and expiratory dyspnoea when severe
19
Q
A dog or cat with neuromuscular weakness will have which breathing patterns?
A
Restrictive breathing, normal breathing sounds but reduced diaphragmatic movement
Also seen in chest wall disease/diaphragm disease
20
Q
A cat or dog with an obstructive breathing pattern and expiratory sounds which are auscultatable (wheezing, coughing) has a condition localised to which area?
A
Intrathoracic disease - trachea and bronchi
21
Q
A cat or dog with an obstructive breathing pattern, inspiratory noises and stridor has a condition localised to which area?
A
Extrathoracic disease - larynx and cervical disease
22
Q
A cat or dog with an obstructive breathing pattern, inspiratory noises and stertor has a condition localised to which area?
A
Extrathoracic disease - nasal cavity and nasopharynx
23
Q
What are the names of the 2 audible sounds heard with obstructive breathing patterns?
A
Stridor
Stertor
24
Q
What causes restrictive respiratory patterns?
A
Restriction of lung expansion
Results in rapid, shallow inspiratory dyspnoea
25
A cat comes in with inspiratory dyspnoea, tachypnoea and reduced breath sounds.
On thoracic lung auscultation it has reduced sounds ventrally.
What is your top differential?
Pleural space disease - likely pleural effusion
If reduced sounds on dorsal lung auscultation then likely pneumothorax
26
How do you diagnose suspected pleural space disease?
Thoracic radiography
Thoracocentesis - cytology and culture
27
What are the 4 main causes of pleural space disease?
Pleural effusion
Pneumothorax
Pleural mass
Diaphragmatic hernia
28
What are the general clinical signs of pulmonary parenchymal disease?
Inspiratory dyspnoea +/- expiratory if severe
Tachypnoea
Increased breath sounds
Parenchymal = pulmonary interstitium and alveolar space
29
How is pulmonary parenchymal disease diagnosed?
Thoracic radiographs
Bronchoalveolar lavage - cytology, culture and sensitivity
Haematology and biochemistry
30
Which parasites can cause pulmonary parenchymal disease?
Lungworm:
Dogs - Angiostrongylus vasorum
- Oslerus osleri
- Crenosoma vulpis
- Eucoleus aerophilus
Cats - Aelurostrongylus abstrusus
- Eucoleus aerophilus
Heartworm:
Dogs - Dirofilaria immitis
Cats - Dirofilaria immitis
31
What are the 4 broad causes of pneumonia?
Aspiration
Viral
Bacterial
Fungal
32
True or False?
Pulmonary parenchymal disease can be due to pulmonary oedema, pulmonary fibrosis, pleural effusion and inflammation
False - all of the above except pleural effusion, which causes pleural space disease
33
A cat comes in with normal breathing sounds but reduced inspiratory excursions. What is your top differential?
Neuromuscular weakness
Caused by:
- Tick paralysis
- Snake venom
- Botulism
- Neuromuscular disease, e.g. polyradiculoneuritis
34
What are the 3 differentials for thoracic wall or diaphragm disease?
Trauma
Neoplasia
Diaphragmatic hernia
35
How can you diagnose thoracic wall or diaphragm disease?
Thoracic radiograph +/- contrast
36
Obstructive airway patterns are seen after either extrathoracic or intrathoracic airway obstruction. How can you differentiate between these using clinical signs?
Extrathoracic:
- Inspiratory dyspnoea and mild tachypnoea
- Stridor (typically from the larnyx)
- Stertor (typically from the nasal/nasopharynx)
Intrathoracic:
- Expiratory dyspnoea and tachypnoea
- Wheeze
- Prolonged expiration and increased expiratory effort
37
Give 4 differentials for obstructive airway disease originating from the nasal cavity and nasopharynx
Brachycephalic airway syndrome
Foreign body
Fungal infection
Inflammatory
Neoplasia
Rhinitis (allergy)
Nasopharyngeal polyps
Stenosis
38
What diagnostic tests can you do to investigate obstructive airway disease from the nasal cavity and nasopharynx?
Nasal cavity examination
Radiographs
Rhinoscopy +/- biopsy
Nasal and nasopharynx flush and culture
CT
39
What diagnostic tests can you do to investigate obstructive airway disease from the larynx and cervical trachea?
Laryngeal examination under light anaesthesia
Radiographs
Bronchoscopy +/- biopsy
Fluoroscopy
40
What diagnostic tests can you do to investigate obstructive airway disease from the intrathoracic trachea and bronchi?
Radiography
Bronchoscopy +/- biopsy
Trans/Endotracheal wash
Bronchoalveolar lavage
41
Name 2 parasites which can cause obstructive disease in the trachea
Filaroides spp. (e.g. Oslerus osleri)
Capillaria spp. (e.g. Capillaria aerophila)
42
Give 4 differentials for obstructive airway disease in the bronchi in dogs and cats
Canine chronic bronchitis
Feline bronchial disease
Infectious bronchitis
Collapse
Parasitic disease:
- Lungworm, e.g. Angiostrongylus vasorum, Oslerus osleri, Aelurostrongylus abstrusus
- Heartworm, e.g. Dirofilaria immitis
43
Give 4 broad differentials for acute onset sneezing in a dog or cat
Nasal cavity/nasopharynx:
- Foreign body
- Allergy
- Infectious (viral)
- Trauma
44
Give 3 broad differentials for chronic sneezing in a dog or cat
Nasal cavity/nasopharynx:
- Infectious (viral, secondary bacterial, fungal, parasitic)
- Neoplasia
- Foreign body
45
Give 3 differentials for reverse sneezing in a dog
Foreign body
Nasal mites
Allergies - lymphocytic plasmacytic rhinitis
Post vomiting
Neoplasia
Fungal diseases - Aspergillus fumigatus or Cryptococcus
Nasal polyps (cats)
46
A dog presents with serous nasal discharge. Which one of the following isn't a likely differential diagnosis?
Viral, allergic, bacterial, foreign body.
Bacterial
47
Give 4 differentials for a dog with purulent nasal discharge
Chronic foreign body
Secondary bacterial infection
Fungal infection
Lower respiratory tract disease
Neoplasia
Dental disease
Inflammatory
48
A cat comes in with a serosanguinous nasal discharge (epistaxis). What are 4 differentials for this?
Neoplasia
Fungal
Trauma
Foreign body
Systemic coagulopathy
Hypertension
Dental disease
Inflammatory
49
A dog is presented with sneezing, nasal discharge and halitosis. On dental examination, there is a hole in the gum above tooth 104. What is your top differential?
Oronasal fistula - opening between the oral cavity and nasal fistula, secondary to severe periodontitis
50
A cat comes in with an acute onset unilateral serous nasal discharge, sneezing and reverse sneezing. What is your top differential and what diagnostic tests will you do?
Foreign body in the nasal cavity/nasopharynx
Diagnostic tests:
- Nasal flush
- Rhinoscopy
- +/- radiographs (4-5 day lag phase for radiographic changes)
51
Which dogs and cats are predisposed to Aspergillus fumigatus infections?
Young dolichocephalic dogs
Brachycephalic cats
52
A dog's owner rings the practice and says they suspect their dog has Aspergillosis. They book an appointment and are coming in now. What clinical signs are you expecting to see?
Purulent to sanguineous nasal discharge
Pain on palpation of the nasal cavity
Ulceration of the nasal planum
Signs of systemic illness if severe
Depigmentation of the nasal planum
53
How can you diagnose an Aspergillus fumigatus infection in a dog or cat?
Serology - fungal antibody titres, but false negatives and only show exposure, not disease
Rhinoscopy (fungal plaques) + biopsy and cytology
Culture from a nasal swab - presence shows exposure, not disease
CT
54
You have diagnosed a dog with an Aspergillus fumigatus infection. How are you going to treat it?
Topical antifungals (enilconazole), often placed under GA
Systemic antifungals if needed (itraconazole)
Local debridement
55
Aspergillus fumigatus is one of 2 common nasal fungal infections. What is the other one?
Cryptococcus - normally Cryptococcus neoformans
Typically a cat disease
56
Describe the common clinical signs of Cryptococcus infection in cats
Sneezing
Hard swelling over the bridge of the nose
Polyps in the nasal passages, which may cause difficulty breathing
Nasal discharge that may be blood-tinged, yellow, clear, or a combination of mucus and pus
Neurological signs if infection with Cryptococcus var gatti
57
How can you treat cases of Cryptococcus infection in cats?
Systemic antifungals - Itraconazole or Amphotericin B if showing neurological signs
58
Give the 3 most common neoplasias of the nasal cavity/nasopharynx
Adenocarcinoma
Squamous cell carcinoma
Lymphoma (cats)
59
A dog presents with right unilateral nasal discharge and a facial deformity on the right side of the dorsal rostrum. The dog is systemically well. What is your top differential diagnosis and what diagnostics will you use?
Neoplasia
Diagnostic tests:
- Radiographs
- CT
- Rhinoscopy and bronchoscopy
60
Lymphocytic-plasmacytic rhinitis is a nonspecific inflammatory condition due to antigen and irritant stimulation. It's most common in dogs, especially Dachshunds. How would you diagnose a suspected case?
Diagnosis of exclusion of other nasal diseases
Biopsy showing lymphocytic plasmacytic inflammation
Treatment includes NSAIDs or corticosteroids at immunosuppressive doses +/- inhaled
61
How can you differentiate between a cat with Feline Herpes Virus and one with Feline Calicivirus?
Feline Herpes Virus - severe conjunctivitis and corneal ulceration
Feline Calicivirus - mild ocular signs, lameness, oral ulcers and gingivitis
Can be concurrently infected with both
62
Give the 3 main bacterial causes of primary nasal respiratory tract infections in dogs and cats
Mycoplasma (can cause conjunctivitis)
Bordetella bronchiseptica
Chlamydophila felis (cats - can cause conjunctivitis)
63
What diagnostic tests are best for diagnosing nasal bacterial respiratory tract infections in dogs and cats?
Conjunctival swab and PCR
Culture of nasal swab - not recommended as almost always secondary to a predisposing factor, e.g. viral infection
64
You have diagnosed a very snuffly cat with a nasal bacterial infection. How are you going to treat it?
Treatment of the underlying disease (nasal bacterial infections often secondary)
Supportive therapy:
- Nebulisation and humidification
- Nutritional support - smell is important for cat appetites
Antibiotics - doxycycline for up to 3 weeks
65
Nasal mites, also known as Pneumonyssoides caninum, cause non-specific clinical signs such as sneezing, nasal discharge and facial pruritis. What diagnostic tests can you do to confirm their presence?
Rhinoscopy and nasal lavage
Cytology
Treated via ivermectin once a week per os (care with collies, and is off-licence use)
66
You have diagnosed a cat with nasal polyps via rhinoscopy and radiographs. What is your next step?
Surgical removal
67
How can you visualise the nasal cavity and nasopharyngeal region?
Scope with a flexible endoscope (rhinoscopy)
Spay hook and mirror
68
What should you always remember to do to prevent aspiration when doing a nasal flush?
Intubate
Place swabs in the back of the pharynx to absorb fluid and collect debris
69
What is haemoptysis?
Coughing up blood
70
True or false? All of the following conditions can result in haemoptysis:
- Coagulopathy
- Pulmonary contusions (trauma)
- Congestive heart failure
- Heartworm disease
True
Haemoptysis can also be caused by:
- Neoplasia
- Pneumonia
- Thromboembolism
- Hypertension
71
You have taken 3 inspiratory thoracic radiographic views of a cat with haemoptysis. On the radiographs, you can see tracheal narrowing due to swelling of the dorsal tracheal membrane. What is your top differential diagnosis?
Coagulopathy
Look at ACT, APTT, PT and platelet counts to diagnose
72
A dog has presented with haemoptysis. You have ruled out a coagulopathy and done thoracic radiographs. What other diagnostic tests can you do?
Complete blood count and biochemistry
Echocardiogram if heart disease suspected
Bronchoalveolar lavage +/- cytology, culture, PCR
Heartworm testing
73
A 10 week old French Bulldog puppy is presented with stertor and respiratory distress. His owners are concerned about brachycephalic airway syndrome, but don't understand what it is. What information will you tell them?
Upper airway obstruction due to extra soft tissue or narrowed airway passages. Caused by short noses without shortened internal soft tissues.
Can result in:
- Stenosis of the nares (narrowed nasal openings)
- Soft palate elongation
- Eversion of the laryngeal saccules
- Laryngeal collapse
- Hypoplastic trachea (mainly English Bulldogs)
74
How can you diagnose a dog or cat with suspected brachycephalic airway syndrome?
Light anaesthesia to visualise the pharynx and larnyx
+/- neck and thoracic radiographs
75
You have an English Bulldog in for routine castration. He presents with stertor and some open mouth breathing. What premedication combination will you choose?
Butorphanol (opioid) or methadone (opioid) - anxiolytic and antitussive
Acepromazine (phenothiazine) - if certain there is no cardiac disease
76
What non-surgical treatment options are there for a stable patient with brachycephalic airway syndrome?
Anti-inflammatories
Initially dexamethasone IV and then long-term prednisolone PO for 2 weeks, and then inhaled anti-inflammatories
77
What are the 4 main pathogens responsible for Infectious Tracheobronchitis (Kennel Cough)
Bordetella bronchiseptica
Canine Parainfluenza Virus
Canine Adenovirus 2
Canine Influenza Virus
Also occasionally Canine Distemper Virus
78
True or False?
Cats can't get Bordetella bronchiseptica infections from dogs
False
79
Give 2 clinical signs of Infectious Tracheobronchitis
Acute onset, violent, harsh, hacking cough, often followed by retching and gagging
Positive tracheal pinch - cough
Systemically well, though can be systemically ill if Bordetella pneumonia occurs
80
You have a 13 year old Staffy with suspected Infectious Tracheobronchitis from clinical signs. Would you do any diagnostic tests, and if so, what would they be?
Thoracic radiographs +/- bronchoalveolar lavage
Done on any dog which is old, systemically ill or has heart disease with suspected Kennel Cough
81
A local rescue centre has had an outbreak of Infectious Tracheobronchitis in their kennels. What will you tell them about disease spread and management?
Spread via direct dog-dog respiratory contact or via fomites
Infection takes about 2 weeks to clear in any individual, or longer if Bordetella bronchopneumonia occurs
Isolate all affected animals and their equipment
Infected animal sheds the parainfluenza virus for up to 2 weeks, and the Bordetella bacteria for up to a month
Antibiotics aren't proven to improve outcome
82
Which dogs are most likely to have tracheal collapse?
Small breeds
Middle-old aged
83
What are the clinical signs of tracheal collapse?
'Goose honk' cough
+/- dyspnoea and collapse
84
Which of the following diagnostic tests wouldn't you use to diagnose tracheal collapse in a dog?
1. Fluoroscopy
2. Radiography
3. Endoscopy
4. Rhinoscopy
Rhinoscopy
Can also do a bronchoalveolar lavage if concurrent pulmonary disease
Inspiratory and expiratory radiographs should be taken
Biochemistry may show concurrent hepatopathy due to chronic hypoxia
85
You are presented with a Yorkshire Terrier who has a 'goose honk' cough and dyspnoea. On thoracic radiography you see what looks like a collapsed dorsal tracheal membrane. What condition do you need to rule out before diagnosing tracheal collapse?
Coagulopathy - can look similar on radiography
86
How would you stabilise a dog which has come in with respiratory distress from tracheal collapse?
SPO2 measurement and oxygen therapy
Sedation - butorphanol or methadone with acepromazine
Dexamethasone IV
87
You have diagnosed an Italian Greyhound with acute respiratory distress due to Tracheal Collapse. She is now stable and you are about to ring her owners with an update. What will you discuss with her owners about long term treatment options?
Prednisolone for 2 weeks PO bidaily for 2 weeks, and then tapered down
Management of exacerbating factors:
- Treat concurrent disease, e.g. heart disease, pneumonia
- Weight loss
- Reduce allergen exposure (if possible)
Medical management:
- Antitussives such as oral codeine or tramadol
- +/- bronchodilators - may help but not really for this
- Anti-inflammatory inhalers, e.g. Fluticasone puffer, budesonide nebuliser
Surgery to place a stent in the trachea - last resort
Walk on a harness
88
True or False?
Laryngeal paralysis is a paralysis of the muscles controlling the arytenoid cartilages, leading to failure of abduction during inspiration. It is always bilateral.
False
Can be unilateral or bilateral
89
Is laryngeal paralysis more commonly seen in dogs or cats?
Dogs, especially middle-aged to large breeds
90
When can laryngeal paralysis present as an acute disease?
Laryngeal paralysis is a chronic condition, but stress and heat can cause acute presentations of dyspnoea
91
Give 4 differentials for laryngeal paralysis
Idiopathic (most common)
Congenital
Trauma or lesion in cervical region
Cranial thorax pathology
Polyneuropathy
Myopathy
Tick paralysis
92
What are the long-term treatment options for a dog with laryngeal paralysis?
Treatment of concurrent aspiration pneumonia or other respiratory disease
Anti-inflammatories - dexamethasone IV and then prednisolone PO BID for 2 weeks before tapering off
Strict rest in a cool environment, +/- sedatives
Surgical management is ideal - medical with a try but be prepared for acute decompensation
93
What is Canine Chronic Bronchitis?
Chronic inflammation of the bronchi and bronchioles
Normally seen in small breeds
No known cause, though possibly due to aerosol allergens
94
True or False?
Canine Chronic Bronchitis involves airway inflammation, which causes fibrosis and mucus, which causes further airway inflammation
True
95
What clinical signs would make you suspect a dog has Canine Chronic Bronchitis?
Chronic hacking cough lasting over 2 months
Obstructive expiratory dyspnoea
+/- sinus arrythmia
96
What 4 diagnostic tests could you use to confirm a case of Canine Chronic Bronchitis?
Thoracic radiographs - +/- bronchial interstitial pattern
Bronchoscopy
Clinical signs (rule out other diseases)
Bronchoalveolar lavage - increased mucus, airway inflammation and infection - cytology, culture, PCR for mycoplasma
97
Which antibiotics would you give a dog with Chronic Bronchitis, and for how long?
Doxycycline PO BID for 4 weeks in case there is a mycoplasma infection
98
What adjunctive therapies can you try on a dog with Chronic Bronchitis?
Reduce airborne allergens, e.g. smoke
Coupage and nebulisation
Cough suppressants, e.g. codeine
99
True or False?
Feline chronic bronchitis and asthma result in inflammation of the bronchi and bronchioles?
True
100
You are presented with a cat which has a chronic cough for over 2 months, wheezing and mild respiratory distress. How would you diagnose a case of feline asthma?
Clinical presentation
Response to bronchodilators
Inflammatory bronchoalveolar lavage (normally eosinophilic)
Hyperplasia of the mucus glands and smooth muscle
101
Define the term 'atelactasis'
Partial collapse or incomplete inflation of the lung
102
How can you stabilise a cat in acute respiratory distress from chronic bronchial disease or feline asthma?
SPO2 and oxygen therapy
Sedation - butorphanol or methadone with acepromazine
Dexamethasone IV
Bronchodilators:
- Terbutaline IV or salbutamol inhaler
- If reduction in rate and effort = likely asthma
- Heart rate increase >200bpm = drug working
103
A cat has bronchial disease. What long-term management strategies do you want to discuss with it's owner?
Anti-inflammatories and bronchodilators (inhalers)
Reduction in airborne allergens (e.g. smoke)
Fenbendazole for 5 days to rule out parasitic causes of eosinophilic bronchoalveolar lavage
Culture for myocoplasma - doxycycline PO for 4 weeks
104
True or False?
Fluticasone (steroid), prednisolone and/or salbutamol should be given to cats with mild to moderate cases of feline bronchial disease?
True
Severe cases (frequent cough and dyspnoea) need higher doses of prednisolone for longer and can have oral terbutaline or theophylline as a bronchodilator
105
Pneumonia in dogs and cats can be caused by bacterial, protozoal, fungal and parasitic infections. What else can cause it?
Chemicals, e.g. fertiliser or pesticide fumes or smoke
106
Does pneumonia result in inflammation of the lung parenchyma or bronchi?
Lung parenchyma
107
Primary bacterial pneumonia is rare. What can it be secondary to?
Aspiration, due to:
- Loss of consciousness
- Seizures
- Oesophageal and laryngeal disease
- General anaesthetic
- Bottle feeding
Immunosuppression, due to:
- Systemic disease
- Endocrinopathies
- Drugs
- Viral infection
108
What are the clinical signs of pneumonia in dogs and cats?
Soft cough in dogs (rare in cats)
Inspiratory restrictive dyspnoea which can progress to inspiratory and expiratory
Crackles and wheezes on respiration
+/- nasal discharge
+/- systemic illness - pyrexia, anorexia, lethargy
109
You have a dog which you think has pneumonia. You have already done thoracic radiographs. What other diagnostic tests could you do to confirm your diagnosis?
Bronchoalveolar lavage - cytology, culture and sensitivity
SPO2 and arterial blood gas
Haematology and biochemistry (systemic effects)
Also: fungal titres, serology for heartworm, FIV/FeLV if cat, faecal flotation
110
What would you expect to see on thoracic radiograph of a cat with pneumonia?
Interstitial or alveolar pattern
Air bronchograms in the right middle and cranial lung lobes
111
You have a dog with pneumonia, and have discovered and treated the underlying cause. The dog also needs antibiotics. What antibiotics will you choose, and how long will you prescribe them for?
Antibiotic therapy for at least 6 weeks
Stable patients:
- Amoxicillin clavulanic acid or trimethoprim sulphate
- Doxycycline if suspect Mycoplasma
Systemically ill patients:
- Cephalothin IV + metronidazole IV + enrofloxacin IV (four quadrant therapy)
Then choose based on culture and sensitivity
112
What supportive therapy should be given to a patient with severe pneumonia?
IV fluids
Nebulisation with sterile saline
Coupage
Turning of recumbent patients
113
Which is more common?
Non-cardiogenic pulmonary oedema
Cardiogenic pulmonary oedema
Cardiogenic pulmonary oedema
114
Which of the following isn't a cause of non-cardiogenic pulmonary oedema?
1. Heartworm
2. Near drowning
3. Aspiration
4. Severe trauma
Heartworm
Non-cardiogenic pulmonary oedema can also be caused by:
- Upper airway obstruction
- Neurological (seizures, electrocution)
- Acute respiratory distress syndrome
115
A dog is presented with a soft cough, restrictive inspiratory dyspnoea and crackles and wheezes during respiration. On thoracic radiography you see pathology on the dorsocaudal lung lobes. What is your top differential?
Non-cardiogenic pneumonia
Cardiogenic pneumonia normally affects the perihilar lung lobes first
116
Why aren't diuretics as effective a treatment for non-cardiogenic pneumonia as they are for cardiogenic pneumonia?
Cardiogenic pneumonia oedema is much lower in protein
117
When would you use mechanical ventilation for a dog or cat with pneumonia?
If it develops hypoxaemia that is non-responsive to oxygen therapy
118
Should you give antibiotics to dogs or cats with non-cardiogenic pneumonia? If so, which ones?
Don't give antibiotics unless worried about infectious pathology
Conservative care - IV fluids and good nursing better
119
What is pneumothorax?
Air within the pleural space
120
What is the difference between open and closed pneumothorax?
Open: outside communication (often trauma)
Closed: no outside communication (air leaking from the airways or parenchyma)
121
A dog has an open pneumothorax. What is the only differential?
Traumatic penetration of the thoracic wall
122
Give 2 differentials for a traumatic closed pneumothorax
Tracheal tear (e.g. after intubation)
Ruptured lung
123
Give 4 differentials for a spontaneous closed pneumothorax
Ruptured bullae
Bullous emphysema
Ruptured neoplasia, granuloma or abscess
Rough endotracheal intubation
Oesophageal perforation
124
A cat comes in with inspiratory obstructive dyspnoea and tachypnoea. On examination she has reduced lung sounds dorsally, hypoxaemia and cyanosis, as well as clinical signs of trauma. What is your top differential?
Pneumothorax
Also possible diaphragmatic rupture, but in this case there are reduced lung sounds dorsally
125
You radiograph a dog with pneumothorax. What do you see on thoracic radiography?
Retraction of the lung lobes and parenchymal structures from the thoracic wall
126
What are the immediate treatment options for an animals with pneumothorax?
Oxygen therapy
Analgesia
Thoracocentesis if in respiratory distress
Cover open wounds - make an air-tight seal
IV antibiotics
+/- thoracic tube placement and continual drainage
127
When would you do surgery on a dog or cat with pneumothorax?
Exploration of open wounds +/- thoracotomy
Spontaneous closed pneumothorax which isn't responding to continual drainage
128
What is a transudate?
Fluid passing through a membrane, pore, etc., and accumulating in tissue, due to changes in hydrostatic pressure and colloidal osmotic pressure
129
What is the difference between transudate and exudate on analysis?
Transudates:
- Lower protein
- Lower specific gravity <1.020
- Lower nucleated cell counts (clearer)
The cell types in transudates include macrophages, lymphocytes, and mesothelial cells
130
What is an exudate?
Fluid leaked as a result of increased blood vessel permeability due to inflammation or injury in a tissue
131
What is the difference between transudate and modified transudate?
Pure transudate:
- Low protein content
- Normally due to hypoproteinaemia from increased loss or decreased production of albumin
Modified transudate:
- High protein content
- Sometimes higher cell count
- Normally venous/lymphatic drainage obstruction
132
What is the difference between septic and non-septic exudate?
Septic = presence of infectious agents in the fluid
133
True or false?
Inadequate IV fluids can result in a transudate oedema in cats
False - excess IV fluids causes this
134
Transudates are cause by reduced oncotic pressure (e.g. hypoproteinaemia). What are 3 differentials for this?
Protein losing nephropathy - mainly glomerular disease
Protein losing enteropathy - loss through GIT
Liver disease - liver makes albumin
135
What diagnostic tests could you do on a dog with suspected protein-losing nephropathy?
Haematology and biochemistry
Urinalysis
Urine protein:creatinine ratio
Urine culture and sensitivity
136
You are presented with a cat with pleural effusion, from which you drained a modified transudate fluid by thoracocentesis.
Assuming this fluid has occurred due to increased capillary hydrostatic pressure, what are your top differentials?
Right congestive heart failure
Left congestive heart failure
Pericardial disease
137
A dog has a pleural effusion. What are you going to do with the fluid you have drained via thoracocentesis?
Cytology and culture to diagnose cause
138
Other than congestive heart failure and pericardial disease, what are the top 4 differentials for pericardial effusion with a modified transudate?
Diaphragmatic hernia
Neoplasia
Lymphatic obstruction - neoplasia, diaphragmatic hernia, abscess
Increased blood and lymph vessel permeability, e.g. FIP
139
Non-septic exudate can occur as a result of which conditions?
Neoplasia
Inflammation:
- FIP (can have high globulins)
- Liver disease
- Lung torsion
- Hernia
140
What are the 3 main causes of a septic exudate?
Ruptured abscess
Foreign body inhalation of penetrating injury
Fungal infection
141
You have diagnosed a cat with pyothorax. What treatment are you going to give her?
Analgesia
IV antibiotics:
- Initially cephalothin IV + metronidazole IV + enrofloxacin IV (four quadrant)
- Then change on culture and sensitivity
Thoracic drain and saline lavage (don't overload)
+/- antifungals
142
When would you operate on an animal with pyothorax?
Foreign body
Penetration wound
Fungal granuloma
Consolidated lung lobe
143
True or False?
Chyle is formed by a rupture/obstruction of lymphatic flow or is secondary to heart failure.
True
Care to differentiate chyle from pseudochyle, which is just fluid high in cholesterol
144
What diagnostic tests will you do to differentiate chyle from other exudates and transudates?
Complete blood count and biochemistry
Cytology and culture of fluid
+/- ultrasound and CT
145
How do you treat chylothorax?
Treat the underlying condition (hard if idiopathic)
Repeat thoracocentesis
Rutin PO 3x daily (likely increases lymphatic fluid uptake)
Thoracic duct ligation with pericardectomy if non-responsive to medical treatment
146
Other than trauma, neoplasia and coagulopathies, what can cause haemorrhage?
Ruptured granuloma
147
How can you differentiate between true haemorrhage and iatrogenic blood on a smear?
If a true haemorrhage then there will be no platelets and the blood won't clot (blood sat around for a long time and clotting factors are all used up)
148
How can you differentiate between acute and chronic haemorrhage?
Compare haemorrhage PCV/TP to venous PCV/TP
If PCV/TP is similar = recent bleed
If PCV is lower in haemorrhaged blood = chronic
Complete blood count
149
How do you treat haemothorax?
Only remove enough blood to relieve clinical signs of dyspnoea
+/- autotransfusion (perform blood smear first to ensure no bacteria present)
Oxygen therapy
Sedation
Intermittent thoracocentesis to improve ventilation
Treat any coagulopathies - plasma transfusion, vitamin K, etc.
