Respiratory Material Flashcards Preview

RUSVM SAM I- Spring '18 > Respiratory Material > Flashcards

Flashcards in Respiratory Material Deck (171):
1

What lesions are associated with infective endocarditis that contain platelets, fibrin, microorganisms, inflammatory cells and bacteria?

Vegetative lesions

2

What is the cause of acute regurgitation in infective endocarditis patients?

Structural valvular changes

3

What are the most common valves affected with infective endocarditis?

Mitral and aortic

4

Describe an aortic and mitral murmur.

Aortic: left basilar diastolic + bounding pulses
Mitral: left apical systolic

5

What is required for the development of IE?

Bacteremia

6

What are three clinical syndromes resulting from IE?

Immune-mediated disease, CHF/arrhythmias and THromboembolic disease

7

What are your most common breeds IE is seen in?

GSD, goldens, Labs

8

What is the most common presenting complaint in a dog with IE?

Owner complains about lameness- this can be due to the immune-mediated complexes that are deposited in the joints (polyarthritis)

9

What important protein is lost in the urine and can lead to thromboembolism?

Antithrombin III is lost in urine. This protein is needed for clot breakdown- without this protein there will be thrombi formed all over the body without "regulation"

10

T/F: You always collect blood cultures before antibiotic therapy.

TRUE

11

What is a common finding on thoracic rads with IE?

L-sided CHF

12

What are the five common causative agents of IE?

Staph intermedius, staph aureus, strep canis, e coli, bartonella

13

What is the mainstay of IE therapy?

Long-term bactericidal antibiotics

14

T/F: dogs with IE have grave prognosis and permanent damage to the valves despite infection resolution.

TRUE

15

A patient with this disease should be receiving periprocedural antibiotics to prevent formation of IE.

Congenital heart disease patients- especially subaortic stenosis

16

Myocardial inflammation in the absence of ischemia --> myocyte damage and cardiac dysfunction is also known as?

myocarditis

17

What CS are commonly seen with myocarditis patients?

Fever, lethargy, hyporexia, resp signs, syncope, muscle pain and diarrhea

18

What arrhythmias are commonly seen in patients with myocarditis?

VPC

19

What is often leaked from damaged/necrotic cardiomyocytes into circulation that can be used to diagnose a patient with myocarditis?

Cardiac troponin I

20

What is the most common cause of myocarditis in Texas?

Chagas disease

21

T/F: Systemic hypertension in dogs/cats is a primary disease

FALSE- occurs secondary to other conditions

22

What is the basic pathophysiology of systemic hypertension?

Arterial/arteriolar walls diseased and vessel lumen is narrowed --> reduced blood flow to tissues/hemorrhage from vessel fragility

23

T/F: Cardiac disease can cause hypertension in SA patients

FALSE- SH can often lead to cardiac disease

24

What are the four target organs of damage?

Renal, Ophthalmic, neurologic and cardiovascular

25

What type of renal damage is seen with SH?

Glomerular/tubulointerstitial (ischemia, necrosis and atrophy)

26

What is the drug of choice used to treat hypertension in cats?

Amlodipine: inhibits Ca influx across vascular smooth muscle cells

27

What are some common side effects of ophthalmic damage from SH?

Vision loss, retinal detachment, retinal hemorrhage

28

What are common cardiac damages seen alongside SH in pets?

LV concentric hypertrophy, diastolic dysfunction, mitral regurgitation

29

What is the leading cause of SH in dogs and cats?

Renal disease

30

What is a common drug used in dogs that can cause SH as an adverse affect?

PPA

31

What happens if the BP cuff you're using is too small/big?

Too big= false low; Too small=false high

32

If there is TOD and BP > 180 what do you do?

Start tx of hypertension in addition to TOD tx

33

What do you do if you patient has >180 mmHg BP?

Start hypertension tx

34

What if you suspect your patient to have SH and upon evaluation they have no TOD and <180 mmHg BP, how do you respond?

Reassess within one week

35

What is the drug of choice in dogs for SH?

Angiotensin-converting enzyme inhibitor: indirect vasodilator blocking formation of angiotensin II

36

How many consecutive readings for BP should you get in hypertensive patients?

3 consecutive readings (toss out the first reading)

37

Where do adult heartworms typically live?

Pulmonary a.

38

T/F: molting of dirofilaria immitis is dependent on ambient temperature & wolbachia

TRUE

39

Where can S5 HW migrate to besides the pulmonary artery?

Main pulmonary artery, right side of heart and vena cavae (heavy infections)

40

What do the worms cause in the artery?

Induce inflammation, endothelial damage, myointimal proliferation, disruption of vascular integrity, fibrosis, and pulmonary hypertension

41

What do dead worms induce?

Thrombosis and more inflammation

42

What is it called when you have mechanical obstruction (by worms) of blood flow in the R. side of the heart and vena cavae?

Caval syndrome

43

What are some CS seen with HWD dogs?

Exercise intolerance, wt loss, lethargy, cough, abdominal distension, syncope, hematuria

44

Which side of the heart is commonly affected in HWD?

R-sided CHF- tricuspid regurgitation (right apical systolic murmur)

45

What tests are commonly run to assess microfilaria after you have a positive antigen test for HWD?

Modified knott or filter test

46

What will you see on thoracic rads in a dog with HWD?

Dilation of any or all pulmonary a. and R-sided enlargement. Infiltrates are commonly seen.

47

What is the test of choice if there is an arrhythmia in a HWD patient?

Electrocardiography

48

What are the four tx options for HWD dog?

1. Macrocyclic lactone preventative (ivermecitn, milbemycin oxime)
2. Doxycycline (reduces/eliminates Wolbachia)
3. Exercise restriction (IMPORTANT)
4. Adulticide therapy with melarsomine dihydrochloride

49

Why should milbemycin be avoided in microfilaricide positive dogs?

This can cause quick death of baby worms resulting in severe anaphylaxis shock

50

T/F: Cats are an unnatural host for Dirofilaria immitis which is why they are quite resistant to the infection

TRUE

51

What is the common reason we use HW preventatives in our feline patients since the pevalance of infection is so low?

We are trying to prevent our feline friends from getting HARD

52

Inflammatory & proliferative disease of the pulmonary arteries, bronchioles and pulmonary parenchyma in cats WITHOUT mature infections is known as what?

Heartworm-associated respiratory disease (HARD)

53

What cell type contributes to the profound inflammatory reaction to S5 in cats?

Pulmonary intravascular macrophages (PIMs)

54

What do the symptoms of HARD in feline patients look similar to?

Asthma

55

What are acute respiratory signs in felines a result from in HW infection?

Dead worm embolization

56

Current dx tests detect Ag produced where in the parasite?

Reproductive tract of adult female (insensitive for detecting HWI in felines because they typically only have 1 worm and this test usually picks it up with >3 worms present)

57

When does Ab-positive status occur in HWD patients?

Larvae have developed to stage L4

58

Why is microfilarial testing not typically performed in cats?

often amicrofilaremic or low microfilaria numbers

59

What defines pulmonary hypertension? (systolic, mean and diastolic)

Systolic: > 30 mmHg
Mean: > 20 mmHg
Diastolic: >15 mmHg

60

What are the three mechanisms of PH?

Increased CO, increased pulmonary vascular resistance and increased pulmonary venous pressure

61

What are the five classifications of PH?

1. PH due to pulmonary vascular dz
2. PH due to L-sided heart dz
3. PH due to chronic pulmonary dz/hypoxia
4. PH due to thrombotic/embolic dz
5. Miscellaneous

62

What are some PE findings with PE patients?

Dyspnea/tachypnea, abnormal lung sounds, cyanosis, murmur from tricuspid regurgitation (might have systemic hypotension)

63

What is the gold standard test for PH patients?

Echocardiography

64

What are some common findings with PH patientson thoracic radiographs?

Pulmonary infiltrates with severe pulmonary hypertension
- dorsal deviation of trachea, sternal contact increased, dilated main pulmonary artery

65

T/F: If you have concentric hypertrophy of RV and the pulmonic valve is normal- you can infer that there is pulmonary hypertension.

TRUE

66

What is seen on Echo due to the increased RV pressure preventing LV to fill up normally

Diastolic flattening of ventricular septum

67

What is the drug of choice for tx pulmonary arterial hypertension?

Slidenafil: phosphodiesterase V inhibitor

68

T/F: Supplemental O2 can be used to dilate pulmonary arteries

TRUE

69

If PH patient hasn't improved on slidenafil on its own, what drug can you use?

Pimobendan

70

___ is the obstruction of a pulmonary artery by a thrombus that originated in systemic venous circulation.

PTE

71

What are the three componenets to a thrombus formation? (Vrichow's triad)

1. Hypercoaguability
2. Endothelial injury
3. Blood stasis

72

What are two mechanisms of gas-exchange impairment seen with PTE patients?

Ventiation-perfusion mismatch and diffusion impairment

73

T/F: Onset of signs with PTE patients is acute.

TRUE

74

What product of clot breakdown can be used as a dx test for PTE?

D-dimers

75

T/F: Thoracic radiographs with a PTE patient may appear completely normal.

TRUE

76

What radiographic finding would be fairly specific for a PTE patient?

Hypovascular area/lobe

77

What arterial blood gas finding may be abnormal with a PTE patient?

Hypoxic, hypocapnic and increased alveolar-arterial gradient

78

T/F: normal D-dimers in a patient with acute respiratory signs rules PTE in?

FALSE- rules out

79

What is an initial/acute tx for PTE patients?

Anticoagulant therapy with unfractionated heparin (less chance of bleeding complication) or low molecular weight heparin (more targeted in coag cascade, $$)

80

What are two categories of drugs used for PTE patients?

Anticoagulant and antiplatelet

81

What is the most common pleural space disease that you will see?

Pleural effusion- abnormal accumulation of fluid in pleural space

82

What kind of breathing pattern is seen in patients with pleural effusion?

Restrictive breathing pattern (shallow and rapid)- increased inspiratory effort and rate

83

What are the three effusion categories?

Transudate, modified transudate and exudate

84

Which type of effusion would a patient with protein-losing enteropathy have?

Transudate- low protein and low cells
This patient will have a colloid oncotic pressure problem

85

What is the most common exudate found in patients with pleural effusion and what is an example of a disease in this category?

Modified transudate
CHF

86

What category of pleural effusion would pyothorax fall under?

Exudate- high protein and high cells (SEPTIC patients)

87

What would you hear when auscultating the lungs of a patient with pleural effusion?

Muffled or absent lung sounds- this is because there is a layer of water between the lungs and your stethoscope, so you will not be able to hear the sound waves as readily as a normal patient where it is just a tissue/muscle interface between

88

What dx method is commonly used to quickly confirm the dx of pleural effusion?

Thoracic FAST- this is important because it causes minimal stress to the patient

89

When would you consider placing a pleural port in a patient with pleural effusion.

When they have an underlying disease that cannot be resolved

90

What is one of the few curable respiratory diseases that was discussed?

Pyothorax- must be caught early

91

Why is it so important to stop the chronic fluid build up in a patient with pleural effusion?

Chronic fluid --> Chronic inflammation --> Fibrosis

92

What are the three types of pneumothorax and which is most commonly seen?

Traumatic, spontaneous, iatrogenic
Traumatic is most commonly seen

93

T/F: The skin wound in a patient with pneumothorax can be centimeters away from the site of penetration into the lungs.

TRUE

94

T/F: Spontaneous pneumothorax patients are often times congenital

TRUE

95

T/F: You as the doctor can cause pneumothorax while performing thoracocentesis.

TRUE (also seen during IPPV mishaps)

96

Pneumomediastinum is most commonly caused by what?

Damage from the trachea

97

What are some CS of a pneumomediastinum patient?

Tachypnea, dyspnea, SubQ emphysema (crunchy skin) and vomiting (CATS)

98

What is a common routine procedure that can cause pneumomediastinum?

Dental cleanings- flipping the patient constantly and the ETT can damage the trachea and potentially rupture it

99

What three components are considered to make up the pulmonary parenchyma?

Alveoli, microvasculature and interstitium

100

What is the primary function of the parenchyma?

Gas exchange

101

T/F: The rate of transfer of gas through tissue is proportional to the tissue area and the difference in partial pressure of gas and inversely proportional to tissue thickness.

TRUE

102

What is the MOST COMMON pulmonary parenchymal disease?

Pneumonia (bacterial)

103

What is the second most common pulmonary parenchymal disease?

Idiopathic pulmonary fibrosis

104

T/F: Primary pathogens more commonly result in bacterial pneumonia as opposed to opportunistic pneumonia?

FALSE- opposite

105

What are your common opportunistic pathogens in dogs and cats?

Dogs: E. coli, pasteurella, klebsiella, staph, strep, bordetella (mycoplasma can-uncommon though)
Cats: mycoplasma, pasteurella, bordetella and e. coli

106

What are the two classifications of bacterial pneumonia?

Community-acquired and hospital acquired pneumonia

107

What is important to know about hospital-acquired pneumonia agents?

These bugs typically are drug resistant

108

T/F: Patients with bacterial pneumonia typically have a non-productive cough as the main presenting complaint

FALSE: productive cough

109

What is the classic rad pattern in a pneumonia patient?

Ventral alveolar pattern

110

What is the def dx. of bacterial pneumonia?

identification of sepsis from lower airway samples

111

What is the typical tx for pneumonia patients?

Ab for at least 2 weeks and continue for 1 week post CS resolution

112

Tx of choice for a dog with HAP pneumonia would be what?

1st generation cephalosporin (B-lactam) + 2nd/3rd generation cephalosporin

113

T/F: Often times patients with pneumonia are in a lot of discomfort from the productive cough- it is important that you supplement the dog with a cough suppressant.

FALSE- never give a patient with pneumonia a cough suppressant- this is their body's way of trying to clear the foreign substance

114

Along with lower respiratory signs, what else is noticed upon evaluation of a patient with mycotic pneumonia?

Lymphadenopathy and weight loss are of concern

115

What is the most common cause of protozoal pneumonia?

Toxoplasma gondii

116

What are the two breeds most commonly predisposed to idiopathic pulmonary fibrosis?

West highland terrier and stafforshire bull terrier

117

What lung sound is often associated with patients who have idiopathic pulmonary fibrosis?

Crackles

118

What radiographic abnormalities are seen in patients with idiopathic pulmonary fibrosis?

Bronchointerstitial pattern is most common in dogs

119

T/F: Non-cardiogenic pulmonary edema is typically protein-rich

TRUE

Cardiogenic pulmonary edema is low in protein

120

What is the most common bronchial disease?

Chronic bronchitis

121

What is the pathophysiology of chronic bronchitis?

BREAK THE CYCLE- airway collapse occurs secondary to chronic inflammation and coughing --> collapse causes more inflammation and mucous production --> more coughing. Intervene the cycle to MAKE IT STOP

122

T/F: Patients with chronic bronchitis have a productive cough with a terminal retch

FALSE- non-productive (white foam seen occasionally)

123

What sounds do you hear on pulmonary auscultation in patients with chronic bronchitis?

Crackles, wheezes and snapping

124

T/F: Expiratory dyspnea is specific to lower airway problems

TRUE

125

What lesions will you see on thoracic radiographs in a patient with chronic bronchitis?

Bronchial pattern (donut lesions)

126

What is the curative tx of chronic bronchitis?

TRICK. NO CURATIVE TX.

127

This disease is commonly seen in young adult siberian huskies and will have coughing, retching, dyspnea and nasal discharge with an eosinophilia.

Eosinophilic bronchopneumopathy

128

What is the difference of chronic bronchitis and feline asthma?

Chronic bronchitis: inflammation, mucus and wall thickening
Asthma: inflammation, mucus, wall thickening AND bronchospasm

129

What are the primary effector cells in allergic asthma in felines?

Eosinophils- release hyper-reactive proteins

130

What are the most common breeds of cats that have chronic bronchitis?

Siamese cats

131

T/F: Cats with bronchitis have intermittent coughing and owner may not see the patient coughing everyday

FALSE- daily coughing

Asthma patients have intermittent/episodic signs

132

What is an important ddx for cats with chronic bronchitis?

HARD (HW associated resp dz)

133

What defines tracheal collapse?

Dorsoventral flattening of the tracheal rings

134

Collapse of ___ occurs during inspiration and collapse of ___ occurs during expiration.

Cervical trachea and thoracic trachea

135

What is a common sound that is heard in dogs with a tracheal collapse?

"Honking"

136

What is the pathophysiology of tracheal collapse?

Mechanical trauma to tracheal mucosa --> inflammation is a result --> coughing is stimulated --> increased intrathoracic pressure --> tracheal collapse is exacerbated -->inflammation increases --> more coughing SO ON SO FORTH

137

What area in the body is the area of severe tracheal collapse?

Thoracic inlet

138

What is the common signalment for a patient with tracheal collapse?

Small breed, chronic honking cough with terminal retch and owner may complain about these episodes when they are picking their dog up

139

T/F: A cough elicited with tracheal palpation is specific for tracheal collapse

FALSE- suggests tracheal sensitivity

140

T/F: Normal radiographs rule out tracheal collapse

FALSE- this is a dynamic condition, so you may not have caught it at the right time

141

What are the three functions of the larynx?

Regulate airflow
Protect trachea from aspiration during swallowing
Control phonation

142

Which nerve innervates all but 1 of the intrinsic laryngeal muscles?

Caudal laryngeal n.

143

What is the most common cause of acquired laryngeal paralysis?

Polyneuropathy

144

What breeds do you commonly see polyneuropathy in?

Rottweilers, dalmatians, and white-coated GSD

145

What is the most common cause of laryngeal paralysis in labs?

Geriatric-onset

146

What will exacerbate clinical signs of laryngeal paralysis?

heat, humidity and exercise

147

What is the name for loud inspiration seen during panting that localizes the problem to the larynx or extrathoracic trachea?

Stridor

148

What is a fast acting laryngeal swelling drug?

Dexamethasone

149

What is the most common cause of laryngeal paralysis in cats?

Neoplastic infiltration

150

What are two other common laryngeal diseases?

Laryngeal collapse and laryngeal masses

151

What are the two primary defects of brachycephalic airway obstruction?

Stenotic nares and elongated soft palate

152

What nasal parasite is seen in cats and causes mild chronic inflammation with minimal CS?

Mammomonogamus

153

What is the dx and tx of Mammomonogamus?

Dx: fecalfloat, rhinoscopic cytology
Tx: fenbendazole

154

What is the name of the nasal mite that causes sneezing, rhinitis, nasal discharge and facial pruritis in dogs?

Pneumonyssoides

155

What is the tx for Pneumonyssoides?

Selamectin or milbemycin oxime

156

What is a problem in the nasopharynx commonly seen in young cats due to chronic inflammation?

Nasal polyps

157

What CS in dogs is related to nasopharyngeal polyps?

Reverse sneezing

158

What is a common cause of nasopharyngeal stenosis?

Regurgitation associated with anesthesia

159

What is the most common cause of fungal rhinitis in cats?

Cryptococcus

160

What are the CS associated with Cryptococcus?

Sneezing and nasal discharge

161

What is the most common source of fungal rhinosinusitis in dogs?

Aspergillus fumigatus

162

What are the CS of a dog with aspergillosis?

Nasal discharge and sneezing

163

What can be used in tx aspergillosis?

Topical infusion of clotrimazole or enilconazole

164

What are the most common causes of canine infectious respiratory disease?

Canine parainfluenza virus with bordetella bronchiseptica

165

T/F: Canine infectious respiratory disease is highly contagious and is transmitted via oronasal exposure from direct contact with secretions or inhalation of aerosolized respiratory droplets

TRUE

166

What is the incubation period for CIRD?

3-10 days

167

How long does virus shedding associated with CIRD last?

10 days

168

T/F: Bordetella can be transmitted through human contact if the human has been exposed to another patient with CIRD

TRUE- fomite and ourselves can transfer this virus- GOOD HYGIENE is important

169

What are the two main viral causes of feline upper resp tract infec?

Feline herpesvirus and feline calicivirus

170

T/F: Shedding of herpesvirus in cats increases dramatically in stressful situations

TRUE

171

What is the definitive dx test for PTE?

CT or angiography