Respiratory - Pulmonary Parenchymal Diseases

Question 1

Which is not included as pulmonary parenchyma?
A) interstitium
B) alveoli
C) Microvasculature
D) pleura

Answer 1

D - pleura

Question 2

Primary function of the parenchyma is

Answer 2

gas exchange

Question 3

The exchange or transfer of gas across the blood-gas barrier occurs by
A) active transport
B) osmosis
C) diffusion
D) no body knows

Answer 3

C - diffusion

Question 4

Fick’s Law

Answer 4

the rate of transfer of a gas through a sheet of tissue is proportional to the tissue area and the difference in the partial pressure of gas on the two sides of the tissue and inversely proportional to tissue thickness

Question 5

Bacterial pneumonia

Answer 5

bacterial infection within the pulmonary parenchyma

Question 6

potential routes of infection causing bacterial pneumonia

Answer 6

inhaled, aspirated, extension from nearby tissues, hematogenous

Question 7

T/F virulent primary pathogens are more common causes of bacterial pneumonia

Answer 7

false, opportunistic pathogens are more common so it is important to investigate for predisposing factors (immunosuppression, pre-existing respiratory disease, aspiration)

Question 8

Common opportunistic pathogens of bacterial pneumonia in dogs

Answer 8

E. coli, pasteurella, klebsiella, staphylococcus, streptococcus, bordetella, mycoplasma

Question 9

Common opportunistic pathogens of bacterial pneumonia in cats

Answer 9

mycoplasma, pasteurella, bordetella, streptococcus, E. coli

Question 10

Virulent (primary) pathogens that can cause bacterial pneumonia

Answer 10

strep. equi subspecies zooepidemicus, extra intestinal E. coi
hemorrhagic or necrotizing pneumonia, parachute to acute, high mortality rate

Question 11

Community Acquired Pneumonia (CAP)

Answer 11

develops in a patient that has not recently been hospitalized (and aspiration of gastric and oropharyngeal contents is not suspected

Question 12

Hospital acquired pneumonia (HAP)

Answer 12

occurs >48h after hospital admission and was not incubating at the time of admission

Question 13

Aspiration pneumonia

Answer 13

result of inhalation of gastric/oropharyngeal contents that are contaminated by pathogenic bacteria

Question 14

T/F: treatment strategies for CAP, HAP and aspiration pneumonia are all similar

Answer 14

False, CAP and aspiration pneumonia similar but HAP differs

Question 15

Signalment of bacterial pneumonia

Answer 15

dogs > cats, young or old but any age can be affected

no breed disposition

Question 16

Common clinical signs of bacterial pneumonia

Answer 16

cough, exercise intolerance, nasal discharge, increased RR and effort, lethargy, hyporexia, pyrexia

Question 17

Potential findings in a PE of an animal with bacterial pneumonia

Answer 17

abnormal lung sounds, tachypnea, dyspnea, nasal discharge, pyrexia, cyanosis, sinus arrhythmia (due to increased vagal tone)

Question 18

Thoracic radiographs of a dog with bacterial pneumonia

Answer 18

classic pattern is alveolar, predominantly ventral
interstitial and/or bronchial markings may be present
diffuse distribution more common with hematogenous pneumonia
pneumonia associated with aspiration, foreign body or a tumor may only involve 1 lobe

Question 19

Definitive diagnosis of bacterial pneumonia requires

Answer 19

identification of sepsis (neutrophilic inflammation and intracellular bacteria) from lower airway samples (obtained via transtracheal wash or bronchoalveolar lavage) followed by culture and sensitivity
mycoplasma ID requires special media or PCR

Question 20

Common CBC findings in bacterial pneumonia

Answer 20

neutrophilic

Question 21

When reading a pulse oximeter, a low (<95%) SpO2 suggests patient is _____

Answer 21

hypodermic and supplemental O2 should be given

Question 22

What are arterial blood gas and pulse oximetry used for?

Answer 22

detecting hypoxia, measuring oxygenation

Question 23

Which is FALSE regarding treatment of bacterial pneumonia?
A) antibiotics are mainstay of treatment and last usually 10-14d
B) Lower airway samples should be obtained prior to starting antibiotic therapy
C) One most always obtain a lower airway sample
D) Multidrug resistant pathogens are common in hospitals so patients with HAP are at increased risk of getting a MDR infection

Answer 23

C - don’t need to if patient has a CAP, no prior history of pneumonia and no recent history of having antibiotic therapy

Question 24

Treatment of bacterial pneumonia in patients with late onset (>4d) HAP or otherwise at risk for having a MDR infection

Answer 24

1) 1st generation cephalosporin + 2nd or 3rd gen cephalosporin
2) carbapenem (B-lactam) or amikacin + amoxicillin/sublactam or ticarcillin/clavulanate

Question 25

Adjunct treatment of bacterial pneumonia

Answer 25

``` supplemental O2 in hypoxic patients fluid therapy to maintain perfusion nebulization to enhance mucus fluidity coupage to encourage coughing of mucus bronchodilator and/or mucolytic not routine but may be helpful treatment of any predisposing causes ```

Question 26

Mycotic pneumonia

Answer 26

blastomyces dermatitis, histoplasmosis capsulate, coccidioides immitis lower resp signs + lymphadenopathy and weight loss rads are nodular or military interstitial and perihilar lymphadenopathy Diagnosis - sample skin or nodes cytologically, urine fungal antigen test Tx - long term anti fungal therapy and supportive care Blasto + history - itraconazole, Cocci - fluconazole or itraconazole

Question 27

``` How would you diagnose a mycotic pneumonia? A) pulse oximetry and blood gas analysis B) transtracheal wash C) bronchoalveolar lavage D) cytology of skin and lymph nodes ```

Answer 27

D - cytology of skin and lymph nodes

Question 28

Pneumocystitis carinii

Answer 28

associated with severe morbidity and high mortality in immunocompromised common in mini daschunds and CKC spaniel fever usually absent despite severe pneumonia mycotic Tx - potentiated sulfonamides and supportive care

Question 29

``` Which type of pneumonia appears as a "snowstorm" on rads? A) bacterial B) Mycotic C) Viral D) protozoal ```

Answer 29

B - mycotic

Question 30

Viral Pneumonia

Answer 30

primary pathogens and contagious canine - parainfluenza, influenza, distemper, coronavirus, infectious hepatitis, herpesvirus Cats - coronavirus, calicivirus, herpesvirus D - PCR Tx - supportive, antibiotic therapy if secondary bacterial infection suspected

Question 31

Protozoal pneumonia

Answer 31

toxoplasma gondii most common, cats are reservoir Dx - serology, tachyzoites may be in airway sample Tx - potentiated sulphonamides or clindamycine

Question 32

what is idiopathic pulmonary fibrosis (IPF)

Answer 32

an interstitial lung disease characterized by the presence of fibrosis - cause of fibrosis unknown

Question 33

which breeds are predisposed to IPF?

Answer 33

wastes, strafforshire bull terrier, usually middle aged to older cats - no breed disposition, any age affected

Question 34

common clinical signs of IPF

Answer 34

cough, exercise intolerance, tachypnea, lethargy, syncope | PE reveals loud crackles in all fields

Question 35

What do you expect to see on the Rads of an animal with IPF?

Answer 35

diffuse bronco interstitial pattern in dogs in cats, bronchial, interstitial and alveolar patterns possible if severe PH present, R sided cardiomegaly + PA enlargment

Question 36

When is an echo indicated for IPF patients?

Answer 36

if PH suspected and to evaluate for concurrent primary cardiac disease

Question 37

Definitive diagnosis of IPF requires

Answer 37

lung biopsy and histopathology | not normally done bc of risk

Question 38

Which is FALSE regarding therapy of IPF? A) cough suppressant therapy can help B) Corticosteroids are contraindicated in treatment C) No specific therapy available D) Bronchodilators can improve clinical signs

Answer 38

B - corticosteroids can help improve clinical signs in some patients

Question 39

What is non-cardiogenic pulmonary edema (NCPE)?

Answer 39

increased vascular permeability secondary to lung injury, is usually protein rich (in contrast to cariogenic pulmonary edema which is low in protein)

Question 40

Hypoxemia during NCPE usually results from

Answer 40

alveolar fluid, decreased lung compliance, airway compression

Question 41

Mechanisms of pulmonary edema

Answer 41

increased hydrostatic pressure, decreased oncotic pressure, increased vascular permeability, and/or impaired lymph drainage

Question 42

2 categories of pulmonary edema

Answer 42

cardiogenic or non-cardiogenic

Question 43

Causes of NCPE

Answer 43

``` acute respiratory distress syndrome secondary to primary pulmonary disease or secondary airway obstruction seizure electrocution vasculitis severe hypoalbuminemia ```

Question 44

Clinical signs of NCPE

Answer 44

parachute or acute onset tachypnea, exercise intolerance, dyspnea, cough, cyanosis, hemoptysis depends on degree of pulmonary injury and amount of NCPE increased BV sounds and/or crackles common auscultatory abnormalities decreased lung sounds if edema severe

Question 45

Treatment of NCPE

Answer 45

``` supplemental O2 in hypoxic patients minimize stres may require mechanical ventilation low-dose furosemide may help specific therapy if underlying cause ```

Question 46

What is ARDS?

Answer 46

acute respiratory distress syndrome | pulmonary inflammatory disorder characterized by NCPE, neutrophilic inflammation, hypoxemia

Question 47

What is SIRS?

Answer 47

systemic inflammatory response syndrome | caused by systemic inflammation of infectious or non-infectious origin

Question 48

Diagnosis of SIRS in dogs and cats

Answer 48

``` 2 of the 4: tachycardia tachypnea hypo or hyperthermia leukocytosis, leukopenia, or >5% bands ```