Respiratory System Disorders Flashcards

Question

why is histopathologic examination preferred over cytologic in most nasal disease cases?

Answer 1

the marked inflammation that accompanies many nasal diseases makes it difficult to cytologically differentiate primary from secondary inflammation and reactive from neoplastic epithelial cells - eg. carcinomas can appear like lymphoma and vice versa

Answer 2

identifying cryptococcal organisms - otherwise their findings are generally nonspecific

Answer 3

- alligator cup biopsy forceps (min. size 2 x 3mm) are used - when possible, adjacent to a rigid endoscope to allow visualisation - no forceps should ever be passed into the nasal cavity deeper than the level of the medial canthus of the eye without visual guidance to keep from penetrating the cribriform plate - min. of 6 tissue specimens/lesion, and if no lesion 6-10 random specimens from each side

Answer 4

- provides the best tissue specimens for histologic examination if diagnosis not made off biopsies - allows clinician to remove abnormal or poorly vascularised tissues, debulk fungal granulomas and place drains for subsequent topical nasal therapy

Answer 5

- hemorrhage; packing the nasal cavity, cold saline solution with/without diluted epinephrine (1:100000), in rare events of uncontrolled haemorrhage ligation of the carotid artery - trauma to the brain; mark the instrument with tape to not advance passed the medial canthus of the eye - aspiration of blood/saline solution/exudate; cuffed ETT inflated, packed nasopharynx

Answer 6

- FHV (feline herpes virus/ feline rhinotracheitis virus) - FCV (feline calicivirus)

Answer 7

- Bordetella bronchiseptica - Chlamydia felis (previously Chlamydia psittaci) + Mycoplasmas (M.felis) primary/secondary

Answer 8

- corneal ulceration - abortion - neonatal death

Answer 9

- oral ulcerations - polyarthritis - interstitial pneumonia - systemic vasculitis (facial and limb oedema, focal necrosis) (rare - severe)

Answer 10

- fever - sneezing - serous/mucopurulent nasal discharge - conjunctivitis and ocular discharge - hypersalivation - anorexia - dehydration

Answer 11

- persistence of an active viral infection - irreversible damage to turbinates and mucosa by FHV (predisposes cat to an exaggerated response to irritants and secondary bacterial rhinitis)

Answer 12

- PCR, virus isolation, bacterial cultures of FHV, FCV, Bordetella, Mycoplasma, Chlamydophila on various samples (swabs/tissue specimen/mucosal scraping)

Answer 13

- mucus clearing + steam vaporisation - topical decongestants (0.25% phenylephrine or 0.025% oxymetazoline 1 drop/nostril for 3 days) - ABs for 10 days if fever, anorexia, lethargy present (Doxycycline - efficacy against Chlamydia and Mycoplasma, or Amoxicillin) - Famcyclovir for cats with FHV

Answer 14

Oral ABs for minimum of 42 days (Doxycycline) + Chloramphenicol or tetracycline ophthalmic ointment should be applied at least three times daily and continued for 14 days after signs have resolved

Answer 15

- topical antiviral drugs; trifluridine, idoxuridine, adenine arabinoside (1drop OU 5-6x daily for 2-3wks) - tetracycline or chloramphenicol ophthalmic ointment q4-6h - topical atropine for mydriasis as needed to control pain - treatment is continued for 1-2wks

Answer 16

- avoiding exposure to infectious agents (eg. FHV, FCV, Bordetella, Mycoplasma, Chlamydophila) - SQ modified live vaccines for FHV and FCV available in combo with panleukopenia (vax @ 6-10wks old, then again in 3-4wks, final @ 16wks old, booster at 1yo, then booster q3yrs)

Answer 17

SQ modified-live vaccines for FHV, FCV + panleukopenia @6-10wks old, then in 3-4wks, final one at 16wks, then booster at 1yr, then booster q3yrs

Answer 18

can cause disease if introduced by the normal oronasal route - vaccine should not be aerosolized in front of the cat - any vaccine on skin should be washed off immediately

Answer 19

in shelters or catteries where these infections are endemic

Answer 20

- rarely occurs as primary disease process but can be caused by Mycoplasma spp., Streptococcus equi subsp. zooepidemicus, Bordetella bronchiseptica - commonly a secondary complication

Answer 21

- according to culture and sensitivity if significant growth obtained otherwise broad spectrum ABs - amoxicillin 22mg/kg q8-12h - Clindamycin 10mg/kg q12h - doxycycline 10mg/kg q12h w/ water to follow chronic infections require prolonged treatment; initial 7-10days if response seen continue for 4-6weeks

Answer 22

- Cryptococcosis neoformans - Aspergillosis fumigatus

Answer 23

- most common in young, male dogs - mucoid, mucopurulent +/- haemorrhagic discharge - sensitivity to palpation of the face - depigmentation and ulceration of the external nares *lung involvement is not expected

Answer 24

Aspergillus terreus

Answer 25

- no single test - aspergillosis can be an opportunistic infection so must rule out underlying nasal disease - radiographic signs; well-defined lucent areas within the nasal cavity with increased radiolucency rostrally, typically no destruction of the vomer or facial bones, fluid opacity in frontal sinus - CT is preferred over radiographs - rhinoscopy; erosion of nasal turbinates and fungal plaques (white-green plaques of mold) - cytology and culture of plaques - multiple biopsies - positive serum antibody titres

Answer 26

- serum antibodies had a sensitivity of 67%, specificity of 98%, positive predictive value 98%, negative predictive value 84% for the diagnosis of nasal aspergillosis

Answer 27

- topical treatment for nasal; aggressive debridement of fungal plaques + clotrimazole infusion - oral itraconazole/posaconazole for patients with extension of disease beyond the nasal cavity and frontal sinuses +/- terbafine - prolonged treatment ave. 9months (range 6-18months)

Answer 28

- success rate following single topical clotrimazole/enilconazole 46% - with aggressive debridement 70%

Answer 29

- aspiration pneumonia - meningoencephalitis; a risk when clotrimazole, polyethylene glycol carrier +/- organisms/debris make contact with the brain through a compromised cribriform plate

Answer 30

Pneumonyssoides caninum is a small, white mite approximately 1mm in size - most infestations are clinically silent but some dogs have moderate to severe CS

Answer 31

- sneezing (violent), head shaking, pawing at the nose, reverse sneezing, chronic nasal discharge, epistaxis

Answer 32

- visualisation of mites via rhinoscopy or retrograde nasal flushing ** mites can be easily overlooks in retrieved saline solution - should be specifically searched for with slight magnification or by placing dark material behind the specimen for contrast

Answer 33

- Milbemycin oxime 0.5-1mg/kg PO q7-10d for 3 treatments - Selemectin topical over shoulders q2wks for 3 treatments - Ivermectin SQ q3wks x 2 doses (not safe for collies)

Answer 34

Nasal capillariasis is caused by a nematode (Capillaria (Eucoleus) boehmi) - adult worm is small, thin, white and lives on the mucosa of the nasal cavity and frontal sinuses of dogs - adults shed eggs that are swallowed and pass in the faeces

Answer 35

- identify double operculated Capillaria (Eucoleus) eggs on routine faecal flotation or visualizing adultery worms during rhinoscopy

Answer 36

ivermectin PO once, or fenbendazole PO BID for 10-14 days

Answer 37

- benign growths that occur most often in kittens and young adult cats - origin unknown but often attached to the base of the eustachian tube and can extend into the external ear canal, middle ear, pharynx, nasal cavity - they are pink, polypoid growths often arising from a stalk

Answer 38

- stertorous breathing - upper airway obstruction - serous to mucopurulent nasal discharge - otitis externa/media/interna; head tilt, nystagmus, Horner's syndrome

Answer 39

- surgical excision by way of traction via the oral cavity; recurrent if tissue left behind + Prednisolone 1-2mg/kg SID 2wks, then half dose for 1 week, then EOD for another week (improved outcomes) + amoxicillin course

Answer 40

- excellent; but treatment of recurrent disease may be necessary - signs of recurrence typically occur within 1 yr

Answer 41

- rare - often locally destructive to turbinates and bone - aggressive surgical removal is recommended

Answer 42

- adenocarcinoma - squamous cell carcinoma - undifferentiated carcinoma - fibrosarcoma/sarcoma

Answer 43

- lymphoma - adenocarcinoma - fibrosarcoma/sarcoma

Answer 44

- adenomas - fibromas - papillomas - transmissible venereal tumours (only in dogs)

Answer 45

- benign tumours (rare) may be treatable with surgical excision alone - radiation therapy recommended for malignant tumours - chemotherapy as adjunct for metastasis, or sole with lymphoma. Carcinomas may be responsive to cisplatin, carboplatin, multiagent chemo - surgical excision alone is not successful for managing malignant nasal tumours - palliation with radiation, piroxicam, anti-inflam steroids

Answer 46

- poor without treatment; survival after diagnosis is usually only a few months - euthanasia often request dt persistent epistaxis or discharge, laboured respiration, anorexia, weight loss - epistaxis is a poor prognostic indicator

Answer 47

- 88 days with epistaxis - 224 days without epistaxis - overall median survival time was 95 days

Answer 48

generally considered to be a hypersensitivity response within the nasal cavity and sinuses to airborne antigens, it is possible that food allergens play a role in some patients *other antigens parasites, infectious diseases, neoplasia also possible

Answer 49

- removing the offending allergen - antihistamines; Chlorpheniramine 4-8mg/dog PO BID, 2mg/cat PO BID (cetirizine may be more successful in cats) - glucocorticoids if antihistamines are not successful; Pred 0.25mg/kg PO BID - then tapered - if treatment is effective signs will resolve within 3-4 days

Answer 50

- long been presumed to be a result of viral infection with FHV, FCV; but studies have failed to show an association - possible than infection with these viruses results in damaged mucosa that is more susceptible to bacterial infection or that mounts an excessive inflammatory response to irritants or normal nasal flora

Answer 51

- chronic mucoid/mucopurulent nasal discharge is the most common CS - sneezing - lack of specific findings; no funduscopic lesions, no lymphadenopathy, no facial or palate deformities, healthy teeth and gums - nasal biopsy; neutrophilic +/- lymphoplasmacytic inflammation, nonspecific chronic inflammatory changes such as epithelial hyperplasia/fibrosis

Answer 52

- facilitating drainage of discharge - decreasing environmental irritants - controlling secondary bacterial infections - treating possible Mycoplasma or FHV infection - reducing inflammation - last resort; turbinectomy and frontal sinus ablation

Answer 53

1. Facilitate Drainage of Discharge - vaporiser treatments - topical saline administration - nasal cavity flushes under anaesthesia - topical decongestants 2. Decrease Irritants in the Environment - Improvement of indoor air quality 3. Control Secondary Bacterial Infections - long-term antibiotic treatment 4. Treat Possible Mycoplasma Infection - Antibiotic treament 5. Treat possible Herpes virus Infection - lysine treatment - reduce inflammation; antihistamine, Pred, other unproven treatments with possible anti-inflammatory effects (azithromycin, piroxicam, leukotriene inhibitors, omega 3 FAs) 6. Provide Surgical Intervention - turbinectomy - frontal sinus ablation

Answer 54

- originally reported to be a steroid responsive disorder - characterized by inflammatory infiltrates seen in nasal mucosal biopsy specimens - 2004 Windsor et al. study failed to find role of bacteria, canine adenovirus-2, parainfluenza virus, Chlamydophila, Bartonella spp. in affected dogs (supported by 2008 Hawkins et al. study) - subsequent study (Henn et al. 2005) find possible association between seropositivity for Bartonella spp. and nasal discharge

Answer 55

- treated for secondary bacterial rhinitis - decreased environmental irritants - immunosuppressive Pred for 2 weeks, then taper to lowest effective amount

Answer 56

- respiratory distress - stridor - gagging/coughing - voice change

Answer 57

- due to airway obstruction; often exacerbated by exercise/excitement/high ambient temperatures resulting in markedly increased respiratory efforts - increased efforts lead to excess negative pressures on the disease larynx, sucking the surrounding soft tissues into the lumen and causing laryngeal inflammation and oedema

Answer 58

- respiratory rate is normal to only slightly elevated (30-40) - inspiratory efforts are prolonged and labored relative to expiratory efforts - larynx tends to be sucked into the airway lumen as a result of neg. pressure within the extrathoracic airways that occurs during inspiration making inhalation - during expiration, pressures are positive in the extrathoracic airways "pushing" the soft tissues open - some obstruction to airflow may occur during expiration with fixed obstructions, such as laryngeal masses - stridor is produced by air turbulence through the narrowed laryngeal opening

Answer 59

- stertor - reverse sneezing - gagging/retching - dysphagia

Answer 60

- stertor is a loud, coarse sound such as produced by snoring/snorting - stertor results when excessive soft tissue in the pharynx, such as an elongated soft palate or mass causes turbulent airflow

Answer 61

- laryngeal paralysis - laryngeal neoplasia - obstructive laryngitis - laryngeal collapse - web formation - trauma - foreign body - extraluminal mass - acute laryngitis

Answer 62

- Brachycephalic airway syndrome - elongated soft palate - nasopharyngeal polyp - foreign body - neoplasia - abscess - granuloma - extraluminal mass - nasopharyngeal stenosis

Answer 63

- identifying radiodense foreign bodies - external compression of airways - adjacent bony changes

Answer 64

- superimposition of the left and right osseous bullae, mandibles, frontal sinuses

Answer 65

Doxapram hydrochloride 1mg/kg IV

Answer 66

refers to a failure of the arytenoid cartilages to abduct during inspiration, creating extrathoracic (upper) airway obstruction

Answer 67

left and right recurrent laryngeal nerves

Answer 68

1. Ventral cervical lesion; trauma to nerves (direct, inflammation, fibrosis), neoplasia 2. Anterior Thoracic Lesion: Neoplasia, trauma (post-op/other), inflammatory mass/lesion 3. Polyneuropathy and polymyopathy: Idiopathic, immune-mediated, endocrinopathy (hypothyroidism), other systemic disorder, toxicity, congenital disease - myasthenia gravis

Answer 69

Bouvier Des Flandres Siberian Huskies Bull Terriers *Dalmations, Rottweilers, Great Pyrenees *Labrador Retrievers

Answer 70

- respiratory distress and stridor - change in voice - gagging or coughing; often noted with eating or drinking

Answer 71

- Thoracic + cervical radiographs - thyroid hormone evaluation - serum biochem - evaluation for polyneuropathy/polymyopathy; electromyography, nerve conduction measurements, antinuclear antibody test, antiacetylcholine receptor antibody test

Answer 72

even with underlying associated disease treatment complete resolution of clinical signs is rarely seen - surgery; arytenoid lateralization (tie-back), partial laryngectomy, castellated laryngoplasty - medical; Pred 0.5mg/kg q12h to reduce oedema (limited effect), limit exercise, trazodone

Answer 73

232 dogs had survival rates of 94% at 1y, 89% at 2yrs, 84% at 3y, 75% at 4yrs

Answer 74

refers to the multiple anatomic abnormalities commonly found in Brachycephalic dogs (and to a lesser extent cats) - includes stenotic nares, elongated soft palate, hypoplastic trachea, abnormal obstructing nasal turbinates - prolonged upper airway obstruction can lead to eversion of laryngeal saccules and laryngeal collapse - concurrent GI signs; ptyalism, regurgitation, vomiting are common

Answer 75

3-4months old; ideally before CS develop - soft palate can also be evaluated and corrected at this time

Answer 76

nonneoplastic infiltration of the larynx with inflammatory cells can occur in dogs and cats, causing irregular proliferation, hyperemia, and swelling of the larynx - inflammatory infiltrates can be granulomatous, pyogranulomatous, or lymphocytic-plasmacytic

Answer 77

- glucocorticoid therapy; Pre 1mg/kg PO BID +/- conservative excision of tissue obstructing the airway if large masses/severe upper airway obstruction present

Answer 78

tumours originating from adjacent tissues such as thyroid carcinoma and lymphoma

Answer 79

- carcinoma (squamous cell, undifferentiated, adenocarcinoma) - lymphoma - melanoma - mast cell tumours - other sarcomas - benign neoplasia

Answer 80

diseases of the trachea, bronchi, bronchioles, alveoli, interstitium, and vasculature of the lung

Answer 81

- Canine infectious respiratory disease complex - Canine chronic bronchitis - Tracheobronchomalacia (collapsing trachea and/or bronchi) - feline bronchitis (idiopathic) - allergic bronchitis - bacterial, including Mycoplasma, infections - Oslerus osleri infection - Neoplasia - Foreign body - tracheal tear - bronchial compression; LA enlargement, hilar lymphadenopathy, neoplasia

Answer 82

1. Viral: - Canine influenza, distemper - Calicivirus - Feline infectious peritonitis 2. Bacterial pneumonia 3. Protozoal Pneumonia; Toxoplasmosis 4. Fungal pneumonia - Blastomycosis - Histoplasmosis - Coccidioidomycosis 5. Parasitic - Heartworm - Pulmonary parasites; Paragonimus, Aelurostrongylus, Capillaria, Crenosoma

Answer 83

1. Infections: viral, bacterial, protozoal, fungal, parasitic 2. Aspiration pneumonia 3. Eosinophilic lung disease 4. Idiopathic interstitial pneumonias; Idiopathic pulmonary fibrosis 5. Pulmonary neoplasia 6. Pulmonary contusions 7. Pulmonary hypertension 8. Pulmonary thromboembolism 9. Pulmonary oedema

Answer 84

an explosive release of air from the lungs through the mouth; generally protective reflex to expel material from the airways, although inflammation or compression of the airways can also stimulate a cough

Answer 85

1. Oedema - heart failure - noncardiogenic pulmonary oedema 2. Mucus or Exudate - canine infectious respiratory disease complex - canine chronic bronchitis - feline bronchitis (idiopathic) - allergic bronchitis - bacterial infection (bronchitis/pneumonia) - parasitic disease - aspiration pneumonia - fungal pneumonia (severe) 3. Blood (Hemoptysis) - heartworm disease - neoplasia - fungal pneumonia - thromboembolism - severe heart failure - foreign body - lung lobe torsion - systemic bleeding disorder

Answer 86

tracheal collapse

Answer 87

pneumonias and pulmonary oedema

Answer 88

airway inflammation (ie. bronchitis) or large airway collapse

Answer 89

coughing associated with heart failure tends to occur more at night, whereas coughing caused by bronchitis tends to occur more frequently upon rising from sleep, during/after exercise or exposure to cold air

Answer 90

continuous, high-pitched sounds occur with obstructive laryngeal conditions (laryngeal paralysis, neoplasia, inflammation, foreign bodies) and presence of airway narroowing - stridor

Answer 91

nonmusical, discontinuous noises that sound like paper being crumpled or bubbles popping

Answer 92

diseases resulting in the formation of oedema, or an Exudate within the airways (eg. pulmonary oedema, infectious or aspiration pneumonia, bronchitis) and some interstitial pneumonias, particularly interstitial fibrosis

Answer 93

- airway narrowing - bronchoconstriction, bronchial wall thickening, exudate or fluid within the bronchial lumen, intraluminal masses, or external airway compression - commonly heard in cats with bronchitis

Answer 94

- tracheal wash - nonbronchoscopic bronchoalveolar lavage - transthoracic lung aspiration

Answer 95

- obtain rads during inspiration and expiration to identify dynamic changes in luminal diameter - only inner wall should be seen; if outer wall visible suggestive of pneumomediastinum - elevated at the Carina is heart is enlarged/pleural effusion present - cartilage can become calcified - normal tracheal lumen is nearly as wide as the laryngeal lumen; tracheal diameter:thoracic inlet diameter can be used - most foreign bodies lodge at the Carina/within bronchi

Answer 96

- vascular - bronchial - alveolar - interstitial

Answer 97

- canine infectious resp. disease complex - canine chronic bronchitis - collapsing trachea - feline bronchitis (idiopathic) - acute foreign body inhalation - gastroesophageal reflux

Answer 98

- pulmonary thromboembolism - acute aspiration/pulmonary hemorrhage/foreign body inhalation

Answer 99

- heartworm disease - aelurostrongylosis (cats) - pulmonary thromboembolism - pulmonary hypertension

Answer 100

left-sided heart failure

Answer 101

= pulmonary overcirculation 1. left-to-right shunts; PDA, ventricular septal defects, atrial septal defect

Answer 102

= pulmonary undercirculation - Cardiovascular shock - hypovolemia; severe dehydration, hypoA, blood loss - pulmonic valve sesnosis = hyperinflation of the lungs; allergic bronchitis or feline bronchitis (idiopathic)

Answer 103

thickened bronchial walls causing the appearance of parallel thick lines with an air stripe between when running transverse to the x-ray beam

Answer 104

- thickened bronchial walls; presence of bronchitis and results from an accumulation of mucus/exudate along the walls within the lumens, an infiltration of inflammatory cells within the walls, muscular hypertrophy, epithelial hyperplasia, or a combination of these changes

Answer 105

- canine chronic bronchitis - feline idiopathic bronchitis - allergic bronchitis - canine infectious resp. disease complex - bacterial infection - Mycoplasmal infection - pulmonary parasites

Answer 106

chronic bronchial inflammation can result in irreversible dilation of the airways - Identified on rads by the presence of widened, nontapering airways - can be cylindrical (tubular) or saccular (cystic)

Answer 107

- when the alveoli are filled with a fluid-dense material - oedema, inflammation, haemorrhage, neoplastic infiltrates

Answer 108

when fluid-dense regions are located at the edge of a lung lobe the curvilinear edge of the affected lung lobe is visible in contrast with the adjacent, aerated lobe

Answer 109

1. Pulmonary Oedema 2. Severe inflammatory disease; bacterial, aspiration pneumonia 3. Haemorrhage; contusions, PTE, neoplasia, fungal pneumonia, systemic coagulopathy

Answer 110

- reticular (unstructured) - nodular - reticulonodular

Answer 111

1. Neoplasia 2. Mycotic infection; Blastomycosis, Histoplasmosis, Coccidioidomycosis 3. Pulmonary Parasites; Aelueostrongylus infection, Paragonimus infection 4. Abscess; bacterial, foreign body 5. Eosinophilic lung disease 6. Idiopathic interstitial pneumonia 7. Inactive lesions

Answer 112

1. Mild pulmonary oedema 2. Infection; viral, bacterial mycotic, parasitic, toxoplasmosis 3. Neoplasia 4. Eosinophilic Lung Disease 5. Idiopathic interstitial pneumonia; idiopathic pulmonary fibrosis (westies( 6. Mild haemorrhage

Answer 113

- severe bacterial/aspiration pneumonia - neoplasia - lung lobe torsion - haemorrhage

Answer 114

- right middle - left cranial

Answer 115

- O.osleri - Aelurostrongylus abstrusus - Crenosoma vulpis

Answer 116

- Capillaria (Eucoleus) aerophila - Paragonimus kellicotti

Answer 117

Tachyzoites

Answer 118

- simple technique - minimal expense - no special equipment - complications rare - volume adequate for cytology and culture

Answer 119

- airways must be involved for specimen to represent disease - may induced bronchospasm in patients with hyper-reactive airways, particularly cats

Answer 120

- bronchial and alveolar disease (particularly bacterial bronchopneumonia and aspiration pneumonia) - because of safety and ease, consider for any lung disease - less likely to be representative of interstitial or small focal processes

Answer 121

- nonbronchoscopic technique requires no special equipment and minimal expense - bronchoscopic technique allows airway evaluation and directed sampling - resultant hypoxemia is transient and responsive to oxygen supplementation - safe for animals in stable condition - large volume of lung sampled - high cytologic quality - large volume for analysis

Answer 122

- GA required - special equipment and expertise for bronchoscopic collection - generally not recommended for animals with tachypnoea, increased respiratory efforts or resp. distress - capability to provide oxygen supplementation for an hour or more is required - may induced bronchospasm in patients with hyper-reactive airways, particularly cats

Answer 123

- primarily diffuse interstitial disease; also small airway and alveolar disease - routine during bronchoscopy

Answer 124

- simple technique - minimal expense - no special equipment - solid masses adjacent to body wall: excellent representation with minimal risk

Answer 125

- potential for complications; pneumonia/hemothorax, pulmonary hemorrhage - relatively small area of lung sampled - specimen adequate only for cytology - specimen blood contaminated

Answer 126

- solid masses adjacent to chest wall (for solitary/localized disease) - diffuse interstitial disease

Answer 127

- ideal specimen - allows histologic examination in addition to culture

Answer 128

- relatively expensive - requires expertise - requires GA - major surgical procedure

Answer 129

- localized process where excision may be therapeutic as well as diagnostic - any progressive disease not diagnosed by less invasive methods

Answer 130

cricothyroid ligament (located in depression immediately above the cricoid cartilage)

Answer 131

- measure distance along path of tracheal from cricothyroid ligament to 4th intercostal space for approximate distance to Carina and ensure catheter reaches just proximal to this position

Answer 132

- sterile gauze sponge with antiseptic ointment immediately placed over catheter site and then a light bandage is wrapped around the neck and left in place for several hours while the animal rests quietly in a cage - to minimize likelihood of SQ emphysema or pneumomediastinum

Answer 133

5F is ideal

Answer 134

- viral, rickettsial infection - idiopathic interstitial pneumonia - lymphoma overall uncommon finding

Answer 135

5ml/kg of body weight = 1 bolus (can rpt 2-3 times)

Answer 136

50-80% of the total volume of saline instilled is expected to be recovered - the rest will be absorbed

Answer 137

<400-500/uL

Answer 138

1.7 x 10^3 CFUs/mL

Answer 139

25% of cases

Answer 140

caudal lung lobe; 7-9th ICS approximately two thirds of the distance from the costochondral junctions to the spine

Answer 141

- ID location, prep, lidocaine skin - 22G 1.5-3.5 inch spinal needle advanced through the skin several rib spaces from desired biopsy site - then move needle to biopsy site; less likely to cause air tracking through needle tract - needle advanced through body wall to the pleura - stylet removed and 12ml syringe placed on hub (put finger on in the interim to prevent pneumothorax) - during inspiration; needle thrust into chest at predetermined depth (rads/US guided) while suction applied to syringe - needle withdraw with a minimal amount of negative pressure maintained

Answer 142

- may resemble adenocarcinoma

Answer 143

- femoral artery - dorsal pedal artery

Answer 144

increased concentration of nonoxygenated hemoglobin in the blood

Answer 145

1. Venous specimen 2. Hypoventilation - airwayobstruction - decreased ventilatory muscle function; anaesthesia, CNS disease, polyneuro/myopathy, myasthenia, extreme fatigue - restriction of lung expansion; thoracic wall abnormality, pneumothorax, pleural effusion, excessive thoracic bandage - increased dead space (low alveolar ventilation); severe chronic obstructive pulmonary disease/emphysema 3. End-stage severe pulmonary parenchymal disease 4. Severe pulmonary thromboembolism

Answer 146

- ventilation/perfusion abnormality = most lower resp. tract diseases

Answer 147

the flow of blood past a totally nonaerated tissue (venous admixture or shunt)

Answer 148

ventilation of areas of lung with decreased circulation - thromboembolism

Answer 149

alveolar-arterial oxygen gradient - factors out the effects of ventilation and the inspired oxygen concentration on PaO2

Answer 150

the premise of the A-a gradient is that PaO2 (a) is nearly equal (within 10mmHg in room air) to the partial pressure of oxygen in the alveoli, PAO2 (A), in the absence of a diffusion abnormality of V/Q mismatch. In the presence of a diffusion abnormality of V/Q mismatch, the difference widens (greater than 15mmHg in room air). Examination of the equation reveals that hyperventilation, resulting in a lower PaCO2 leads to a higher PAO2. Conversely, hypoventilation, resulting in a higher PaCO2 leads to a lower PAO2.

Answer 151

PCV divided by 3

Answer 152

the value measured indicates the saturation of hemoglobin in the local circulation

Answer 153

- vasoconstriction - low CO - local stasis of blood - anaemia - hyperbilirubinaemia - carboxyhemoglobinaemia/methemoglobinaemia - external lights - location of the probe

Answer 154

Canine Infectious Respiratory Disease Complex "Kennel Cough"

Answer 155

- Canine adenovirus 2 - Canine influenza viruses (H3N8, H3N2) - Canine parainfluenza virus - Canine Herpes virus - type 1 - Canine respiratory coronavirus - Canine pneumovirus

Answer 156

- Bordetella bronchiseptica - Streptococcus equi, subsp. zooepidemicus - Mycoplasma cynos - Other mycoplasma spp

Answer 157

Bordetella organisms infect ciliated respiratory epithelium and decrease mucocilliary clearance

Answer 158

1. More than one type of organism is responsible 2. It is like colds and flu in people; some never get sick, some get sick frequently, most people recover without treatment others develop pneumonia and can die 3. More likely to get sick if frequently exposed to others, being very old/young, immunocompromised, underlying respiratory disease, particularly virulent organisms 4. Vaccines are not completely effective, antibiotics are not usually necessary and ineffective against viruses

Answer 159

- sudden onset of a severe productive/nonproductive cough which is usually exacerbated by exercise, excitement or pressure of the collar on the neck - tracheal pinch - gagging, retching or nasal discharge - a recent history (<2wks) of boarding, hospitalisation, exposure for a puppy or dog with similar signs - mostly self-limiting but secondary bacterial pneumonia can develop in puppies, immunocompromised dogs, dogs that have preexisting lung abnormalities (ie. chronic bronchitis)

Answer 160

results can be positive for 28 days post intranasal B.bronchiseptica, Canine parainfluenza virus, canine adenovirus 2 vaccination (Ruch-Galle et al., 2016)

Answer 161

- rest for at least 7 days, avoid exercise/excitement to reduce irritation of airways caused by excessive coughing - cough suppressants ONLY if severe cough to allow sleep/prevent exhaustion...should not be given if cough if overtly productive (Dextromethorphan, Butorphanol, Hydrocodone bitartrate) - antimicrobials to be considered within the first 10 days if fever, lethargy, inappetence is present with mucopurulent discharges; antibiotics to be administered for 5 days beyond the time clinical signs resolve, or for at least 10 days

Answer 162

puppies must be vaccination with combination distemper vaccines every 2-4wks beginning at 6-8wks of age through to 14-16wks. - at least 2 vaccines given initially with a booster after 1yr and subsequent vaccines q3ys - unless high risk

Answer 163

- injectable and intranasal for B.bronchiseptica, PIV, CAV2 - oral for B.bronchiseptica - injectable modified-live for CAV2 and PIV - killed, injectable for canine influenza virus (H3N8, H3N2)

Answer 164

Intranasal Bordetella vaccines occasionally cause clinical signs, predominantly cough.

Answer 165

Canine Chronic Bronchitis is a disease syndrome defined clinically as cough that occurs on most days of 2 or more consecutive months in the past year in the absence of other active disease.

Answer 166

Histologic changes in the airways are those of long-term inflammation and include fibrosis, epithelial hyperplasia, glandular hypertrophy and inflammatory infiltrates.

Answer 167

Presumed that it is a consequence of a long-standing inflammatory process initiated by infection, allergy or inhaled irritants or toxins. A continuing cyclone of inflammation likely occurs as mucosal damage, mucus hypersecretion and airway obstruction impair normal mucocilliary clearance and inflammatory mediators amplify the response to irritants and organisms.

Answer 168

- middle-aged/older, small breed dogs - Terriers, Poodles, Cocker Spaniels

Answer 169

- loud, harsh cough - mucus hypersecretion is a component of the disease; but cough may sound productive/nonproductive - usually slowly progresses over months to years, although can be presented acutely due to disease progression resulting in exercise intolerance, incessant coughing, respiratory distress

Answer 170

- Bacterial infection - Mycoplasmal infection - Left atrial enlargement - Pulmonary parasites - Heartworm disease - Allergic bronchitis - Neoplasia - Foreign body - Chronic aspiration - Gastroesophageal reflux

Answer 171

- Tracheobronchomalacia - Pulmonary Hypertension - Bacterial infection - Mycoplasmal infection - Bronchiectasis

Answer 172

- tracheobronchomalacia - left atrial enlargement - heart failure

Answer 173

- a bronchial patterns with increased interstitial markings but changes are often mild and difficult to distinguish from clinically insignificant changes associated with aging - thoracic rads are most useful to identify OTHER CAUSES/SECONDARY DISEASE

Answer 174

- neutrophilic or mixed inflammation and increased amounts of mucus are usually present

Answer 175

- increased amounts of mucus, roughened mucosa, hyperaemia - major airway collapse during expiration dt weakened walls - polypoid mucosal proliferation - bronchial dilation (bronchiectasis)

Answer 176

- ciliary motion is abnormal, uncommon but should be considered in young dogs with bronchiectasis or recurrent bacterial infection - abnormalities exist in all ciliated tissues and situs inversus is seen in 50% of such dogs - sperm motility can be evaluated in intact males - diagnosed on the basis of the rate at which radioisotopes deposited at the Carina are cleared and the findings from electron microscopic examination of bronchial biopsy, nasal biopsy or sperm specimens

Answer 177

1. Avoid exacerbating factors/triggers (ie. smoke inhalation, perfumes) 2. Improve air quality at home 3. Reduce anxiety/stress/excitement with anxiolytic drugs if causing acute worsening/episodes 4. Routine dental/teeth brushing to maintain a healthy oral flora to decrease oral flora pathogen aspiration 5. Airway hydration; systemic hydration + steam inhalation, saline nebulisation 6. Weight loss 7. Medications; bronchodilators, glucocorticoids, cough suppressants +/- ABs

Answer 178

- effective in treating the underlying inflammation of chronic bronchitis (at lower doses than bronchodilation dose) - anti-inflammatory effects may be synergistic with glucocorticoids - may improve mucociliary clearance - inhibit the release of mast cell mediators of inflammation - decrease fatigue of respiratory muscles *theophylline alone is rarely sufficient to control chronic bronchitis unless mild case

Answer 179

1. Methylxanthines; Aminophylline, Theophylline 2. Sympathomimetics: Terbutaline, Albuterol

Answer 180

GI signs, cardiac arrhythmias, nervousness, seizures *Note other drugs such as fluoroquinolone can delay its clearance therefore must reduce dose to 1/3 or 1/2, or double the dosage interval *Serious AEs are extremely rare at therapeutic doses

Answer 181

Based on human study (Barnes, 2003). - bronchodilation: 10-20ug/mL - anti-inflammatory: 5-10ug/mL

Answer 182

Pros: most effective for controlling signs of chronic bronchitis and may slow development of permanent damage by decreasing inflammation Cons: increased susceptibility to infection, tendency towards obesity, muscle weakness and hepatomegaly which may adversely affect ventilation, risk of PTE

Answer 183

- originate from the oropharynx - frequently gram-negative with unpredictable AB sensitivity patterns - protected by airway secretions

Answer 184

- allergic bronchitis - pulmonary parasites (Aelurostrongylus abstrusus, Capillaria aerophila, Paragonimus kellicotti) - heartworm disease - bacterial bronchitis - Mycoplasmal bronchitis - idiopathic pulmonary fibrosis - carcinoma - toxoplasmosis - aspiration pneumonia - idiopathic feline bronchitis

Answer 185

- reversible airway obstruction primarily resulting from bronchoconstriction - hypertrophy of smooth muscle - increased mucus production - eosinophilic inflammation

Answer 186

- reversible airway inflammation of short duration (<1-3months) - increased mucus production - neutrophilic or macrophagic inflammation

Answer 187

- chronic airway inflammation (>2-3months) resulting in irreversible damage (eg. fibrosis) - increased mucus production; neutrophilic, eosinophilic, mixed - isolation of bacteria or Mycoplasma organisms causing infection or as nonpathogenic inhabitants - concurrent bronchial asthma

Answer 188

- destruction of bronchiolar and alveolar walls resulting in enlarged peripheral air spaces - cavitary lesions (bullae) - result of or concurrent with chronic bronchitis

Answer 189

- most commonly develops in young adult to middle-aged adults - cough or episodic respiratory distress or both - slowly progressive signs

Answer 190

- bronchial pattern - increased reticular interstitial markings and patchy alveolar opacities - lungs may be overinflated as a result of trapping air - occasionally collapse (atelectasis) of the right middle lung lobe is seen

Answer 191

1. Environmental; improvement of indoor air quality and removal of triggers/irritants 2. Glucocorticoids +/- bronchodilators 3. Possible ABs; Doxycycline 14 days, Azithromycin

Answer 192

complete cure is unlikely - most cats require continued medication - cats with persistent, untreated airway inflammation can develop permanent changes of chronic bronchitis and emphysema - severe, acute asthma attacks are at risk for sudden death

Answer 193

refers to narrowing of the tracheal lumen resulting from weakening of the cartilaginous rings, redundancy of the dorsal tracheal membrane or both

Answer 194

- primary = congenital; toy breed related - secondary = acquired; due to chronic airway inflammation

Answer 195

- extrathoracic; upper airway obstruction = resp. distress pronounce on inspiration and audible stertorous sounds - intrathoracic; pronounced on expiration and is usually associated with an audible, loud wheeze or cough

Answer 196

- middle-aged toy and mini dogs - signs may occur acutely then slowly progress over months to years - nonproductive, 'goose honk' cough worsening with excitement/exercise/pressure on neck

Answer 197

- radiographs of neck and thorax to evaluate the size of the tracheal lumen during expiration and inspiration

Answer 198

1994 White et al. study found medical therapy resulted in a resolution of signs for at least 1yr in 71% of cases

Answer 199

- weight loss - harnesses (not collars) - prevention of excessive excitement/exercise (anxiolytics) - cough suppressants - anti-inflam. pred - bronchodilators

Answer 200

a novel TBM treatment studied in 2012 by Adamama-Moraitou et al. - though to improve tracheal wall strength via enhanced protein or collagen synthesis, increased chondroitin sulfate content, increased lean body mass, and decreased inflammation

Answer 201

Rosenheck et al., 2017 study 27 dogs; medical survival 502 days; 78% to 6months, 60% to 1yr, 26% to at least 2 years. + ongoing medical management Rate of serious complications ~40%

Answer 202

allergic bronchitis is a hypersensitivity response of the airways to an allergen or allergens

Answer 203

- uncommon parasite of young dogs (<2yrs usually) - adult worms live at the Carina and mainstem bronchi and cause a local, nodular inflammatory reaction with fibrosis - first-stage larvae are coughed up and swallowed - persistent cough, eventual airway obstruction due to nodule formation

Answer 204

- nodules at the Carina visualized via radiographs or bronchoscopy (+brushings of nodules for cytology - larvae) - cytologic examination of tracheal wash (ova/larvae)

Answer 205

- ivermectin q3wks for 4 doses - fenbendazole for 14 days

Answer 206

- calicivirus (but rare) - dry form of FIP (also rare) feline viruses tend to cause URT signs

Answer 207

- B.bronchiseptica - Streptococcus spp. - Staphylococcus spp. - E.coli - Pasteurella spp. - Klebsiella spp. - Proteus spp. - Pseudomonas spp.

Answer 208

- aspiration of ingested material or gastric contents caused by cleft palates/megaO - decreased clearance from the lungs of normally inhaled debris; chronic bronchitis, ciliary dyskinesia, bronchiectasis - immunosuppression; drugs, malnutrition, stress, endocrinopathies - inhalation or migration of foreign bodies - rare but neoplasia, fungal or parasitic infection

Answer 209

1. Antibiotics 2. Airway hydration 3. Physiotherapy; coupage, mild exercise if stable, turning of recumbent animals q1-2h 4. Bronchodilators (esp. cats) 5. Oxygen supplementation 6. AVOID; corticosteroids, diuretics, cough suppressants

Answer 210

Drying of secretions results in increased viscosity and decreased ciliary function, which interfere with the normal clearance mechanisms of the lung.

Answer 211

- provides moisture deeper into the airways as nebulisers generate small, variably sized droplets (0.5-5um diameter)

Answer 212

- sterile saline +/- premedication with a bronchodilator - 2-6x daily for 10-30minutes - deliver nebulised saline via face mask/enclosed cage

Answer 213

- it is a mucolytic agent and also an antioxidant

Answer 214

- discontinue one week after clinical and radiographic signs have resolved OR - 5-7 days after the normalisation of CRP

Answer 215

fluffy alveolar and interstitial opacities throughout the lungs in such animals - less often, a nodular interstitial, diffuse interstitial or bronchial patterns, lung lobe consolidation or pleural effusion is seen

Answer 216

blastomycosis, histoplasmosis, coccidioidomycosis - cryptococcal organisms (usually nasal in cats but can infect lungs)

Answer 217

- diffuse, (miliary) nodular, interstitial patterns of the lungs +/- alveolar, bronchointerstital, consolidated regions +/- hilar lymphadenopathy (esp. with histoplasmosis - lesions can calcify)

Answer 218

- neoplasia - atypical bacteria; Mycobacterium, Actinomyces, Nocardia - eosinophilic lung disease

Answer 219

- Toxocara canis (GIT) - Dirofilaria immitis - Oslerus osleri - Capillaria (Eucoleus) aerophila - Paragonimus kellicotti - Aelurostrongylus abstrusus - Crenosoma vulpis

Answer 220

- a small nematode - adult worms are located primarily beneath the epithelial surfaces of the large airways - very few animals developed CS, but can show signs of allergic bronchitis

Answer 221

finding the characteristic eggs in tracheal wash fluid or faecal flotation

Answer 222

fenbendazole 50mg/kg PO SID for 14 days

Answer 223

- a small fluke, both snails and crayfish are necessary intermediate hosts - pairs of adults are walled off by fibrous tissue (usually in caudal lung lobe) with connection to an airway to allow passage for the eggs - a local granulomatous reaction may occur around the adults, or a generalized inflammatory response to the eggs may be noted - infection more common in cats than dogs - CS: allergic bronchitis, spontaneous pneumothorax (if cyst ruptures)

Answer 224

Paragonimus kellicotti

Answer 225

- Fenbendazole (as with capillariasis) - Praziquantel 23mg/kg PO TID for 3 days

Answer 226

- a small worm that infects the small airways and pulmonary parenchyma of cats - infects cats; usually no CS, or bronchitis, in young cats

Answer 227

- often consistent with bronchitis +/- diffuse miliary or nodular interstitial pattern +/- pulmonary arterial enlargement

Answer 228

fenbendazole 50mg/kg PO SID for 15 days +/- bronchodilators

Answer 229

- a lungworm of foxes that can infect dogs (Atlantic Canada, Europe, rare in the US) - snails and slugs are intermediate hosts - worm resides in the airways - CS; like allergic/chronic bronchitis

Answer 230

bronchointerstitial or patchy alveolar patterns, or occasionally a nodular pattern

Answer 231

single oral dose of milbemycin oxime (0.5mg/kg)

Answer 232

inflammatory lung disease that occurs as a result of the inhalation of overt amounts of solid or liquid material into the lungs (stomach contents/food) - typically presence of aspiration pneumonia indicates an underlying predisposing abnormality

Answer 233

- Megaoesophagus - Reflux oesophagitis - Esophageal dysmotility - Esophageal obstruction - Myasthenia gravis - Bronchoesophageal fistulae

Answer 234

- laryngeal paralysis - cleft palate - cricopharyngeal motor dysfunction - laryngoplasty - Brachycephalic airway syndrome

Answer 235

- myasthenia gravis - polyneuropathy - polymyopathy

Answer 236

- esophageal disorders - localized oropharyngeal abnormalities - systemic neuromuscular disorders - decreased mentation - iatrogenic - vomiting

Answer 237

- diffuse, increased interstitial opacities with alveolar flooding (air bronchospasm) and consolidation of the dependent lung lobes

Answer 238

a broad term that describes inflammatory lung disease in which the predominant infiltrating cell is the eosinophil

Answer 239

a severe type of eosinophilic lung disease of dogs and characterized by the development of nodules and often hilar lymphadenopathy

Answer 240

- eliminating source of the antigen - glucocorticoids when antigen source cannot be identified - immunosuppressive therapy if more severe eosinophilic granulomatosis (Pred + cyclophosphamide) if signs remained in remission for 3 months, discontinuation of therapy can be attempted

Answer 241

Generally denotes inflammatory infiltration and/or fibrosis of the lungs involving primarily the alveolar septa. The known etiologies of interstitial lung disease must be ruled out to diagnose "idiopathic". The alveolar septa include alveolar epithelium, epithelial basal lamina, capillary endothelial basal lamina, and capillary endothelium.

Answer 242

1. Exclusion of other known causes of interstitial lung diseases including domestic and occupational environmental exposures, connective tissue disease, and drug toxicity. 2. Characteristic pattern on high resolution computed tomography in patients without surgical lung biopsy abnormalities AND 3. Specific combinations of HRCT and surgical lung biopsy lesions in patients with biopsy

Answer 243

- fibrosis - areas of fibroblast proliferation - metaplasia of the alveolar epithelium - mild to moderate inflammation - honeycomb change (enlarged airspaces lined by abnormal alveolar epithelium) - abnormal regions often subpleural, lungs are heterogenously affected

Answer 244

- West Highland White Terriers! - Staffies, Jack Russels, Cairn Terriers, Schipperkes (to a lesser extent)

Answer 245

- signs slowly progressive over months - respiratory compromise is the most prominent CSS; exercise intolerance, tachypnoea/dyspnoea - crackles +/- wheezes

Answer 246

- diffuse interstitial pattern +/- bronchial pattern - cats often have patchy/diffuse infiltrates - bronchiectasis

Answer 247

- corticosteroids - bronchodilators +/- omeprazole (microaspirations speculated to play a role)

Answer 248

- poor - dogs; mean survival time is 18months after onset of signs (Corcoran et al.,1999) - cats; within weeks of onset of signs, <1/3 live longer than a year (Cohn et al., 2004)

Answer 249

- carcinomas; adenocarcinoma, bronchoalveolar carcinoma, squamous cell carcinoma

Answer 250

- lymphoma - malignant histiocytosis - mastocytoma

Answer 251

55/76 dogs went into remission - median survival time was 330 days. Of those that did not achieve remission survival time was 28 days.

Answer 252

when pulmonary systolic pressure exceeds 30mmHg - diagnosis it made by direct pressure measurements obtained via cardiac catheterisation

Answer 253

- obstruction to venous drainage as can occur with left-sided heart disease, increased pulmonary blood flow caused by congenital heart disease, increased pulmonary vascular resistance OR - idiopathic/primary

Answer 254

- PTE - Heartworm - complication of chronic pulmonary parenchymal disease (chronic bronchitis, pulmonary fibrosis) due to hypoxic vasoconstriction

Answer 255

- exercise intolerance - weakness - syncope - respiratory distress

Answer 256

sildenafil citrate - causes vasodilation through a Nitric oxide pathway (1mg/kg PO TID)

Answer 257

- only if related to chronic valvular heart disease (Atkinson et al., 2009) - Murphy et al., 2017 study found that it didn't help in cases associated with lung disease

Answer 258

- clinical picture; severe dyspnea of acute onset with minimal/no radiographic signs of respiratory disease - clinicopathologic evidence of a disease known to predispose animals to thromboemboli - TEG indicating hypercoagulability - if radiographic signs occur; caudal lung lobes most often involved with blunted pulmonary arteries, in some cases ending with focal or wedge-shaped areas of interstitial or alveolar opacity resulting from extravasation of blood or oedema - arterial blood gas; can show mild-profound hypoxemia, tachypnoea leads to hypocapnia - a D-dimer concentration >500ng/mL was able to predict the diagnosis of thromboembolic disease with 100% sensitivity with a specificity of 70% - CT pulmonary angiography - selective angiography (gold standard); sudden pruning of pulmonary arteries or intravascular filling defects and extravasation of dye are characteristic findings

Answer 259

1. Stabilise; oxygen therapy, IVFT as needed 2. Theophylline, sildenafil (if pulmonary hypertension) 3. Anticoagulant therapy to prevent formation of additional thrombi 4. Prevention; long term low-molecular-weight heparin, aspirin or clopidogrel

Answer 260

Acute Lung Injury; an excessive inflammatory response of the lung to a pulmonary or systemic insult. The rapid leakage of high-protein edema fluid from damaged capillaries is a key feature of ALI. Epithelial cell proliferation and collagen deposition add to pulmonary dysfunction and can ultimately result in pulmonary fibrosis.

Answer 261

Acute Respiratory Distress Syndrome describes severe ALI based on degree of hypoxaemia

Answer 262

1. Decreased plasma oncotic pressure 2. Vascular Overload 3. Lymphatic Obstruction (rare) 4. Increased Vascular Permeability 5. Miscellaneous Causes

Answer 263

- GI loss - Glomerulopathy - Liver Disease - Iatrogenic overhydration - Starvation

Answer 264

- inhaled agents; smoke inhalation, gastric acid aspiration, oxygen toxicity - drugs or toxins; snake venom, cisplatin in cats, paraquat - electrocution - trauma; pulmonary contusions or multisystmic - sepsis or SIRS - pancreatitis - uremia - disseminated intravascular coagulation - inflammation (infectious or non-infectious)

Answer 265

Serum albumin concentrations are required to be <1g/dL (typically) - generally there are also other factors such as volume overload/vasculitis contributing

Answer 266

At least four, ideally five of the following criteria must be met; 1. Acute onset (<72hours) of tachypnea and labored breathing at rest 2. Known risk factors 3. Evidence of pulmonary capillary leak without increased pulmonary capillary pressure (eg. bilateral diffuse pulmonary infiltrates on radiography or CT, proteinaceous fluid retrieved from airways) 4. Evidence of insufficient gas exchange 5. Evidence of diffuse pulmonary inflammation based on tracheal wash or BAL fluid analysis

Answer 267

1. Cage rest + minimal stress 2. +/- Oxygen therapy 3. +/- Positive-pressure ventilation in severe cases (PEEP/ventilator) 4. +/- Methylxanthine bronchodilators; mild diuretics that also decreased bronchospasms and possibly respiratory muscle fatigue 5. Frusemide is indicated for the treatment of most forms of oedema unless hypovolaemic 6. Conservative fluid supplementation if hypovolaemic - if it is necessary to maintain vascular volume in animals with cardiac impairment or decreased oncotic pressure, then positive inotropic agents or plasma infusions (respectively) are necessary 7. Oedema caused by hypoalbuminemia req. plasma or colloid infusions

Answer 268

- the animal will hopefully be more stable - the air/fluid have been removed and the lungs have time to re-expand to properly evaluate the pulmonary parenchyma - the presence of fluid can also obscure mass lesions and the heart shape/size

Answer 269

- right sided heart failure - pericardial disease - hypoalbuminemia (pure transudate) - neoplasia - diaphragmatic hernia

Answer 270

- FIP - neoplasia - diaphragmatic hernia - lung lobe torsion

Answer 271

- trauma - bleeding disorder - neoplasia - lung lobe torsion

Answer 272

- low protein concentrations <2.5-3g/dL - low nucleated cell counts <500-1000/uL - primary cell types; mononuclear cells; macrophages, lymphocytes, mesothelial cells

Answer 273

- slightly higher (than pure) protein concentrations of up to 3.5g/dL - nucleated cell counts of up to 5000/uL - primary cell types; neutrophils and mononuclear cells

Answer 274

- increased hydrostatic pressure - decreased plasma oncotic pressure - lymphatic obstruction

Answer 275

- high protein concentrations >3g/dL - NCC high >5000/uL - cell types in non-septic exudates; neutrophils, macrophages, eosinophils, lymphocytes + no evidence of organisms

Answer 276

- extremely high NCC 50000 to more than 100000/uL - main cell types; degenerate neutrophils + bacteria observed within neuts/macs and extracellularly

Answer 277

- spontaneously - secondary to penetrating wounds (chest wall/oesophagus), migrating grass awns or other foreign bodies - extension of bacterial pneumonia

Answer 278

to identify Actinomyces and Nocardia spp.

Answer 279

- results from leakage of fluid from the thoracic duct which carries lipid-rich lymph from the body - can be idiopathic, secondary to trauma, neoplasia, cardiac disease, pericardial disease, dirofilariasis, lung lobe torsion or diaphragmatic hernia - chyle is milky, white and turbid, largely as a result of chylomicrons that carry fats from the intestines

Answer 280

- cytologic characteristics of a mod.transudate or nonseptic exudate - mod. concentration of protein, usually >2.5g/dL - NCC low to moderate; 400-10000/uL - predominant cell type; small lymphocytes (early disease), with time non-degenerative neutrophils and macrophages, and plasma cells - diagnosed via measuring concentration of triglycerides in pleural fluid and serum

Answer 281

- >3g/dL of protein - >1000 NCC/uL - cell type; similar to peripheral blood; over time neuts and macs increase

Answer 282

- effusions show erythrophagocytosis and an inflammatory response on cytology - effusions do not clot - PCV of effusions should be lower than periphery

Answer 283

- trauma - systemic bleeding disorder - neoplasia; haemangiosarcoma of heart/lungs most common - lung lobe torsion

Answer 284

- neoplasm may not exfoliate cells into the fluid - inflammation can result in considerable hyperplastic changes in mesothelial cells ** a cytologic diagnosis of neoplasia other than lymphoma should be made with extreme caution **

Answer 285

- pleural thickening; a thin, fluid-dense line between lung lobes arcing from the periphery toward the hilar region (pleural fissure lines) - pleural effusion; generally visible after about 50-100ml accumulate - pneumothorax; air opacity without vessels/airways - heart is generally elevated above the sternum

Answer 286

- prior pleural disease and subsequent fibrosis - mild active pleuritis - low-volume pleural effusion **note: infiltration of the pleura with neoplastic cells generally results in effusion rather than thickening**

Answer 287

- mild effusions = pleural fissure lines - as volume increases; the lung lobes retract and the lungs lobe borders become rounded (esp. caudodorsal angles of the caudal lung lobes) - fluid silhouettes the heart and diaphragm obscuring their borders - lungs float on top of the fluid, displacing trachea dorsally and causing illusion of mediastinal mass/cardiomegaly - collapses lung lobes

Answer 288

- heart - great vessels - oesophagus - lymph nodes

Answer 289

- the outer wall of the trachea and other cranial mediastinal structures (oesophagus, major branches of aortic arch, Cr.VC) are contrasted against air

Answer 290

- megaoesophagus - diaphragmatic hernia

Answer 291

- atelectasis, lobectomy, adhesions of the mediastinum to the chest wall - space-occupying lesions

Answer 292

- immediately dorsal to the sternum near the thoracic inlet at the level of the first to third sternebrae

Answer 293

at the heart base around the carina

Answer 294

- lymphoma - fungal infection (esp. histoplasmosis) - metastatic neoplasia - oesinophilic pulmonary granulomatosis - mycobacterial infection *any inflammatory disease that causes a lymphadenopathy

Answer 295

- atrial enlargement - heart base tumours - hilar lymphadenopathy

Answer 296

- 7th ICS - two thirds of the distance from the costochondral junction towards the spine - insert just in front of the rib

Answer 297

21G is usually large enough to collect air and most fluids (unless extremely viscous such as FIP or pyothorax)

Answer 298

- management of continued pneumothorax after multiple thoracocenteses - treatment of pyothorax

Answer 299

- pneumothorax - hemothorax - iatrogenic pyothorax

Answer 300

1. Lateral size of animal over the caudal rib cage is shaved and prepped 2. Animal is heavily sedated + local or anaesthetised 3. Measure tube; should extend from the 10th ICS to 1st rib (with fenestrations not extending outside the point of exit from the pleural cavity) 4. Stab incision made through skin at 10th ICS + purse string placed but not yet tied around opening 5. Tube is tunnelled SQ (with hemostats/stylet) to the 7th ICS 6. The palm of the hand is placed over the end of the stylet/hemostat handles and the tube is thrust through the body wall with one rapid motion. Once tube has entered pleural space, it is quickly advanced forward until the measured length and the stylet/hemostats are withdrawn. 7. Air is removed from pleural cavity with 35ml syringe 8. Purse-string is tied around the tube. The tube is then attached to the body wall (Chinese-finger trap) 9. Light wrap around the tube and chest wall. Hose clamp + 3-way tap. E.collar. 10. 2 view thoracic rads to check positioning; tube should extend a long the ventral aspect of the pleural space to the thoracic inlet. The absence of persistent fluid/air accumulation.

Answer 301

- repeat radiographs every 24-48hours - cytologic assessment of fluid - check skin site for inflammation/subcut emphysema - rebandaged and cleaned daily (at least)

Answer 302

- idiopathic is most common (esp. in cats) - otherwise results from foreign bodies (migrating grass awns (Foxails)), puncture wounds, oesophageal tears (usually from ingested FB)s, extension of pulmonary infection

Answer 303

1. Antibiotics; initial treatment with fluoroquinolone + a penicillin/clinndamycin (Lappin et al.,2017) injectable first then PO for 4-6 weeks 2. Drainage of pleural cavity; chest tube with continuous drainage or q2h, pleural lavage with saline 3. Supportive care

Answer 304

- twice daily - slow infusion of warmed sterile saline solution (~10ml/kg) - roll animal side to side and then remove fluid - should recover ~75% - no benefit in adding antibiotics/antiseptics/enzymes - Booth et al., 2010 study found benefit in adding heparin (1000-1500U/100mL) to lavage fluid to decrease fibrin formation

Answer 305

- volume of fluid recovered should be <2ml/kg/day - fluid cytology; no longer septic, neutrophils are not degenerative - no pockets of fluid on thoracic rads OR if FAILURE TO RESPOND: need chest tube for >1wk after starting appropriate ABs and drainage --> surgery

Answer 306

- 1yr survival rate 29% (Booth et al., 2010) - 25% successfully treated medically (Rooney et al., 2002)

Answer 307

- generalized lymphangiectasia, inflammation and obstruction of lymphatic flow (neoplasia or increased venous pressures) - cardiomyopathy, dirofilariasis, pericardial diseases, other causes of RSHF, central venous thromboses, lung lobe torsion, diaphragmatic hernia

Answer 308

fibrosing pleuritis and pericarditis (common in cats)

Answer 309

Afghan hounds and Shiba Inus

Answer 310

- generally required for weeks to months - intermittent thoracocentesis PRN - low-fat diet - Administration of Rutin, a benzopyrone drug, has been used in humans to treat lymphoedema - it is through to decrease the protein content of the effusion by affecting macrophage function - the resorption of effusion may thereby be enhanced and fibrosis of the pleura minimised (available over the counter, dosage of 50-100mg/kg PO TID)

Answer 311

- if failure to improve with medical management within 1-3months - thoracic duct ligation + pericardiectomy +/- ablation of the cisterna chyli - placement of pleuroperitoneal/pleurovenous chunts or mesh to allow fluid to drawing away from the pleural space if surgery is unsuccessful.

Answer 312

positive response in 50-80% of patients (Singh et al., 2012b)

Answer 313

- mediastinal lymphoma - mesothelioma - carcinoma

Answer 314

occurs if a one-way valve is created by tissue at the site of leakage, such that air can enter into the pleural space during inspiration but cannot return to the airways or atmosphere during expiration

Answer 315

- traumatic injury/blunt trauma to chest - tracheal tears (eg. overinflation of endotracheal tube cuffs in cats) - spontaneous; pre-existing pulmonary lesions rupture

Answer 316

- blebs, bullae and cysts - chronic airway disease (cats) - Paragonimus infection - necrotic neoplasms - thromboembolised region (eg. dirofilariasis) - abscesses - granulomas

Answer 317

Mooney et al.,2012 54% survived to discharge

Answer 318

- lymphoma (cats) - thymoma - rarely - thyroid carcinoma, parathyroid carcinoma, chemodectoma Neoplastic >> non-neoplastic

Answer 319

- tracheal washing - tracheostomy - ETT placement + overinflation of cuff

Answer 320

- trauma; bites to neck, blunt trauma, excessive resp. effort against obstructed airways, severe coughing causing sudden intrathoracic pressure changes, oesophageal tears (FBs) - iatrogenic

Answer 321

- strict cage rest to facilitate natural sealing of the tear - surgical repair

Answer 322

a certain position taken when there is difficulty breathing - elbows abducted and neck extended - movement of abdominal muscles to assist ventilation may be exaggerated

Answer 323

laryngeal paralysis and BOAS

Answer 324

- collapse of mainstem bronchi +/or intrathoracic tracheal (Tracheobronchomalacia)

Answer 325

refers to a breathing pattern in which the abdominal walls are 'sucked in' during inspiration

Answer 326

- animals with an inadequate arterial oxygen concentration (<60mmHg) despite supplementation - animals with arterial carbon dioxide pressures exceeding 60mmHg

Answer 327

- require air to be humified - >50% oxygen conc. is toxic to pulmonary epithelium --> function deteriorates and death can result - DO NOT PROVIDE air w/ >50% OXYGEN for >12hours

Answer 328

- mask - nasal catheter - transtracheal catheter - endotracheal tube - tracheal tube - oxygen cage

Answer 329

1. Ventral midline incision is made just below the larynx 2. Tracheal is entered through an incision made a few rings below the cricoid cartilage, parallel to the trachea and perpendicular to the rings, and through just enough rings to allow passage of the tube 3. Stay sutures are placed on each side of the incision 4. Tube is tied with gauze around the neck 5. Tube must be cleaned every 30-60minutes initially (single or double-lumen tube)

Answer 330

- tube obstruction (26%) - dislodgement (21%) - aspiration pneumonia (21%) - stoma swelling (21%) Nicholson and Baines 2012 study 86% of patients had complications, most were clinically insignificant

Answer 331

- increased intrathoracic pressure to fill the lungs with air results in decreased venous return to the heart --> systemic hypotension ---> can result in AKI

Respiratory System Disorders Flashcards

(367 cards)