Respiratory - Upper Respiratory Tract Flashcards
(45 cards)
1
Q
What are the signs of respiratory distress in SA?
A
- Respiratory rate >50 breaths per min
- Anxious, open mouth breathing
- Orthopneic position
- standing or sitting in a certian position to make breathing easier
- Reluctance to move
- Cough, wheezes, short shallow breaths
- Pale, cyanotic mucous membranes
2
Q
Define stertor
A
snoring-like congestion of upper respiratory tract
3
Q
Define stridor
A
Inspiratory wheeze over larynx
4
Q
Devine wheezes
A
- Airway sounds occurring secondary to narrowing of bronchi, may be from increased secretions or inflammation
- most commonly expiratory, can be inspiratory or continuous
5
Q
Define crackles
A
fine popping inspiratory sounds caused by opening of alveoli/small airways found in patients with pulmonary edema, pneumonia, or hemorrhage
6
Q
What are the differentials for Epistaxis (nasal bleeding)
A
- Local:
- Aspergillosis
- Nasal Adenocarcinoma (other cancers)
- Trauma
- Foreign Body
- Dental Disease (abscess, fistula)
- Inflammatory (allergic)
- Nasal Mite (Pneumonysoides caninum)
- Systemic:
- Thrombocytopenia
- Systemic Coagulopathy
- Hypertension
- Multiple myeloma
7
Q
How are systemic causes of Epistaxis diagnosed?
A
- Check platelets
- look for petechiae and do CBC or blood smear
- If low, think about tick-borne and immune-mediated disease
- May need to check clotting times (PT/PTT)
- Check blood pressure
- Hypertension can be related to:
- disease (Cardiac, Cushing’s, renal)
- drugs (phenylpropanolamine)
- Hypertension can be related to:
8
Q
How are local causes of Epistaxis diagnosed?
A
- Check the teetha dn do an oral exam
- +/- CT Scan vs Skill Radiographs
- Before scope or biopsies
- +/- Rhinoscopy
- Biopsy nasal cavity
- Measure to medial canthus of eye
- Histopathology, culture
- Nasal flush with saline
9
Q
What is Aspergillosis? common signalment? signs?
A
- Fungal organism commonly seen in dogs
-
Aspergillus fumigatus
- ubiquitous soil saprophyte
-
Aspergillus fumigatus
- Signalment:
- young - middle aged dogs
- Dolichocephalic breeds
- Outdoor dogs
- Rare in US cats
- Signs:
- Epistaxis, sneezing, pain
- May have depigmentation of nares
- Can invade cribriform and cause neurologic disease
10
Q
How is Aspergillosis diagnosed?
A
- Imagining: Radiograph, CT, scope
- Cytology (fast)
- Histopathology (confirms)
- Antibody test - false negatives occur
- Antigen not helpful for nasal disease (helpful for systemic aspergillosis)
- Culture? - too slow
11
Q
What is the treatment for aspergillosis?
A
- Debulk fungal plaques
- Clotrimazole infusion OR
- topical treatment under anesthesia for about 1 hour
- Complications - laryngeal irritation/inflammation
- Only if the cribriform plate is intact
- Itraconazole:
- systemic treatment 60-70% success rate
- 5 mg/kg PO BID for 2+ months
- Other options include ketoconazole and terbinafine
12
Q
Why is fluconazole not a treatment option for Aspergillosis?
A
aspergillosis inherent resistance
13
Q
What findings are common with Nasal Adenocarcinomas? how is it diagnosed?
A
- Common differential for older dogs with epistaxis
- PE: Pain, asymmetry, bony changes
- Diagnostics:
- Rads vs CT
- CT can be used for radiation planning too
- Nasal biopsies for histopathology
- CT/rhinoscopy help guide - can collect biopsies blindly
- Rads vs CT
14
Q
What is the treatment for Nasal Adenocarcinoma?
A
- Radiation therapy is treatment of choice
- Consult with oncologist for other options
15
Q
What is Lymphoplasmacytic Rhinitis?
A
- Allergies!
- Signalment:
- young/mid-age dogs, any cats
- German shepherds, dachshunds, (possible in any breed)
- Signs: chronic serous bilateral discharge
- Can have cough from post-nasal drip
- Sometimes has a cloudy or mucoid appearance
- Etiology: often unknown, likely multifactorial
16
Q
What is the pathophysiology of Lymphoplasmacytic Rhinitis?
A
- Allergen present in nose
- Infiltration with inflammatory cells
- Vasodilation and ⇡ permeability
- Leakage of fluid into nasal cavity
- Destruction of mucociliary clearance
- Can have secondary bacterial infections
- Present with more mucoid/purulent discharge
17
Q
What is the diagnostic plan for Lymphoplasmacytic Rhinitis?
A
- Consider likelihood of differentials
- Dental disease, foreign body, mites, fungal, bacterial, neoplasia
- Empirical treatment trial okay
- Confirm rhinitis with histopathology, rule out differentials
- Culture to identify secondary infection (if signs are present)
18
Q
What is the treatment of Lymphoplasmacytic Rhinitis?
A
- Avoid allergens, smoke, etc (if IDed)
- Antihistamines - not routinely helpful
- Glucocorticoids
- Systemic: prednisone/prednisolone
- goal is control, not realistic to cure completely
- Inhaled fluticasone propionate
- rare systemic side effects
- Systemic: prednisone/prednisolone
- Cyclosporine
- alone or with steroid therapy
- Desensitization (?) small studies done
- Antimicrobial Agents (secondary bacterial infections)
19
Q
What nasal mites are common in SA? Signs? Treatment?
A
- Pneumonysoides caninum
- Transmission - direct contact
- Signs:
- Sneeze, reverse sneeze
- serous or epistaxis
- Decrease smell
- Diagnostics: visualize mite
- Therapy: Selemectin, Ivermectin, Milbemycin
20
Q
What is Feline Herpesvirus-1? Who is affected? How is it transmitted? Incubation time?
A
- Replicates in the upper respiratory tract
- Causes multifocal epithelial necrosis
- Osteolytic changes of turbinates
- Signalment:
- most severe in kittens
- multi-cat households or shelters
- Remain infected for life
- Transmission: Direct contact (fomites aerosol?)
- High morbidity, low mortality
- Incubation 2-6 day
21
Q
What symptoms does Feline Herpesvirus-1 cause?
A
- Lethargy
- Fever
- Nasal and ocular discharge
- Sneezing, stertorous breathing
- Conjunctivitis, keratitis, corneal ulcers
- Rare oral ulcers
22
Q
How is Feline Herpesvirus-1 treated?
A
- Self-limiting Disease
- Usually resolves in 1-3 weeks
- Carriers:
- nearly all recovered cats are latent carriers (trigeminal ganglia)
- Intermittent shedding and flare-ups
- Stress trigger
- 1 week lag to shedding that lasts 1-2 weeks
23
Q
What is Feline Calicivirus?
A
- Single-stranded RNA virus
- High mutation rate
- Minimal repair
- Antigenic diversity
- Non-enveloped virus
- High morbidity, Low mortality
- Transmission:
- Shed in nasal, oral, and ocular secretions
- Fomites play an important role
24
Q
What symptoms does Feline Calicivirus cause?
A
- Fever
- Sneezing
- Nasalocular discharge
- Oral ulceration - Hallmark!
- Conjunctivitis and chemosis
- Lameness
- Dermatitis
- Can also cause: vasculitis, edema (head/limbs) ulcers on skin and paws, multiorgan disease/failure
25
What is the treatment for Feline Calicivirus?
* Self-limiting disease
* supportive care
* Shedding temporary, not life-long
26
What are the core vaccinations for cats for respiratory diseases?
* Feline Rhinotracheitis (herpes-1)
* Feline calicivirus
* Panleukopenia
27
What are the goals of core feline respiratory vaccines?
* Minimize clinical signs and shedding
* will **not prevent infection** or carrier state
28
What are the differential Diagnoses for Upper Respiratory Disease in cats?
* Recurrent Herpesvirus or Calicivirus
* Secondary Bacterial infection
* *Mycoplasma spp.*
* *Bordetella bronchiseptica*
* Dental Disease or Fistula
* Nasopharyngeal Polyp of foreign body
* Neoplasia (lymphoma or carcinoma)
* Lymphoplasmacytic Rhinitis
* Fungal Disease: *cryptococcus*
29
What are the risk factors in cats for secondary bacterial infections?
* Chronic viral infection
* bony destruction
* brachycephalic
* repeated antimicrobial use
30
What are the normal respiratory flora that may cause secondary bacterial infections in cats? what are other options?
* *Staph, Strep, Pasteurella, Moraxella*
* liquid doxy or amoxi (empirical choices)
* More resistant bacteria including *Pseudomonas*
31
What is the diagnostic Strategy for Cats with Upper Respiratory Disease?
* Mild/First occurrence:
* Discuss DDx, Vx status, exposure to other cats, stress
* If consistent with viral infection: diagnostic tests optional
* Educate owners about viruses
* Clinical signs likely to resolve without intervention
* Supportive care as needed
* Severe/Chronic
* Test for *Cryptococcus*
* Good dental exam, rule out polyp
* Imaging: nasal CT/rhinoscopy
* Biopsies for histopathology
* Culture for bacteria
* Test of *Mycoplasma*
32
What is the treatment for cats with Upper Respiratory Disease?
* Supportive:
* keep nose clean, nares patent
* Humidification
* Nutritional support
* L-lysine
* Antimicrobial trial?
* If mucopurulent discharge with fever, anorexia, lethargy
* Saline Nasal Flush
33
What is *Bordetella bronchiseptica?* What are the risk factors?
* Aerobic Gram-negative bacteria
* 1o and 2o pathogen
* Risk factors:
* Rescue cats
* Multi-cat households
* Exposure to dogs with kennel cough
* Concurrent respiratory infections
34
What are the signs of a *Bordetella bronchiseptica* infection in cats? diagnostics?
* Signs:
* Upper Respiratory Infection - sneezing, discharge
* Kennel cough - coughing
* Bronchopneumonia - dyspnea
* Diagnostics:
* Bacterial Culture or PCR - biopsies or wash
35
What is the treatment for *Bordetella bronchispetica*
* _Oral liquid_ doxycycline 5mg/kg PO BID 2-4wks
36
Why are doxycycline pills not used in cats?
Can cause esophageal stricture!
37
What is *Mycoplasma felis? (*and other spp*)*
* Prokaryotic organism
* Lack cell wall (not true bacteria)
* Some are part of the normal flora of cats'/dogs' upper respiratory tracts
* 1o or 2o pathogen
* Transmisssion:
* Direct contact and aerosol droplets
* Aspiration from own flora to lower respiratory tract
38
How are *Mycoplasma spp* infections diagnosed?
* Nasal biopsy, nasopharyngeal swabs, or airway wash
* Mycoplasma PCR
* Culture (request growth media for Mycoplasma)
39
What is the treatment for a *Mycoplasma spp* infection?
* Antibiotic that does NOT target the cell wall
* Doxycycline, azithromycin, fluoroquinolones
40
What is Cryptococcosis?
* *Cryptococcus neoformans*
* More common in cat than aspergillosis
* Dimorphic fungus
* Nasal Cryptococcosis:
* Bump/mass on nose in common
* Very invasive
* Destroys turbinates
* External skin erosion/ulceratoin
* Can invade CNS via direct extension
* Through cribriform plate
41
What is the pathogenesis of Cryptococcosis?
* Spores inhaled
* Classically “pigeon droppings”
* Most stay locally in the nose
* may spread to skin, eyes, CNS
42
What is the common signalment of cats with Cryptococcosis?
* Any breed (Siamese, Birmans, Ragdolls ⇡ risk)
* Usually young adults
* ⇡ risk:
* outdoor cats
* live near construction sites
* Immunosuppressed (FIV+, FeLV+, steroids)
43
What are the signs and symptoms of Cryptococcosis?
* History:
* ⇣ appetite, weight loss, nasal and ocular discharge, sneezing
* PE:
* BAR, usually not febrile
* Bump on nose, ulceration, palpable bony destruction, asymmetry, pain
* Decreased nasal airflow, discharge
* May have big lymph nodes, neurologic deficits, blindness
* Fundic exam ⇢ chorioretinitis
44
What are the diagnostic tests for Cryptococcosis?
* Cytology of mass, ulcer, discharge
* Aspirates, are fast, easy, and may be diagnostic
* India Ink, Diff-Quik, New methylene blue
* Numerus small yeast with thick/large capsule
* Latex agglutination for Capsular Antigen
* 90-100% sensitivity and specificity on serum
* Biopsy - wedge or punch biopsy on superficial lesion
* Nasal CT Scan, biopsies inside the nose, CSF for latex agglutination are options
45
What is the treatment of Cryptococcosis?
* Fluconazole
* 10 mg/kg PO BID
* treat for 1 mo past resolution of signs
* Side effects: GI upset and hepatotoxicity
