Small Animal Respiratory Diseases

Question 1

1. Feline chronic rhinosinusitis (CRS) accounts for approximately ________ of feline nasal disease.
   a. 5-10 cases per year in the US
   b. 10%
   c. 20%
   d. 35%

Answer 1

d. 35%

Question 2

All of the following are common historical findings in cats with chronic rhinosinusitis (CRS), EXCEPT:
a. Recent stressor
b. Gagging or reverse sneezing
c. Inappetence
d. Stertorous respiration

Answer 2

b. Gagging or reverse sneezing

Question 3

The definitive diagnosis of chronic rhinosinusitis (CRS) is made with:
a. Exclusion of other diagnoses
b. Polymerase chain reaction (PCR) testing
c. Nasal swab culture
d. Radiographs
e. Serology

Answer 3

Exclusion of other diagnoses

Question 4

Which of the following antibiotic, used to treat secondary bacterial infection in CRS, is associated with causing esophageal strictures:
a. Amoxicillin-clavulanate (Clavamox)
b. Marbofloxacin
c. Doxycycline
d. Azithromycin

Answer 4

c. Doxycycline

Question 5

To investigate canine epistaxis, of the diagnostics listed, which should be the FIRST:
a. Blood pressure
b. CT scan
c. Rhinoscopy
d. Sedated oral exam
e. Chemistry profile

Answer 5

a. Blood pressure

Question 6

Which of the following disease processes may be associated with nasal manifestations in the dog:
a. Diabetes
b. Zinc toxicity
c. Leptospirosis
d. Ehrlichia

Answer 6

Ehrlichia

Question 7

Which of the following neoplasias are a most commonly identified nasal tumor type in dogs:
a. Melanoma
b. Adenocarcinoma
c. Mast cell tumor
d. Hemangiosarcoma

Answer 7

Adenocarcinoma

Question 8

Definitive diagnosis of laryngeal paralysis requires:
a. CT scan
b. Fluroscopy
c. Tensilon testing
d. Sedated laryngeal examination

Answer 8

Sedated laryngeal examination

Question 9

A common complication of laryngeal disease in dogs is:
a. Aspiration pneumonia
b. Chronic kidney disease
c. Pulmonary hypertension
d. Nasal adenocarcinoma

Answer 9

Aspiration pneumonia

Question 10

Appropriate medications to consider to mitigate anxiety in an acutely distressed animal with laryngeal dysfunction include all of the following EXCEPT:
a. Phenobarbitol IV
b. Acepromazine IV
c. Butorphanol IV
d. Buprenorphine IV

Answer 10

Phenobarbitol IV

Question 11

Management of tracheal collapse includes all of the following EXCEPT:
a. Antitussives
b. Weight loss
c. Nebulization in a steam room
d. Stress reduction

Answer 11

Nebulization in a steam room

Question 12

Diagnosis of tracheal/airway collapse includes all of the following EXCEPT:
a. Radiographs
b. Bronchoscopy
c. Fluoroscopy
d. MRI

Answer 12

MRI

need to see to see it in real time

Question 13

Grade 1 tracheal collapse is characterized by _____% reduction in luminal diameter:
a. 10%
b. 25%
c. 50%
d. 75%

Answer 13

25%

Question 14

Acute clinical signs of upper respiratory tract disease in cats is most often caused by:
a. Calicivirus (FCV)
b. Herpesvirus (FHV-1)
c. A or B
d. Distemper virus

Answer 14

c. A or B

Question 15

The ACVIM Working Group recommends the following testing for all cats with suspected bacterial upper respiratory tract infection:
A. Cytology of nasal discharges
B. Aerobic bacterial culture and susceptibility testing of nasal discharges
C. Head CT or MRI with biopsy
D. Feline leukemia virus antigen and feline immunodeficiency virus antibodies in serum

Answer 15

D. Feline leukemia virus antigen and feline immunodeficiency virus antibodies in serum

Question 16

The ACVIM Working Group recommends, when used, enrofloxacin should be administered at ≤ 5 mg/kg/24 h in cats to lessen the risk of:
A. esophageal stricture
B. retinal degeneration
C. acute kidney injury
D. hepatopathy

Answer 16

B. retinal degeneration

Question 17

With the exception of canine distemper virus, the immunity induced by vaccination does not prevent colonization and shedding of the organisms and clinical signs of disease can develop in vaccinated dogs.
A. False
B. True

Answer 17

B. True

Question 18

18. Specific canine respiratory disease testing by molecular methods (e.g., PCR) and/or culture testing and/or viral serology is recommended by the ACVIM Working Group under which of the following circumstances:
    A. Single cases with typical clinical presentation, no evidence of pneumonia and high-risk populations (e.g., breeding kennels) are not involved.
    B. Dogs that have coughed once
    C. Evidence of an outbreak associated with dogs that frequent the same dog park.
    D. All of the above circumstances

Answer 18

Evidence of an outbreak associated with dogs that frequent the same dog park.

Question 19

If bacterial Canine Infectious Respiratory Disease Complex (CIRDC) is suspected with associated systemic clinical signs (e.g., fever, lethargy), the ACVIM Working Group recommends administration of ____________ (medication) for ______________ (duration):
A. Amoxicillin, 10-14 days
B. Enrofloxacin, 10-14 days
C. Doxycycline, 2-4 weeks
D. Doxycycline, 7-10 days
E. Aminoglycoside inhalation, 7-10 days

Answer 19

D. Doxycycline, 7-10 days

Question 20

If history, physical exam, complete blood count (CBC) and thoracic radiographs support a diagnosis of pneumonia (inflammatory leukogram, alveolar lung disease, respectively) the ACVIM Working Group recommends the following:
A. Empirical therapy with enrofloxacin
B. Thoracic CT scan
C. Transtracheal, endotracheal or bronchoalveolar lavage sampling
D. Mechanical ventilation

Answer 20

C. Transtracheal, endotracheal or bronchoalveolar lavage sampling

Question 21

Exudative effusions have the following characteristics:
A. Low total protein, High nucleated cell count
B. High total protein, High nucleated cell count
C. Low total protein, Low nucleated cell count
D. High total protein, Low nucleated cell count

Answer 21

High total protein, High nucleated cell count

Question 22

Optimal therapy for dogs and cats with pyothorax include all of the following EXCEPT:
A. Supportive care, including oxygen and fluid therapy
B. Source control, including chest tubes and/or thoracotomy
C. Twice daily nebulization and coupage
D. Antimicrobial therapy, including aerobic coverage

Answer 22

C. Twice daily nebulization and coupage

Question 23

The most common cause of chlylothorax in dogs and cats is:
A. Idiopathic
B. Cardiogenic
C. Neoplasia
D. Trauma

Answer 23

. Idiopathic

*diagnose by triglycerides in pleural effusion compared to the blood
rule out heart by NT-proBNP or echo
rule out neoplasia via CT, radiograph
rule out trauma by history

Question 24

In dogs, a history of “cough” might suggest tracheobronchial disease, interstitial lung disease or pulmonary edema. In cats, a history of “cough” is most consistent with:
A. tracheobronchial disease
B. asthma
C. interstitial lung disease
D. pulmonary edema

Answer 24

asthma

Question 25

In cats presenting for acute respiratory distress and evidence of pulmonary parenchymal disease, which test is most effective in a primary care setting for determining whether the underlying cause is cardiogenic vs. non cardiogenic (e.g., pneumonia, non-cardiogenic pulmonary edema, neoplasia, etc.)
A. NT-pBNP
B. Viral serology
C. FeLV/FIV
D. Thoracic radiographs

Answer 25

A. NT-pBNP

Question 26

What is the biggest complication of the unilateral arytenoid lateralization procedure (tie-back) in the dog **

Answer 26

aspiration pneumonia

Question 27

Rowdy, A 7-yr-old neutered male Labrador Retriever presents to your facility due infrequent
vomiting (1-2x/mo) over the past 18 months. The patient continues to have an excellent energy
level and ravenous appetite. In fact, he eats so voraciously he occasionally seems to choke on
his food. Physical examination upon presentation reveals a soft, non-painful abdomen. Routine
blood work is performed and unremarkable. Abdominal radiographs do not reveal any evidence
of intestinal obstruction or other abnormalities, but you notice stertorous breathing while in
radiology. In questioning the owner further, the owner reports intermittent stertorous breathing
starting about 8 months ago, which has gotten more pronounced during this timeframe.
What would you recommend (diagnostically)? *

Answer 27

Sedated orolaryngeal exam to confirm top
differential: laryngeal paralysis. Absolutely reasonable to consider evaluating thyroid levels if
not part of the “routine blood work” indicated above.

Question 28

What are your therapeutic recommendations if you confirm laryngeal paralysis? *

Answer 28

1) Restricted activity
2) Use of a harness
3) Minimize situations that would result in panting (stress, excessive heat, etc.): note – this does not mean “never let him pant”, just try to minimize/reduce.

NOT YET: Unilateral arytenoid lateralization (mild symptoms: right now risk of surgery&raquo_space;>
low risk of implementing life-style changes); NSAIDS/steroids: again – mild symptoms – risks
of medication (GI, renal, hepatic) outweigh the minimal risks if lifestyle changes implemented.

Question 29

What should you do if a patient presents with shock *

Answer 29

When we approach the emergent patient by assessing FIRST A (airway), B (breathing), C
(Circulation). If there is an abnormality, the first step is to address this. Rowdy has immediate
issue with A and B, and needs to be intubated (endotracheal intubation). Additionally, he is in
shock (C), so IV catheter and initiating IVF would also be an appropriate answer for FIRST step.
Oxygen can be delivered through the ET tube, and via flow by/mask until team has tools needed
to intubate (would also accept “flow by/mask oxygen” as acceptable FIRST step)

Not appropriate answers: Temporary tracheostomy (intubation will work just fine), Unilateral
arytenoid lateralization (need to stabilize first), Prednisone (1mg/kg) administration (will be
appropriate to give, but not FIRST - right now: stabilize!)

Question 30

What are two rule outs for a transudate *

Answer 30

1) Hypoalbuminemia
2) heart failure (less commonly in dogs – usually have pulmonary
edema with L sided heart failure, cats will more commonly develop a pleural effusion with L
heart failure)

Question 31

What are two differentials for a modified transudate *

Answer 31

1) Some neoplasias, 2) occasionally L sided heart failure has low protein levels,
chronic d-hernia, lung lobe torsion

Question 32

What are differentials for a non-septic exudate *

Answer 32

1) Pleuritis
2) neoplasia (e.g., lymphoma)
3) chylous effusions
4) bilothroax effusion
(rare), [For cats: Feline infectious peritonitis]

Question 33

What are diffetrentials for a septic exudate *

Answer 33

(=pyothorax) penetrating injury (bite, puncture), migrating FB, ruptured
pulmonary abscess, hematogenous spread, esophageal perforation

Question 34

What are differentials for hemorrhagic pleural effusion *

Answer 34

Unwitnessed trauma, neoplasia, coagulopathy (primary hemostatsis (cells)=not
enough plateles OR platelet not working) vs secondary hemostatis (protein)=hepatic failure (not
making), anticoagulant rodenticide (not activated), etc.)

Question 35

How do you treat pyothorax in dogs and cats *

Answer 35

1. Antibiotics: start with broad spectrum (e.g., enrofloxacin and penicillin based drug
   (ampicillin, unasyn) – this is what many use; there are others listed in the article
2. Source control: (this is where the “chest tube” vs. “surgical intervention” falls. The article is
   not definitive, and some of the decisions tend to be “regional”. Here @ CSU, “rule of thumb” is
   that dogs go to surgery (lots of migrating FB here) and cats treated medically with chest tubes.
   Again – that is a “soft” recommendation – lots of individual patient factors that will influence
   recommendations for a specific patient.
3. Supportive
4. Intravenous fluids (IVF): to replace and/or maintain intravascular and interstitial volume
   (see Dr. Guillaumin’s notes). Note: respiratory system is one of the main places for “ongoing
   losses” (renal, GI, respiratory, 3rd spacing)
5. Oxygen – as needed
6. POSSIBLY ventilation if meet criteria Dr. Zersen went through (rare)
7. Symptomatic
8. Pain medications (post-op and/or for chest tubes). Can be local blocks (incisional or rib
   blocks) +/- systemic analgesia.
9. Consideration for anti-vomiting medication (e.g., maropitant, metoclopramide) – with
   incision or chest tube, want to reduce increased thoracic pressure associated with the act of
   vomiting.