Veterinary Medicine - Respiratory Tract Diseases Flashcards
(181 cards)
1
Q
What region: Stertor, Stridor, Reverse sneeze, Cough
A
Stertor - Nasal cavity, Nasopharynx
Stridor - Larynx, Nasopharynx
Cough - Trachea and Distally
Reverse sneeze - Nasopharynx.
2
Q
Epistaxis - Diagnostic work up
A
Blood pressure (Hypertension)
CBC (Thrombocytopenia, PCV/TS)
Biochemistry (e.g. Hyperviscosity syndre causes - Hyperglobulinemia, Hypertriglyceridemia)
PT/PTT (Hypocoagulation)
BMBT (Thrombocytopathy)
Rule out Oro-nasal fistula (Though usually a more mucopurulent secretion)
Imaging (CT) + Rhinoscopy
Cytology
+/- Histopathology
+/- samples for bacteriology +/- mycology.
3
Q
Epistaxis - Treatment
A
Lower Blood Pressure: ACP + Benzodiazepines/Opiates
Control Bleeding: Gauze + Adrenaline, Ice Packs
**Ligation of external carotid
**Promote Coagulation: Tranexamic Acid, Yunan Baiyao
**Blood Products
4
Q
Canine nasal tumor - What tumors are most frequent
A
Two thirds - Carcinomas
One third - Sarcomas
Round cell - The rest
5
Q
Canine nasal tumors - Diagnostic work up
A
CT > MRI
Histology:
CT - Guided
Rhinoscopy Guided
Nasal Hydropulsion
Blind
Cytology - Less Useful. Only for round cell tumors.
6
Q
What percent of canine nasal tumor histology turn out positive (as opposed to false negative)
A
70%
Always repeat samples when in doubt
7
Q
Canine nasal tumors - MST?
A
3 Months
8
Q
Canine nasal tumors - Describe radiotherapy (Treatment of choice)
A
1) Curative-intent high energy megavoltage radiotherapy: 3-5 Visits a week - but less powerful Best MST - 8-20 Months
2) Hypofrctionated palliative radiotherapy Weekly/Bi-weekly visits - but more powerful. MST - 150-500 Days
9
Q
Canine nasal tumors - Side effects of Curative Intent Radiotherapy?
A
Acute side-effects: Rhinitis, Keratoconjunctivitis, Oral mucositis, Desquamation of skin
10
Q
Canine nasal tumors - Side effects of Hypofractionated Palliative RT?
A
Late side effects: KCS, Cataracts, Retinal or optic disc degeneration, Brain necrosis, Osteonecrosis
11
Q
Feline nasal tumors - Most frequent kind? MST? Best treatment(s)?
A
Lymphoma
MST-1000 Days (Great)
Chemotherapy/RT/ Both - All with good prognosis
12
Q
Nasal polyps in dogs - Signalment? Epithelium-layer origin? How to diagnose? Difference from tumor? Treatment?
A
Old Dogs
Nasal mucosa
Same as with neoplasia (CT/Biopsy/Rhinoscopy)
Non-invasive
Surgery - Curative
*If there is recurrence - Steroids
13
Q
Nasal (Not nasopharyngeal) polyps in cats - Signalment? Clinical sign unique to feline nasal polyps as opposed to canine ones? treatment?
A
Young cats - <1 Year
Epistaxis
Rhinoscopy & Removal
14
Q
Sinonasal aspergillosis in dogs - Infective? Zoonosis?
A
No
15
Q
Sinonasal aspergillosis in dogs - Acute/Chronic? Invasive/Non-Invasive?
A
Chronic
Non invasive
16
Q
Sinonasal Aspergillosis in dogs - Signalment, Classic History/Clinical signs
A
Meta/Dolichocephalic > Brachycephalic
Chronic disease - Weeks to years
Mucopurulent discharge - usually unilateral that can progress to bilateral
Epistaxis
Depigmentation of Nasal Planum
17
Q
Sinonasal Aspergillosis in dogs - Diagnosis
A
CT - Turbinates/Cribriform destruction
Rhinoscopy - Fungal plaques/Turbinate destruction
Cytology - (Highest sensitivity when sample is taken from plaques)
Histology
Culture - Mainly for identifying specific species. Doesn’t matter for treatment.
18
Q
Sinonasal Aspergillosis in dogs - Treatment (Local or systemic?/What drugs are used? Single or multiple treatments?)
A
Local
Clotrimazole or Enilconazole. Multiple treatments for over 50% of cases are necessary (90-95% success rate). Trephinations (If sinuses are also involved). Extensive debridement can help.
(Systemic treatment - 50%-70% Success Rate).
19
Q
Aspergillosis in Cats - Signalment? Invasive or Non Invasive? most common lab finding?
A
Brachycephalic breeds
Tends to be more invasive as opposed to dogs
Hyperglobulinemia
20
Q
Aspergillosis in Cats - what are the 2 syndromes and which is more invasive? Clinical Signs?
A
Sino-nasal Aspergillosis:
Stertor
Sneezing
Reverse sneezing
Mucopurulent discharge
Epistaxis
Sino-orbital Aspergillosis (Invasive):
Exophthalmos
3rd Eyelid prolapse
Severe cases - Destruction of hard palate and nasal bones, Fever, Lymphadenopathy. Can also progress to CNS (e.g. Vestibular signs)
21
Q
Aspergillosis in cats - Treatment
A
In invasive cases - Systemic treatment in addition to local (e.g. Clotrimazole/Enilconazole + Keto/Flu/Itraconazole)
Surgery with invasive cases also might be indicated
Enucleation
22
Q
Cryptococcus - Clinical signs/appearance in dogs and cats? Prognosis?
A
Cats: Local disease that also infects paranasal tissues - very swollen nose bridge
Common URT signs (e.g. Sneezing, Reverse sneezing, Stertor)
Skin lesions
Can progress to ocular and CNS disease
Prognosis - Good when only URT disease (75% Response to treatment), Guarded in CNS cases
Dogs: Systemic disease common Can Involve URT, CNS (50-80% of cases) and eyes
Prognosis - Guarded (50% response to treatment)
23
Q
Cryptococcus - Diagnosis
A
Cytology - Diagnostic in 75-90% of cases
Stains - Giemsa/Gram’s
Latex cryptococcal antigen agglutination test - very specific & sensitive for diagnosis and monitoring! Used on: Serum, Urine & CSF
24
Q
Cryptococcus - Treatment
A
Treatment - Amphotericin B + Flucytosine / Ampho B + Azoles
Duration - 2 Months after cessation of clinical signs. Alternatively, treatment can be discontinued when antigen titers normalize.
25
Viral feline rhinitis - what are the viruses?
Calicivirus & Herpes
26
Feline Calicivirus - Clinical signs and physical exam findings
Lethargy
Anorexia
Fever
Lymphadenopathy
Rhinitis (Sneezing, Sero/mucopurulent discharge)
Stomatitis
Lingual ulcers (Relatively pathognomonic)
Conjunctivitis
Occasionally GI signs (e.g. vomiting, diarrhea)
27
Feline Herpesvirus - Clinical signs
Lethargy
Anorexia
Fever
Lymphadenopathy
Rhinitis (Sneezing, Sero/mucopurulent discharge)
Stomatitis
Conjunctivitis, Keratitis, Corneal ulcers, Sequestrum
28
Feline URT Viruses - Treatment
Suppurative:
IV fluids
Appetite stimulant
Anti-emetics (if indicated)
Antipyretics
Analgesia
Antibiotics for 2nd Infections (e.g. Azithromycin / Doxycycline / Augmentin)
Specific treatments: Lysine (indicated when Herpes is suspected)
Famciclovir (indicated when Herpes is suspected)
Treatment for corneal ulcers (If indicated in cases of herpes)
Long term for Herpes - Provide a stress free environment to prevent recurrence
29
Canine viral rhinitis - dog. Most common viral agent?
Distemper
30
Causes for bacterial rhinitis? (Primary & secondary anatomical causes)
Primary:
Bordetella
Mycoplasma
Chlamydia
Secondary:
Oro-nasal fistula
Cleft palate
Ciliary dyskinesia
31
Diagnosis Of Oro-nasal fistula? Common locations?
Signalment - Older animals
History & Clinical signs:
Chronic URT disease clinical signs (Sneezing, Stertor, Reverse sneezing)
Mucopurulent discharge, Unilateral
Diagnosis:
Probe & Florecin staining
Dental x-rays
Common locations: Canines, PM1 & PM2
32
Treatment of osteomyelitis secondary to rhinitis
AB treatment for 2-4 weeks (e.g. Augmentin +/- Fluoroquinolone)
33
Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - Classic histological changes
-Lymphoplasmocytic infiltrate +/- Eosinophils +/- Neutrophils
-Mucosa - Hyperplastic and squamous metaplastic changes
-Loss of muco-ciliary apparatus
-Hyperplasia of mucus glands
34
Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - Signalment and prevalence
Young to middle aged dolico & mesocephalic breeds (Dachshunds & Whippets over represented)
20-40% of chronic rhinitis in dogs and cats.
35
Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - 2 Most common rhinoscopy findings
Mucosal hyperemia
Secretions
36
Canine Lymphoplasmacytic rhinitis & Feline chronic rhinosinusitis - Treatment
2 modalities of therapy:
1) Immunomodulatory antibiotics (Azithromycin/Doxycycline) + NSAIDs + Augmenting for 2nd Infections
2) Steroids - If works - switch to MDI. 2nd Immunosuppressant may be add (e.g. Cyclosporine)
Treatment usually prolonged (2-6 months) and start tapering off
Add Vigorous Flushing
37
Canine Lympho-Plasmocytic Rhinitis & Feline Chronic Rhinosinusitis - Clinical Signs
Sneezing
Reverse Sneeze
Muco-Purulent Secretions
Stertor. Rarely epistaxis
Bilateral disease common
38
Neurogenic rhinitis - fancy name?
Xeromycteria
39
Neurogenic rhinitis - Cause
Loss of parasympathetic innervation - Commonly because of otitis media
40
Neurogenic rhinitis - Common ocular clinical signs / pathologies associated with the disease
KCS
Conjunctivitis
41
Neurogenic rhinitis - Treatment
Treat underlying cause (e.g. Otitis media)
Artificial eye drops
42
Nasopharyngeal polyps in cats - Signalment, Specific location, Treatment
Young cats
Eustachian tube => from there extends to the nasopharynx / ear
Surgery + Steroids (To prevent recurrence)
43
Nasopharyngeal diseases - Common clinical signs
Stertor
Stridor (Cats)
Reverse sneezing
Vomiting
Regurgitation (Negative pressure in thorax)
44
Nasopharyngeal diseases - Foreign bodies - How do they end up in the nasopharynx
Vomiting / Regurgitation
45
Nasopharyngeal stenosis - Causes
Congenital (rare) - Choanal Atresia
Acquired:
Irritation from gastric reflux (e.g. Anesthesia)
Chronic inflammation
46
Brachycephalic Airway Obstructive Syndrome (BAOS) - Primary changes
Stenotic nares
Elongated soft palate
Thickening of soft palate
Macroglossia (Large tongue)
Distorted ethmoidal turbinates
Tracheal hypoplasia (Commonly associated with English bulldog)
47
Brachycephalic Airway Obstructive Syndrome (BAOS) - Secondary changes
Pharyngeal soft tissue thickening & subsequent obstruction
Everted laryngeal saccules
Laryngeal collapse
48
Brachycephalic Airway Obstructive Syndrome (BAOS) - Common concurrent lower respiratory tract disease
Bronchial collapse (Bronchomalacia)
*Tracheal hypoplasia can also be considered
49
Brachycephalic Airway Obstructive Syndrome (BAOS) - Common "Extra-respiratory" complication/clinical signs. Why does it happen and associated pathologies. How would you treat it?
Regurgitation & Vomiting
Increase in intra-thoracic negative pressure
Sliding hiatal hernia, Esophageal / Gastro-esophageal intussusception
1) Correct BAOS if possible (Might resolve GI clinical signs as well)
2) Metoclopramide +/- PPI
3) If clinical signs do not resolve /Gastro-esophageal intussusception is present - corrective surgery.
50
Brachycephalic Airway Obstructive Syndrome (BAOS) - Common clinical signs
Hyperthermia
Tachypnea
Exercise intolerance
Weight gain
Stertor, Stridor, Reverse sneezing
Cyanosis
Coughing (Tracheal +/- Bronchial involvement)
Syncope
Vomiting & Regurgitation
51
Anti-tussive drugs - 2 Contraindications
Bacterial pneumonia / bronchopneumonia
Bronchiectasis
52
What effects do organic phosphates have on the respiratory system?
Bronchoconstriction
Bronchorrhea (Increase in mucus production)
53
B2 Agonists - Side effects
Tachycardia
Muscle tremors/twitching
Hypokalemia (Translocation into the cells)
Hyperglycemia (Inhibits release of insulin)
Decrease Uterine Motility
MDI - Direct irritation and inflammation of airways
54
B2 Agonists - Effects
Potent bronchodilators
Inhibition of mast cell degranulation
Increase muco-ciliary clearance
Improved diaphragm function
55
Methylxanthines - Effects
Bronchodilators
Mast cell stabilization
Increased respiratory muscle strength
Increased muco-ciliary clearance
Decreased microvascular leakage
56
Methylxanthines - Side Effects
GI - Nausea/ Anorexia
Restlessness
Arrhythmias
Vasodilation
Diuresis
CNS signs
57
Glucocorticoides - Name 3 chronic LRT diseases that are treated with GCs
Canine & Feline Chronic Bronchitis
Feline Asthma
Eosinophilic Bronchopneumopathy
58
Steroids - Side effects (Clinical signs & Common lab-work findings)
Pu/Pd
Polyphagia
Panting
Dermal Changes
Muscle atrophy
Pot-belly
Obesity
2nd infections (e.g. Pyoderma, Cystitis)
CBC: Neutrophilia, Lympfhocytopenia, Polycythemia, Thrombocytosis
Biochem: Elevation of liver enzymes (primarily ALP in dogs), Hypertriglyceridemia, Hyperglycemia, Hypernatremia, Hypokalemia
UA: Isosthenuria, Proteinuria.
59
Steroids - Effects on the respiratory system& Preferred method of use (and name of the drug)
Decrease production of cytokines, PG and Leukotrienes
Reduce edema
Decrease granulocyte and lymphocyte migration & activity
Potentiate B2 agonists and mitigate down-regulation of B2 receptors
Metered dose inhaler (MDI) - Fluticasone (Less systemic side effects)
60
Mucolytics - Name, Mode of administration and why? Name 2 other alternatives to main drug
N-Acetylcystein
IV
Oral (Not nebulization - Causes Bronchoconstriction)
1) Maintain proper hydration (makes secretions less viscous)
2) Saline nebulization
61
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Histological Changes
Decreased cellularity of cartilage
Increased water content
Decreased GAG, Glycoprotein, Chondroitin, Calcium
Laxity of dorsal tracheal membrane
62
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Diagnosis (3 methods)
Chest X-Rays (Better for diagnosing TC >>>> BM. In the case of BM - sensitivity is highest for Mainstem bronchimalacia and decreases further distally)
Fluoroscopy - (Better than X-rays. Better for TC and proximal airway collapse)
Endoscopy - Gold standard for both
63
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - When doing fluoroscopy - what is an additional diagnostic procedure you should always perform?
BAL (Broncho-alveolar lavage)
Tracheobronchomalacia has a strong association with bacterial infections.
64
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - What can make the disease suddenly clinical?
Obesity
Airway Inflammation/Infection
Intubation
Laryngeal Paralysis/Paresis
Airway Irritants
65
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Treatment
1) Conservative / Medical approach (usually the preferred approach):
Switch from leash to harness
Promote weight loss
No extraneous exercise
Anti-tussives
Bronchodilators
GC (Short course to reduce inflammation)
*AB (if indicated for 2nd infection)
2) Surgical approach (in case medical approach fails, relevant only for TC):
-External prostheses (cervical trachea)
-Stents (cervical + thoracic trachea + proximal bronchi)
*Short course of GC + AB
66
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Treatment of an acute episode (Rare)
ACP + Benzodiazepine
Anti-tussive (e.g. Butorphanol)
Bronchodilators
Oxygen - might help
Short term GC
67
Tracheobronchomalacia (Tracheal collapse & Bronchomalacia) - Signalment & Clinical Signs
Middle age to older dogs
BM - Generally large breeds and brachycephalic dogs (present in 88% of BAOS cases)
TM (AKA Tracheal collapse) - small breed dogs (Pomeranian over-represented)
Chronic disease
Hyperthermia
Tachypnea
Cyanosis
Exercise Intolerance
Weight gain
Cough
Crackles & Wheezes
Goose Honk (TM)
Syncope
68
Canine Infectious Tracheobronchitis (Kennel Cough) - Causative agents
Bordetella Bronchiseptica>>>>
Mycoplasma
Canine adenovirus
Parainfluenza
Calicivirus (Cat).
69
Canine Infectious Tracheobronchitis (Kennel Cough) - What are the 2 methods of vaccination? Onset of efficacy? Protection period
Bordetella Bronchiseptica:
1) Parenteral: 2 Injections 3-4 weeks apart, Effective 2 weeks after second shot
2) Intranasal - Starts working after 3 days. Single dose. Duration of immunity - 1 Year
*CAV, PI, Calicivirus - Core vaccinations
70
Canine Infectious Tracheobronchitis (Kennel Cough) - Treatment
A self limiting disease
If choosing to treat: Doxycycline (Drug of choice) / Azithromycin / Augmentin
Anti-Tussives
Fluids
71
Canine Infectious Tracheobronchitis (Kennel Cough) - Clinical signs
1) Nasal discharge without cough
2) Episodes of retching & coughing
72
Canine Infectious Tracheobronchitis (Kennel Cough) - Duration of Clinical signs without treatment & Duration of shedding
2 Weeks for clinical signs
2-3 Months of shedding
73
Tracheal Hypoplasia - Signalment & CS
Congenital disease - Median 5 Months (2 Days - 12 years). Strong association with BAOS (English bulldog over-represented). Hyperthermia, Tachypnea, Weight gain, Exercise Intolerance, Cough, Inspiratory & Expiratory Difficulty, Syncope
74
Tracheal Hypoplasia - Diagnosis
X-Ray (Irregular Trachea to T1 Ratio - < 0.16)
75
Tracheal Hypoplasia - Treatment
Lifestyle changes:
Switch to harness
Promote weight loss
Avoid strenuous exercise
Treat concurrent diseases (e.g. 2nd infection, BAOS)
Symptomatic treatment:
Anti-tussives
Bronchodilators
**Tracheal diameter may increase with age
76
Segmental Tracheal Stenosis - Causes
Intubation (Over inflation of the tube)
Trauma
Surgery
Neoplasia
Infection
77
Primary ciliary dyskinesia - Name 3 Body systems that are associated with the disease, the pathologies and one rare associated condition
Respiratory tract - Recurrent Bronchopneumonia and Rhinosinusitis
Eustachian tube - Deafness
Reproductive tract - Infertility
Situs Inversus - Kartagener's syndrome
78
Primary Ciliary Dyskinesis - Classical Presentation
Very young dog (Days to Months) with recurrent episodes of rhinitis / pneumonia that resolves after antibiotics
79
Primary Ciliary Dyskinesis - Diagnosis
Signalment, History, Clinical signs
X-Rays:
evidence of pneumonia
Bronchiectasis
Situs Inversus
Radioactive droplet (Mucociliary Scintigraphy) - droplet doesn't leave the carina for 30 minutes (not specific)
Electron microscope - abnormal arrangement of the microtubules
80
Primary Ciliary Dyskinesis - Treatment
Antibiotics
Mucolytics
81
Canine Chronic Bronchitis - Signalment & Clinical signs & Physical exam findings
Middle aged-older dogs
Chronic cough (> 2 Months)
Retching +/- White phlegm spitting out
Exercise intolerance
Obesity
Crackles & Wheezes
Cough on tracheal palpation (Extremely not specific)
82
Canine Chronic Bronchitis - Secondary complications
2nd Bacterial bronchopneumonia
Bronchiectasis
Pulmonary hypertension
83
Canine Chronic Bronchitis - Diagnosis
Hx, Sig, CS
X-Rays:
Bronchial pattern +/- alveolar patches (Normal chest radiographs do not rule out)
Tracheobronchoscopy findings - Hyperemia, Increased granularity, Nodules, Increased vascularity and secretions
BAL - Mature neutrophils predominate +/- Eosinophils
84
Canine Chronic Bronchitis - Treatment
Glucocorticoids (Anti-inflammatory dosage) and gradually taper off. Start P.O and can later switch to MDI
Anti-tussives
Bronchodilators
AB for secondary infections
Nebulization / Mucolytics for secretions
85
Feline Asthma - Possible X-Ray Findings
Bronchial pattern
Lung hyperinflation
Caudal displacement of diaphragm
Mediastinal right shift (Atelectasis of right middle lung lobe)
Alveolar infiltrates
Bronchial mineralization (Chronic change)
86
What are the considerations when preforming BAL in cats
Cats tend to undergo bronchoconstriction when lungs are irritated (unlike dogs)
Complications are mild but very common (40%)
Prior to BAL - Give bronchodilators
87
Feline Asthma - Treatment
Acute Episode - GC & Bronchodilators (IV/Inhalation)
Chronic - GC (PO/Inhaled/ Depomedrol for tough cases) & Bronchodilators for Acute Episodes
Removal of Irritants (New Furniture, Dust, Cigarettes)
Weight loss
88
Feline Asthma - Signalment & Clinical signs
Young cats (Mean age 4 years)
Episodes of coughing (classic) but can also be chronic daily coughing.
89
Feline Asthma/Chronic Bronchitis - Predominant cell in BAL
Feline Asthma - Eosinophils
Chronic Bronchitis - Neutrophils (Predominant) +/- Eosinophils.
90
Feline Asthma - Other major DD For episodes/chronic coughing in young cats and eosinophils in BAL
Lung worms - Aelurostrongylus Abstrusus
91
Feline Asthma - What is a common CBC finding? In what frequency of asthmatic cats?
Eosinophilia (20-40%)
92
Respiratory abdominal effort in cats - Suggestive of...?
Pleural effusion
93
Bacterial Pneumonia - Predisposing Factors
Immunocompromised (Young >> Old)
Immunosuppression (e.g. Cushing's disease, Steroids, FeLV)
Congenital Diseases / Anatomical Defects (e.g. Tracheal hypoplasia, PCD, IgA deficiency)
Aspiration pneumonia (e.g. Regurgitations > Vomiting, Larynx pathologies, Anesthesia)
Debilitating Disease (Prolonged Recumbency)
Pulmonary diseases (e.g. Bronchiectasis, Neoplasia)
94
Bacterial Pneumonia - Treatment
Treat underlying cause. AB: 1st Line: Augmentin / Beta-Lactam + Fluoroquinolone / Azithromycin + Fluoroquinolone / TMS / Clindamycin + Fluoroquinolones 2nd Line (G- Aerobes) : Aminoglycosides / Chloramphenicol / TMS / 3rd & 4th Gen Cephalosporins 3rd Line: Carbapenem . Oxygen (When PaO2 < 80 mmHg / SpO2 < 94 % ) *When PaO2 < 60 / pCO2 > 50mmHg / PaO2 : FIO < 2 - 3 ==> Positive pressure inhalation. Fluids, Bronchodilators, Mucolytics / Saline Nebulization, Coupage and periodic walks (Physical therapy) - clearance of secretions
95
Bacterial Pneumonia - What is a good blood test to rule in / differentiate BP From other pulmonary diseases?
C-Reactive protein (High in BP)
96
Bacterial Pneumonia - How long to treat? (2 Options)
1-2 Weeks after X-rays normalize. The moment C-reactive protein normalizes
97
Bacterial Pneumonia - Most common infectious agents
Common Bacteria : E.Coli, Strep, Staph, Pasteurella, Pseudomonas. Bacteria with Tropism & are Contagious: Bordetella, Strep equi sub zooepidemicus, Yersinia Pestis. Unique: Mycobacteria, Actinomyces, Rhodococcus, Nocardia.
98
Bacterial Pneumonia - Treatment failed. Possible causes?
Wrong AB / Not-susceptible bacteria. Abscessation, Foreign Body, Neoplasia. Underlying cause not resolved: (e.g. Anatomical defects, causes for aspiration pneumonia, Immunosuppression). ARDS. Lipid pneumonia
99
Viral Pneumonitis - Viral agents (Specific to LRT & Non-specific)
Specific: Canine Influenza (H3N8), Feline Influenza (H5N1), PI, Canine Adenovirus. Non Specific: Distemper, FIP, Virulent Calicivirus, Herpes (Mostly Lethal in puppies), Cowpox in Cats (zoonotic)
100
Viral Pneumonitis - What are the 3 main target systems for Distemper?
GI, Respiratory (e.g. Rhinitis, Pneumonia), CNS
101
Viral Pneumonitis - Treatment
General supportive (e.g. fluids, anti-pyretics, appetite stimulant), Mucolytics, Nebulization, Coupage, O2 (If indicated), AB for secondary Infections
102
Mycotic Bronchopneumonia - Classic X-ray findings
Nodular interstitial pattern, Lymphadenopathy
103
Toxoplasmosis (Protozoal Bronchopneumonia) - After Infection when does the cat start to excrete the parasite? How long after does it become infective?
7-14 Days after infection. 1-5 Days after being excreted. Remains infective for months to years
104
Toxoplasmosis (Protozoal Bronchopneumonia) - What is the Stage that does the damage?
Tachyzoites (Bradyzoites remain quiet within the tissues).
105
Toxoplasmosis (Protozoal Bronchopneumonia) - Mode of Infection
Ingestion (All life stages), Transplacental, Lactation
106
Toxoplasmosis (Protozoal Bronchopneumonia) - What are the causes for respiratory disease/parasite reactivation?
Immunosuppression (e.g. FIV, FeLV, Steroids, Cyclosporine)
107
Toxoplasmosis (Protozoal Bronchopneumonia) - Diagnosis (2 main methods)
Detection of Bradyzoite cyst or Tachyzoites in fluids - BAL, CSF, Pleural effusion). Serology - High IgM / Seroconversion of IgG (4x increase in 2 Weeks)
108
Toxoplasmosis (Protozoal Bronchopneumonia) - Treatment and prognosis for pulmonary Toxoplasmosis
Clindamycin or TMS (Not in Cats). Grave
109
Neosporosis (Protozoal Bronchopneumonia) - Most common signalment and affected systems
Puppies. Muscles (Polymyositis), CNS, Lungs
110
Neosporosis (Protozoal Bronchopneumonia) - Diagnosis & Treatment
In fluids (CSF, BAL, Cysts in Muscles) Serology (IgM, IgG Seroconversion). Clindamycin / TMS
111
Pneumocystis Carinii - Signalment (2 Over-represents breeds & and one Situational/Non-specific)
Miniature Dachshund, Cavalier King Charles (Young). Immunosuppressed animals
112
Pneumocystis Carinii - Clinical Signs
Exercise Intolerance, Weight loss (different than other respiratory disease), Hair-Coat Changes., Cough, Cyanosis, Tachypnea, Dyspnea
113
Pneumocystis Carinii - Diagnosis
X-Ray: Symmetric milliary interstitial to alveolar infiltrate Emphysema. Signs of pulmonary hypertension. Direct demonstration of P.Carinii cysts in respiratory fluids. PCR on BAL fluids
114
Pneumocystis Carinii - Treatment and for duration
TMS . Several Months
115
Pneumocystis Carinii - Zoonosis?
Risk mainly for Immune-comprised
116
Aleurostrongylus Abstrusus - Clinical signs and arterial blood gas findings
Cough (Chronic), Dyspnea, Tachypnea. Hypoventilation due to obstruction
117
Aleurostrongylus Abstrusus - Modes of infection
Ingestion of molluscans or paratenic hosts (Rodents/Birds)
118
Aleurostrongylus Abstrusus - Diagnosis
X-rays, L1 in Fecal Floatation (Berman) , See the worms BAL cytology
119
Aleurostrongylus Abstrusus - Treatment
Fenbendazole for 2 - 3 Weeks (Broadline, Advocate also fine). GC (to reduce inflammation). Bronchodilators
120
Interstitial Lung Diseases - Clinical signs
Shallow Breathing, Tachypnea, Cyanosis , Signs of R-CHF (e.g. Syncope, Ascites), Exercise Intolerance, Cough
121
Interstitial Lung Diseases - Name the 2 main methods in which a general diagnosis of ILD can be achieved
Imaging (CT), Histology
122
Interstitial Lung Diseases - 2 Main Histological Findings
Inflammation , Fibrosis
123
Interstitial Lung Diseases - Common CT Findings (But not Specific)
Ground-glass opacity, Traction bronchiectasis, Honeycomb, Subpleural fibrosis
124
Interstitial Lung Diseases - Clinical signs are due to 3 elements:
Hypoxemia, Inflammation, Pulmonary hypertension
125
Eosinophilic Bronchopneumopathy - Signalment (and common breeds) and main clinical sign
Young adult females (Husky, Malamute, Rottweiler over-represented). Cough (Chronic)
126
Eosinophilic Bronchopneumopathy - Diagnosis
X-rays: Various patterns can be seen such as broncointerstitial, Nodules, alveolar infiltrates and more. Bronchiectasis in severe cases. BAL - Predominantly Eosinophils
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Eosinophilic Bronchopneumopathy - Treatment & Prognosis
GCs and slowly taper off (MDI if possible), Anti-tussives, Bronchodilators. Prognosis for cure is good. Relapses are common
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Eosinophilic Bronchopneumopathy - How frequently are radiographic changes seen in times of clinical signs? As opposed to what other diseases that are accompanied with chronic cough?
EBP - Radiographic changes can be seen the majority of cases. As opposed to Chronic Bronchitis, Feline asthma (Lack of changes do not rule out the diseases)
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Eosinophilic Bronchopneumopathy - Common bloodwork finding, and in what frequency does it appear?
Eosinophilia (~50%)
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Idiopathic Pulmonary Fibrosis - Signalment, Clinical signs and main PE findings
Middle age to old dogs. Terriers, Particularly West Highland White Terrier, Pekingese (A more severe disease) Tachypnea, Dyspnea, Severe exercise intolerance, Syncope (Pulmonary Hypertension 40% of Cases), Cough, Cyanosis , Crackles, Velcro sounds
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Idiopathic Pulmonary Fibrosis - Diagnosis
CT (Ground glass opacity, Traction bronchiectasis, Subpleural bands, Honeycomb) *Suggestive but not specific. Histology (Gold standard): Severe fibrosis with no significant inflammation
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Idiopathic Pulmonary Fibrosis - Treatment & Prognosis
O2, PDE-5 inhibitors (e.g. Sildenafil) - for Pulmonary hypertension. AB for 2ndary Infections, Guarded, but can live for a few more years
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Idiopathic Pulmonary Fibrosis - MST for Pekingese IPF
60 Days
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Lipid Pneumonia - Exogenous common cause and why does it occur to begin with?
Mineral Oil / Vegetable / animal-based. It doesn't irritate the mucosa going down - suspicion only rises after clinical signs begin
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Lipid Pneumonia - Endogenous causes
PTE, Neoplasia, Bacterial Pneumonia, Idiopathic
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Lipid Pneumonia - What is the source of the lipids in Endogenous lipid pneumonia?
Cholesterol from Pneumocytes type II that spill out upon destruction
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Lipid Pneumonia - Common arterial blood gas results
Hypercapnia, Hypoxemia
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Lipid Pneumonia - Diagnosis
BAL cytology - Oil laden macrophages
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Lipid Pneumonia - Exogenous - Treatment
Supportive treatment for pneumonia. If treatment fails - short course of GC to reduce inflammation. Oxygen if needed. AB for secondary pneumonia
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Lipid Pneumonia - Endogenous - Treatment
Treat primary disease, GC to reduce Inflammation, Removal of affected lobes if severe
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Lung neoplasia - what is the most common primary malignant neoplasia
Adenocarcinoma >> Carcinoma (70%)
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Lung neoplasia - what is more common - primary or metastasis?
Metastasis
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Lung neoplasia - What are 2 common clues to a thoracic mass (commonly associated with neoplasm)? Name one in a dog and one in cat
Dogs - Hypertrophic Osteopathy. Cats - Lung-digit syndrome
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Lung neoplasia - Most efficient diagnostic tools
FNA (~80% Diagnostic). Biopsy
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Lung Neoplasia - Negative prognostic indicators
Presentation with clinical signs, Centrally located (Closer to lung hilus), Lymph node involvement, Multiple lesions, Pleural lesions, Undifferentiated carcinomas, Adenocarcinoma>SCC (More metastasis)
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Aspiration Pneumonia - Predisposing Factors
Force feeding. Regurgitation (e.g. Megaesophagus, Myasthenia Gravis, Esophagitis, Sliding hiatal hernia). Vomiting (less of a risk factor than regurgitation). Impaired laryngeal function (e.g. Laryngeal paralysis, Masses adjacent to larynx). Impaired consciousness: (e.g. Anesthesia, Coma, Syncope, Seizures)
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Aspiration Pneumonia - Treatment
Remove underlying problem, AB for 2nd infection, Oxygen
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Aspiration Pneumonia - Diagnosis
CBC: neutrophilia. High CRP. X-rays: Interstitial-Alveolar Pattern - Cranio-ventral distribution (classically but not limited to right cranial, right middle (most commonly affected) lung lobes
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Aspiration Pneumonia - Prevention (Think about the general causes and how to prevent each one)
Regurgitations: Treat underlying issue if possible, Baileys chair / feed from above, High frequency + low volume meals, Pro-motiles. Anesthesia related AP: Proper fasting before procedure, Use endotracheal tube and inflate appropriately, Pro-motiles (e.g. Metoclopramide), PPIs
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Aspiration Pneumonia - What are the characteristics of the worst kind of ingest to inhale (3)
Big particles , High tonicity, Acidic
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Pneumothorax - 3 Main categories of causes and name common causes for each
Traumatic: HBC, Bite wound. Iatrogenic: Rapid re-expansion of lungs, Open pop-off valve, High pressure ventilation, Thoracocentesis. Spontaneous: 1) Primary- Bullae, Blebs. 2) Secondary: Abscess, Neoplasia, Granuloma, Inflammatory diseases (e.g. Asthma, Chronic bronchitis), Ruptured esophagus, Tracheal rupture
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Pneumothorax - Classic signalment for primary pneumothorax
Middle age to old, large breed, deep chested dogs
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Pneumothorax - What are the common types of spontaneous pneumothorax (Primary vs. secondary) - Cats vs dogs?
Dogs - Primary. Cats - Secondary
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Pneumothorax - Diagnosis
TFAST - Absence of "glide sign" and / or B-lines (Can help rule out if present) and presence of lung point.. Diagnostic thoracocentesis. Chest X-rays: Cardiac silhouette elevations, Evidence of bullas (not sensitive). CT (For bullae - still sensitivity only 40-60%)
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Pneumothorax - Clinical signs, PE findings and arterial blood gas
Tachypnea, Dyspnea, Cyanosis, Auscultation - decreased respiratory sounds dorsally. Hypercapnia, Hypoxemia
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Pneumothorax - Treatment (Traumatic / Primary / Secondary)
Traumatic : Monitoring=>Thoracocentesis=> Chest tubes. Oxygen (Lesions heal 3-5 days). Secondary (e.g. Foreign body, Abscess, Neoplasia): Treat underlying problem (Surgery) and occasionally requires thoracocentesis but most heal conservatively after surgery. Primary (Bulla, Blebs): Pleurodesis treatment of choice = Blood Pleurodesis
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Pulmonary thromboembolism (PTE) - Causes
IMHA Pancreatitis PLN/PLE, Inflammation, Cushing's/Steroids, Sepsis, S.Lupi, Cardiomyopathy, Neoplasia
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Pulmonary thromboembolism (PTE) - Diagnosis
High D-Dimer - Mostly for acute cases (after 24h sensitivity drops). Not specifiec. Useful for ruling out PTE. Angio-CT/ MRI (Gold standard). *Echocardiography - useful for detecting pulmonary hypertension 2nd to PTE. *Arterial blood-gas - Hypoxemia
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Pulmonary thromboembolism (PTE) - Treatment
Treat underlying cause. Anti l-coagulants/anti-thrombotics (e.g. Clopidogrel/LMWH/Rivaroxaban). *Thrombolysis is not recommended. Oxygen
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Pulmonary Hypertension - Causes (From most to least common)
L-CHF - 50%, Pulmonary diseases with hypoxia (Bronchitis/TBM/Fibrosis) - 25%, PTE/Emboli - 10%, R-L Shunts (PDA/VSD) - 10%, Idiopathic (Rare)
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Pulmonary Hypertension - Definition & Diagnosis (Optimal imaging technique and possible findings)
Pulmonary arterial pressure > 25 mmHg. Echocardiography: Bernoulli's equation (4v^2)- right ventricle/atrium pressure increases. Flattening of interventricular septum. Pulmonary artery/aorta diameter > 1. Right ventricular hypertrophy
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Pulmonary Hypertension - Clinical signs and PE findings
Syncope, Ascites, Exercise Intolerance. Basal, Left Sided, Decrescendo Murmur, Split S2, Right apical systolic murmur, Jugular distension and or pulsation
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Pulmonary Hypertension - Treatment
Treat underlying cause, Avoid strenuous exercise, PDE-5 Inhibitors (Sildenafil, Tadalafil), Oxygen
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Cardiogenic/Non-cardiogenic pulmonary edema - General categories of causes of fluid extravasation
Increase in hydrostatic pressure, Decrease in oncotic pressure, Increase in vascular permeability, Decrease in lymphatic drainage
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Cardiogenic/Non-cardiogenic pulmonary edema - of the general causes for fluid extravasation - Which 2 categories are more likely to cause pulmonary edema? What pathologies do the other 2 generally lead to?
Causes pulmonary edema: 1) Increase in hydrostatic pressure (e.g. L-CHF) 2) Increase in permeability (e.g. SIRS). Don't generally cause pulmonary edema: 1) Decrease in osmotic pressure: (Hypoalbuminemia) - Pleural effusion. Also - Ascites, Peripheral edema. 2) Decrease in lymphatic drainage - Chylothorax.
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Cardiogenic/Non-cardiogenic pulmonary edema - for each main category of fluid extravasation which can lead to pulmonary edema - What is the fluid type and does it respond to diuretics?
1) Increase in hydrostatic pressure (e.g. L-CHF) - Transudate (Protein poor) - Responds well to diuretics. 2) Increase in permeability - Protein Rich - Doesn't respond well to diuretics
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Non-cardiogenic pulmonary edema - Common causes for increase in permeability
Post-obstructive lung edema: Rapid lung Re-expansion, Strangulation. ALI/ARDS: Pancreatitis, IMHA, Vasculitis, Uremia, Heat stroke, TRALI, Oxygen toxicity, Sepsis, Snake bite. Direct lung damage: Aspiration pneumonia, Paraquat, PTE. Neurogenic lung edema: Seizures, Electrocution, Head trauma
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Cardiogenic/Non-cardiogenic pulmonary edema - A useful lab parameter which can help distinguish between cardiogenic and non-cardiogenic pulmonary edema
NT-proBNP
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Cardiogenic/Non-Cardiogenic Pulmonary Edema - Common arterial blood gas results
Hypoxemia, High A-a Gradient, low PaO2:FIO2 , Normo to hypocapnia (Hypoxemia which leads to tachypnea and hyper-ventilation)
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Non-cardiogenic pulmonary edema - Treatment
Treat underlying cause, Oxygen Support while the lungs heal, Positive pressure when SpO2 <90%, PaO2 < 60 mmHg
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Lung lobe torsion - Signalment & Clinical signs
Deep-chested dogs (Afghan hounds, Pugs over-represented. Non-Specific - Malaise, Fever, Anorexia, Shock, Collapse, Tachypnea, Cough, Hemoptysis
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Lung lobe torsion - Commonly affected lung lobes
Left-cranial, Right middle
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Lung lobe torsion - Diagnosis & Treatment
CT > X-Ray (Lung consolidation). Thoracocentesis of pleural effusion if present (Modified transudate / Hemorrhagic / Chyle). Removal of affected lung lobe
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What drug inhibits the metabolism of Theophylline in the liver - risking overdose?
Enrofloxacin
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What 2 respiratory diseases are in strong association with BAOS?
Bronchomalacia, Tracheal hypoplasia (Mainly English Bulldogs)
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Feline Calicivirus - in addition to common Calicivirus clinical signs and physical exam - name the pathologies commonly associated with virulent stains
Pneumonia, Polyarthritis, Jaundice, Vasculitis, Edema, and ulceration (Face, limbs, foot pads)
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Neurogenic rhinitis - Common clinical signs
Mainly unilateral disease, Hyperkeratosis and dryness of nasal planum, Nasal discharge, Sneezing
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Coughing Patient - Important Hx Questions
How long has it been coughing? Productive cough or not? Exposed to irritants? Any other clinical signs? Worse in the morning (Respiratory) or at night (Cardiogenic)
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Cough is Respiratory or Cardiogenic: Elevation of sleeping respiratory rate
Cardiogenic
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Pulmonary hypertension - Common causes
R-L Shunt (e.g. PDA, VSD) , Cardiac diseases (e.g. Mitral regurgitation) Respiratory diseases (Mainly lower tract disease), PTE, Heart worms, Idiopathic
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Pulmonary hypertension - treatment
Treat underlying cause, Oxygen supplementation, PDE-5 Inhibitors (Sildenafil / Tadalafil), Less exercise
