Clinical Evaluation of the Respiratory System Flashcards
true/false: tachypnea is a sensitive indicator if hypercapnia or hypoxia
true
how much of a reduction of Hb/100ml does cyanosis indicate?
> 5g- severe hypoxia
what are the terms stertor and stridor used for?
audible abnormal breath sounds without a stethoscope
upper airway
what does hemoptysis usually indicate?
bleeding from lungs or airways
what is a tension pneumothorax?
when breathing, the patient pulls air in through a laceration and then the breathing out keeps it in
what does percussing the sinuses in large animals allow you to assess?
potential fluid or tumor tissue accumulation
how does consolidation of the lung parenchyma affect how you hear lung sounds?
more consolidation makes it louder
true/false: anything in the pleural space dampens lung sounds
true
what causes crackles?
explosive reopening of lung areas (previously collapsed)
also excess secretions in airways or rupture of fluid films
what causes wheezes?
constricted airway walls or intraluminal airway masses
what are pleural friction rubs?
sliding inflamed pleural surfaces during inspiration and expiration
what are the normal lung field parameters for horses?
tuber coxae: 17th space
tuber ischii: 16th space
mid-thorax: 13th space
shoulder: 11th space
olecranon: 6th space
what are the normal lung field parameters for bovine?
tuber coxae: 11th space
mid-thorax: 9th space
olecranon: 5th space
what are the normal lung field parameters for ovine?
tuber coxae: 11th space
mid-thorax: 8th space
olecranon: 5th space
what is transtracheal aspiration?
sterile saline is introduced via tracheal puncture and a variable amount is aspirated back
what is bronchoalveolar lavage?
a distal area is flushed with saline and sampled
what are the normal constituents of a transtracheal aspiration or bronchoalveolar lavage?
mucus, columnar epithelial cells, macrophages, and rare neutrophils
what can be used to evaluate how a disease impacts the respiratory system of a patient?
arterial blood gases
pulmonary function testing
what would you expect in a transtracheal aspiration or bronchoalveolar lavage from a patient with an allergic reaction or parasitic infection?
macrophages
neutrophils
what would you expect in a transtracheal aspiration or bronchoalveolar lavage with mucopurulent inflammation?
abundant neutrophils
increased mucus
bacteria
what are some important things to distinguish when taking a history for a respiratory complaint?
environment and use (athlete or not)
contact with other animals- healthy or not
recent travel
previous and concurrent illness
presenting complaint
what are some potential adverse effects of coughing?
removal mucous layer and less effective mucociliary transport
dissemination of infection
emphysema
pneumothorax
exhaustion
what does rapid shallow respiration suggest?
restrictive disease or pain
what does accentuated expiratory effort suggest?
obstructive disease
what should you check before auscultation in a large animal with respiratory signs?
examine upper respiratory tract: conformation, symmetry, mucous membranes, +/- discharge
percuss sinuses
palpate trachea and larynx
intermandibular and retropharyngeal lymph nodes
when you percuss the sinuses of a large animal, what are you checking for?
fluid or tumor tissue accumulation
where are bronchial sounds generated and heard?
airways and when you auscultate over these airways
true/false: fluid in the lung or pleural space will make lung sounds louder
false: only louder when consolidated lung
muffled with fluid OR AIR in pleural space
when are inspiratory sounds heard more loudly and when are expiratory sounds heard more loudly?
inspiratory: extrathoracic airway obstruction
expiratory: constriction of intrathoracic airways
what can be delineated by percussion?
lungs just beneath chest wall
large intrathoracic masses
pleural effusion
what is the greatest advantage of ultrasound in the respiratory system?
evaluation of pleural space and peripheral masses in lung parenchyma
pleural fluid accumulation and pleural adhesions can be evaluated
how are nuclear imaging or lung scans made?
gamma emitting isotopes to assess regional ventilation and perfusion
what is used in rhinoscopy?
arthroscope in small animals
can you do quantitative sample analysis for protein or cell numbers using fluid from bronchoalveolar lavage or transtracheal aspiration?
no- flush fluid in and get some back
what are some complications of an indwelling chest tube?
sepsis
pneumothorax
should a diagnostic post mortem be performed on an animal that died previously or one you euthanized?
one you euthanized- do not want post mortem necrosis
how can a lung biopsy be obtained?
percutaneously
bronchoscope
surgical thoracotomy
what kinds of diagnostics and procedures can be done from a post mortem?
bacterial culture
virus isolation
parasite identification and counts
morphologic identification
what anticoagulants are acceptable for blood gas samples?
heparin
what is the difference between bronchial sounds and vesicular sounds?
bronchial sounds generated in airways and heard when auscult over these
vesicular sounds are generated in the large airways but heard over periphery: attenuated during transmission through aerated parenchyma
what does bronchoscopy allow us to assess in small animals?
airway lesions
foreign bodies
mucosal edema
mucous plugs
dynamic airway changes
collect samples
what is the downside of bronchoalveolar lavage in large animals?
requires short term light anesthesia
may induce hypoxemia
sample analysis is not quantitative
is a lung biopsy more useful for diffuse disease or focal/multifocal disease?
diffuse: could miss it with focal/multifocal
