Clinical Exam of the Resp Tract in SA Flashcards
What characteristics make up signalment?
Age, breed, species, sex/repro status
What are some important clinical history questions you might ask that relate to the respiratory system?
*recent contact with other/new animals? Kennels? Dog parks? etc.
*indoor/outdoor?
*vaccinations
*meds
*C/S/Nasal d/c, RR
*Duration, progression, any exacerbating factors?
What are some clinical signs assoc’d w/ resp dz?
*C
*increased RR & effort (tachypnoea vs dyspnoea)
*S vs reverse S
*nasal d/c
*postural breathing
*abnormal breathing sounds (stertor, stridor, wheezing, crackles)
*abnormal breathing pattern
*cyanotic MM
*other systemic clin signs
What are the 3 phases of cough?
- Deep inhalation
- Increase in airway pressure leads to contraction of resp muscles against closed glottis
- Rapid expiration
Stimulation of cough receptors can occur in what locations?
Larynx, trachea, bronchi
What is the expiration reflex?
stimulation of larynx that sounds similar to a cough but has no inspiratory phase
What is a sneeze?
rapid expulsion of air/particles through the nose at expiration
Where are the stimulation receptors for a sneeze?
nasal mucosa
What is a reverse sneeze?
intake of air through the nose as a sign of nasopharyngeal irritation
How would you characterize nasal d/c?
*unilateral vs bilateral
*types of d/c (mucopurulent - white/green; clear; epistaxis)
*other alterations (depigmentation, etc)
When you see epistaxis, what might you first think to differentiate the cause?
is it intranasal or systemic?
Nasal d/c is typically secondary to…
intranasal dz
What are signs of postural breathing?
‘Air hunger’ –> mouth open, neck extended, elbows abducted, reluctance/inability to lie down
What is stertor?
Inspiratory nasal sound when awake that disappears when mouth breathing
What is stridor?
inspiratory laryngeal sound present when mouth breathing
What are the 4 types of respiratory patterns?
normal
obstructive
restrictive
paradoxical
What are the 3 types of obstructive respiratory patterns?
inspiratory
expiratory
mixed
What is an inspiratory obstructive pattern and where do you hear it?
Present in upper respiratory tract
increased duration of inspiration often assoc’d w/ loud inspiratory noise
What is an expiratory obstructive pattern and where does it come from?
Lower respiratory tract
increased duration of expiration often assoc’d w/ effort
Wheeze often audible by stethoscope
May be externally audible
What is a mixed inspiratory & expiratory obstructive pattern?
increased duration of both inspiration & expiration
Due to fixed airway obstruction or dz affecting multiple sites
What is a restrictive pattern of breathing?
Rapid respiration w/o exaggeration of the inspiratory or expiratory component
May be panting
When might you see a restrictive pattern of breathing?
pleural space or interstitial lung dz
What is a paradoxical respiratory pattern?
movement of the chest or flanks in the opposite direction to what is expected during inspiration & expiration
When might you see a paradoxical respiratory pattern?
pleural effusion
other causes of marked dyspnoea
What are the 4 things you might hear upon lung auscultation?
normal breath sounds
wheezes
crackles/rales
referred noises
What are wheezes and when might you hear them?
Air flowing through narrow airways
Most commonly on expiration
What are crackles/rales and when might you hear them?
Popping open of small airways & alveoli
Inspiration
What signs would point to an extrathoracic airway issue?
Inspiratory
Obstructive
Mild increase in RR
stertor - nasal/ stridor - larynx
normal chest percussion
What signs would point to an intrathoracic large airway?
expiratory
obstructive
normal to mildly increased RR
Wheeze +/-
Normal chest percussion
What signs would point to an intrathoracic small airway?
Expiratory
obstructive
increased RR
+/- wheeze
normal or resonant chest percussion
What signs would point to an issue in the pulmonary parenchyma?
inspiratory +/- expiratory
restrictive
increased RR
+/- crackles
normal/dull chest percussion
What signs might point to an issue in the pleura & chest wall?
inspiratory
restrictive
increased RR
reduced sounds
Dull chest percussion - solid/liquid; resonant - air
What initial diagnostics might you run to help diagnose a respiratory tract problem?
General blood panel
faecal/serology for infectious dz
initial imaging - chest rads or u/s
What advanced imaging tests might you run to help diagnose a resp tract problem?
Fluoroscopy
CT
bronchoscopy
Sampling: BAL, U/S-guided cytology
What would be required for direct examination of the upper airway?
Sedation
Why and what would you need for tracheo-bronchoscopy or rhinoscopy?
General anesthesia
For targeted sampling or direct observation of trachea & bronchi
When doing an upper airway exam, what are the main structures that can be assessed?
oral cavity, soft palate, larynx
When would you do a bronchoalveolar lavage (BAL)?
For cytology, culture, PCR for infectious dz
For lesions affecting airways or alveoli
Echographic-guided cytology can be used for…
superficial focal lesions that require specific sampling
