Coughing and dyspnoea Flashcards

Question

Treatment of feline asthma

Answer 1

Control obesity Control secondary bacterial infection Glucocorticoid therapy often dramatic. May need to be given IV. Bronchodilators: theophylline 4 mg/kg PO tid terbutaline 0.6 - 1.25 mg/cat PO bid - tid Nebulized bronchodilators and steroids have been helpful and can help avoid the side effects of using chronic steroids or tableting/giving oral medication Supplemental oxygen in a severe attack Inhalational therapy

Answer 2

Poorly defined clinical entity as offending allergens rarely identified. Characterised by eosinophilic inflammation. Clinical signs and diagnosis similar to chronic bronchitis Responds well to anti-inflammatory doses of glucocorticoids

Answer 3

characterised by interstitial or alveolar infiltration and the presence of eosinophilic inflammation Coughing is the usually the primary complaint, although tachypnoea and dyspnoea may be seen. Weight loss, depression and anorexia may also occur. increased breath sounds or crackles. Wheezes and decreased lung sounds may occur Circulating eosinophilia supports a diagnosis

Answer 4

Usually include an interstitial pattern and patchy alveolar opacities. A bronchial component may also be present. Occasionally even large pulmonary nodules indistinguishable from neoplasia, which represent eosinophilic pulmonary granulomatosis. Hilar lymphadenopathy is common.

Answer 5

Prednisolone 1 mg/kg BID initially. Repeat radiographs to assess response. Reduce to lowest effective dose over several months. May require continual alternate day dosing. Prognosis for control is good except in the more severe granulomatous form of the disease

Answer 6

Chronic irreversible, saccular, cylindrical, cystic or varicose dilatations and constrictions of bronchi and bronchioles which may contain large quantities of bronchial secretions. Usually occurs secondary to destructive inflammatory disease (acute bronchitis/bronchopneumonia). Bronchiectasis is an irreversible change which usually predisposes to recurrent infection, due to a failure of the mucociliary escalator. May occur in cases of ciliary dyskinesia. Cough may be productive.

Answer 7

Bronchial pattern with widened and irregular lumen of affected bronchi. May be localised or generalised. Ill-defined amorphous area of increased density due to pneumonia or atelectasis, particularly peripherally. Increased interstitial pattern. Bronchography for confirmation.

Answer 8

Mitral regurgitation can be associated with coughing either as a result of pulmonary congestion and oedema or due to compression of the left mainstem bronchus by massive left atrial enlargement.

Answer 9

Left atrial enlargement Bronchial collapse may be identified.

Answer 10

Infection usually acquired by pups from the bitch. Clinical signs usually apparent in dogs less than 1 year of age. May be asymptomatic in older dogs. Cough paroxysmal, unproductive and distressing often ending in retching and vomiting. Occasionally nodules may cause respiratory obstruction and dyspnoea. Little improvement with antibiotics or corticosteroids

Answer 11

Nodules present in terminal trachea and bronchi. Can be difficult to identify.

Answer 12

Fenbendazole (Panacur) 20 mg/kg daily for five consecutive days. Five days off treatment. Repeat treatment four times. Imidocloprid and moxidectin (Advocate) spot-on, two applications one month apart.

Answer 13

Dogs become infected from ingesting snails and slugs which contain infective third stage larvae. Enzootic in Europe and the UK, particularly Cornwall, Wales and the south-east. Clinical signs include coughing, dyspnoea, exercise intolerance, haemoptysis, anaemia, bleeding, haematoma formation and death. Coagulopathy may be associated with chronic disseminated intravascular coagulation or immune-mediated thrombocytopenia.

Answer 14

Bronchial thickening Diffuse interstitial lung disease Focal areas of alveolar pattern, especially in the caudal lobes Right heart and pulmonary artery enlargement Tortuous pulmonary arteries which may appear truncated

Answer 15

Fenbendazole (Panacur) 20 mg/kg daily for five consecutive days. Five days off treatment. Repeat treatment four times. Imidocloprid and moxidectin (Advocate) spot-on, two applications one month apart.

Answer 16

Bronchiolar parasite of cats. Intermediate host (slugs and snails) may be eaten by birds and small mammals. Infection usually asymptomatic and self-limiting. Occasionally causes coughing, wheezing and respiratory distress. Auscultation may reveal wheezes or crackles

Answer 17

Small nodular densities throughout lung parenchyma, especially associated with bronchi. Nodules may be well-defined or poorly-defined and irregular. An accentuated bronchial pattern and a confluent alveolar pattern may be seen in severely affected cats.

Answer 18

Fenbendazole

Answer 19

Usually whole head of wheat or barley with awns favouring deeper penetration into bronchus. Incidence highest in the summer. Coughing is the most common clinical sign. Halitosis is often a feature. Some response to antibiotics, but relapse on withdrawal.

Answer 20

Often minimal change. Localised increase in density around bronchus, most commonly of the caudal or accessory lobes. Expiratory radiographs may be helpful. Lobar pneumonia. Large soft tissue mass due to abscess. Bronchography may be helpful.

Answer 21

Primary neoplasia - usually well-defined solitary mass with consolidation of entire lung lobe. May be able to biopsy mass at bronchoscopy. Secondary neoplasia - usually well defined multiple nodules of dissimilar size. Occasionally ill-defined and multiple. Cavitation may occur in rapidly growing tumours. Lymphosarcoma - always ill-defined, multiple, small nodules particularly associated with bronchi and bronchioles. May be associated with hypertrophic pulmonary osteoarthropathy.

Answer 22

May be secondary to bronchopneumonia, bronchiectasis or bronchial foreign body, nocardiosis, tuberculosis, fungal infection. Lymphomatoid granulomatosis is an inflammatory condition which may progress to lymphoma. It has been reported in young to middle-aged dogs. Coughing, choking, gagging, dyspnoea, anorexia and vomiting are the main presenting signs. Radiographic abnormalities included lung lobe consolidation or pulmonary mass lesions, as well as abnormally large tracheobronchial lymph nodes. Some dogs respond well to combination chemotherapy.

Answer 23

Most frequently seen in toy and miniature breeds. Multifactorial aetiology involving a primary cartilage abnormality resulting in weakness of the tracheal rings together with secondary factors such as obesity, recent endotracheal intubation, respiratory infection, obstructive airway disease, which exacerbate the clinical signs. Characterised by a chronic, persistent paroxysmal cough precipitated by excitement, anxiety or pulling on a lead. A chronic expiratory 'honking' cough is a frequent, but not consistent finding.

Answer 24

Tachypnoea: increased rate of breathing Orthopnoea: difficulty in breathing when lying down Dyspnoea: difficult, laboured, or painful breathing

Answer 25

Pleural effusions - ○ Hydrothorax § Transudate § Modified transudate ○ haemothorax ○ chylothorax ○ pyothorax ○ neoplastic ○ inflammatory Pneumothorax Diaphragmatic rupture/hernia Cardiac enlargement Intrathoracic masses Abdominal masses/fluid

Answer 26

hypoproteinaemia (gut or urine loss, severe liver disease)

Answer 27

congestive cardiac failure, particularly cats neoplasia (particularly cranial mediastinum, thoracic wall) lung lobe torsion diaphragmatic rupture and incarceration of liver

Answer 28

trauma coagulopathies

Answer 29

trauma neoplasia idiopathic

Answer 30

nocardia bacteroides tuberculosis

Answer 31

Dyspnoea, hyperpnoea and tachypnoea especially on exertion. Reluctance to settle or lie down due to orthopnoea. Increased density on percussion, reduced heart sounds.

Answer 32

Interlobar pleural fissures. Retraction of lung lobes from chest wall producing scalloped appearance in lateral and rounding of the costophrenic angle in DV. Cardiac and diaphragmatic lines obscured. Unilateral effusion suggests pyothorax or chylothorax.

Answer 33

may result from haematogenous spread of bacteria or fungal organisms or from extension of underlying infective processes most commonly diagnosed in young to middle-aged, medium to large breeds of dog may be found in association with FIV or FIP infections

Answer 34

1/3 way down the 7th intercostal space

Answer 35

Over the 9th intercostal space

Answer 36

Neoplasia Traumatic Congestive heart failure, especially in cats Infectious Congenital Lung lobe torsion, although lung lobe torsions can occur as a complication of chylothorax also Spontaneous

Answer 37

Chyle is sudan III positive and has high triglycerides

Answer 38

Thoracocentesis Feed a high carbohydrate, low fat diet Add medium-chain triglycerides, e.g. coconut oil, as these are taken up directly into the portal circulation Rutin, a benzopyrone, non-anticoagulant coumarin, has been used. Dose 20 - 50 mg/kg TID. Rutin reduces high protein oedema fluid by increasing proteolysis by macrophages and increasing the number of macrophages at the site of oedema. Surgery?

Answer 39

Traumatic rupture of lung or airway. Penetrating wounds of the thorax wall. Ruptured lung bulla, pulmonary cyst, emphysema Ruptured pulmonary abscess or necrotic tumour. Spontaneous pneumothorax. Extension of pneumomediastinum (rare)

Answer 40

Reduced lung sounds. Increased resonance on percussion.

Answer 41

Retraction of lung lobes with increased density due to collapse. Visualisation of the visceral pleura. Collapsed lobes surrounded by radiolucent area containing no lung markings (beware of skin folds in deep-chested dogs) Cardiac silhouette elevated from sternum in recumbent lateral view. With tension pneumothorax, there is over distension of the thoracic cavity (barrel chest) with flattening of the diaphragm and visualisation of the diaphragmatic attachments. The ribs and costal cartilages become perpendicular to the spine. Tension pneumothorax requires immediate thoracocentesis to relieve the intra-pleural pressure.

Answer 42

Usually the result of trauma. Rarely congenital herniation. Clinical signs include increased density on percussion and displacement of the apex beat of the heart.

Answer 43

Loss of diaphragmatic line. Loss of normal intrathoracic anatomy with displacement of lung lobes, heart and mediastinum. Presence of abdominal viscera within the thorax. Absence or displacement of viscera within the abdomen. Possibly the presence of free pleural fluid especially if liver or spleen is incarcerated in defect. Ultrasonography is very useful in the diagnosis of diaphragmatic rupture and is particularly helpful for incarcerated organs. Barium study may help if plain films are equivocal. In congenital diaphragmatic hernia, the viscera may be contained in a peritoneal sac appearing as a discrete thoracic mass continuous with the diaphragm

Answer 44

Bronchopneumonia Pulmonary oedema Pulmonary haemorrhage/contusion Metastatic neoplasia Pulmonary thrombosis Paraquat poisoning Pulmonary emphysema Idiopathic pulmonary fibrosis

Answer 45

not uncommon. i) Infection secondary to kennel cough, cat flu, damage caused by smoke, chronic bronchitis, bronchiectasis, foreign body inhalation, pulmonary neoplasia, granulomata. ii) Aspiration secondary to megaoesophagus, swallowing disorders, broncho-oesophageal fistulae, chronic rhinitis. iii) Pulmonary infiltration with eosinophilia (PIE) is believed to be an allergic pneumonia. Solitary, well-defined granulomas can also occur. iv) Pneumocystis carinii infection, a ubiquitous parasite that can cause severe respiratory disease particularly in immuno-compromised patients. Trimethoprim-sulphamethoxazole is the treatment of choice.

Answer 46

Fluffy, ill-defined areas of density with air bronchograms due to alveolar flooding. Areas of consolidation. Peribronchial infiltration in less affected areas. Bronchial lymph node enlargement.

Answer 47

Blood-tinged frothy oedema fluid can appear from the nostrils or mouth. Abnormal accumulation of fluid in the interstitial tissues, alveoli and bronchi of the lungs. Radiological signs include increased interstitial and/or alveolar opacity. Cardiomegaly in left-sided cardiac failure. Cause usually cardiogenic. In acute failure, oedema is widespread with a patchy distribution. When chronic it tends to affect mainly the perihilar and dependent portions of the lung lobes. Heart usually but not always enlarged. Non-cardiogenic causes include altered capillary permeability (infection, toxic inhalants, systemic toxins, allergy, anaphylaxis, uraemia); increased capillary pressure or obstruction (fluid overload, lymphatic or venous obstruction); decreased oncotic pressure (hypoproteinaemia); neurogenic (head trauma, seizures, electric shock).

Answer 48

Coughing ± haemoptysis. Traumatic - pulmonary contusion is most common. Develops within 6 hours of trauma. Improves within 24 to 48 hours and is usually completely resolved within 3 to 10 days. May be associated with other signs of thoracic trauma, e.g. fractured ribs. Coagulopathies e.g. Warfarin, von Willebrand's disease, D.I.C. May be associated with mediastinal and/or pleural haemorrhage.

Answer 49

Most commonly associated with cardiac disease, autoimmune haemolytic anaemia, neoplasia, disseminated intravascular coagulation, hyperadrenocorticism, sepsis, heartworm disease, nephrotic syndrome. Clinical signs of acute dyspnoea, collapse and shock. Echocardiography may reveal a thrombus occluding the lumen of the pulmonary artery.

Answer 50

A response to chronic inflammation, paraquat poisoning, Cushing’s disease, other systemic inflammatory diseases and also as an idiopathic syndrome particularly in the WHWT and other terrier breeds In WHWT, the disease affects older dogs and the onset is slow and insidious. Deterioration happens slowly but inevitably and dogs are often euthanased when their QoL is poor due to respiratory distress and dyspnoea leading to exercise intolerance (median survival 15 months in one study). The disease often happens concurrently with chronic bronchitis and mitral valve disease and it can be difficult to know which is causing the major problem. The classical clinical exam findings are of diffuse pulmonary crackles and wheezes. These can be so loud that the heart is difficult to hear. Treatment with steroids or steroids and azathioprine may be beneficial and cause disease stability. Using another immunosuppressive may allow the dose of glucocorticoid to be reduced and avoid too many steroid side effects.

Answer 51

Ingestion of the bipyridilium contact herbicide, paraquat, causes multisytemic signs. In dogs, respiratory signs are most prominent due to diffuse alveolitis and subsequent fulminant, obliterating pulmonary fibrosis. Radiological findings are notably unspectacular in relation to the severity of the dyspnoea. Major differential diagnosis is interstitial pneumonia usually of viral origin. Pneumomediastinum - highlights structures not normally identified such as the oesophagus, azygos vein and cranial blood vessels. Both luminal and extraluminal outline of the trachea can be identified. Increased interstitial pattern - linear/curvilinear and faint nodular patterns. Patchy alveolar pattern in late stages due to pulmonary haemorrhage and oedema.

Answer 52

Congenital lobar emphysema. Acquired pulmonary emphysema complicating chronic bronchitis or bronchiectasis, particularly West Highland white terriers. Expiratory dyspnoea is the usual clinical sign. Inspiratory crackles and/or wheezing are usually heard on auscultation.

Answer 53

Increased radiolucency with loss of normal lung pattern. Pruned and attenuated pulmonary vessels. Bronchial pattern lost. Thoracic volume increased - flattened diaphragm, visualisation of diaphragmatic muscle attachments, ribs at right angles to spine. May see emphysematous bullae, blebs and cysts.

Answer 54

Nasal cavity stenotic nares foreign body chronic rhinitis aspergillosis intra-nasal neoplasia Pharynx/larynx soft palate obstruction laryngeal paralysis laryngeal oedema/collapse Trachea tracheal collapse hypoplastic trachea tracheal haemorrhage Oslerus (Filaroides) osleri foreign body Brachycephalic obstructive airway syndrome (BOAS

Answer 55

Diffuse enlargement mediastinitis mediastinal haemorrhage mediastinal oedema mediastinal abscess N.B. Brachycephalic dogs normally have a more prominent and wider cranial mediastinum. Obese dogs frequently accumulate excessive fat in this area. Radiological signs Widening of cranial and/or caudal mediastinum Reverse fissures Ultrasound is useful and allows accurate fine needle aspiration biopsy

Answer 56

Diffuse enlargement mediastinitis mediastinal haemorrhage mediastinal oedema mediastinal abscess N.B. Brachycephalic dogs normally have a more prominent and wider cranial mediastinum. Obese dogs frequently accumulate excessive fat in this area. Radiological signs Widening of cranial and/or caudal mediastinum Reverse fissures Ultrasound is useful and allows accurate fine needle aspiration biopsy Focal enlargement tumours lymphadenopathy granuloma/abscess Radiological signs Cranial mediastinal mass - increased width of the cranial mediastinum, caudal displacement of heart, elevation and deviation of trachea, caudal and lateral displacement of cranial lobes. Ultrasound is useful and allows accurate fine needle aspiration biopsy