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Module 15 > Coughing in Small Animals: Diagnostic Approach COPY > Flashcards

Coughing in Small Animals: Diagnostic Approach COPY Flashcards

1
Q

what is the cough reflex

A

forced expiratory effort against a closed glottis

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2
Q

what is the cough reflex mediated by

A

irritant receptors in airways and lungs

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3
Q

what occurs to the expectorate coughed up

A

swallowed or terminal retch with white forth (productive)

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4
Q

what are respiratory causes of a cough (6)

A
  1. bacterial & viral
  2. inflammatory/allergic/chronic airway disease
  3. neoplastic
  4. parasitic
  5. protozoal/fungal
  6. traumatic/structural abnormality
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5
Q

what are cardiovascular causes of persistent cough

A
  1. cardiomegaly
  2. pulmonary edema (esp if acute)
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6
Q

do cats cough with pulmonary edema

A

controversy

cats are said to not cough with pulmonary edema

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7
Q

how are coughs investigated (9)

A
  1. history
  2. clinical features (signalment)
  3. physical exam
  4. blood/fecal tests
  5. thoracic radiographs
  6. thoracic and cardiac ultrasonography
  7. bronchoscopy, bronchoalveolar lavage
  8. FNA of lungs
  9. CT
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8
Q

what are the history considerations of a persistent cough (11)

A
  1. acute vs. chronic (=daily for at least 2 months)
  2. concurrent signs (sneezing, dyspnea)
  3. character: soft/harsh/honking
  4. productive/non-productive
  5. duration/frequency/timing
  6. relationship to activities
  7. vaccination/travel/worming
  8. respiratory noises: stridor/stertor
  9. respiratory pattern: dyspnea
  10. exercise intolerance/lethary
  11. appetite
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9
Q

what are toy breeds predisposed to

A

tracheal collapse

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10
Q

what are terriers predisposed to

A

lung fibrosis

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11
Q

what are cats predisposed to

A

asthma

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12
Q

what are large breed dogs predisposed to

A

laryngeal paralysis

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13
Q

what are older dogs prone to

A

neoplasia

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14
Q

what are small dog breeds predisposed to

A

DMVD

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15
Q

what are the specific physical exam (8)

A
  1. palpate cervical area
  2. tracheal pinch reflex: if cough is elicited
  3. pulse quality
  4. resp pattern
  5. resp noises
  6. facial edema (cranial mediastinal masses(
  7. abdominal palpation
  8. lymph nodes
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16
Q

what sounds when auscultating indicate cardiac causes to a cough (5)

A
  1. sinus tachycardia
  2. arrhythmias
  3. murmurs
  4. gallop sounds
  5. pulmonary crackles
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17
Q

what sounds would indicate respiratory causes when auscultating (5)

A
  1. sinus arrhythmia
  2. bradycardia
  3. crackles
  4. wheezes
  5. stridor/stertor
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18
Q

what lab tests can be used to investigate a cough (7)

A
  1. hematology
  2. biochemistry
  3. cats: FELV/FIP/FIV
  4. Baermann’s fecal larval migration
  5. serology/microfilaria for heart worm
  6. biomarkers: NTproBNP
  7. AngioDetect: angiostrongylus vasorum
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19
Q

what findings on radiograph can indicate a cough (5)

A
  1. soft tissues of neck: upper resp tract lesions (foreign bodies, trauma, cervical tracheal collapse)
  2. mediastinum: masses, compression/deviation of normal structures
  3. cardiomegaly, pulmonary edema & vascular congestion
  4. alveolar, lobar, interstitial, bronchial lung patterns
  5. tumours, cysts
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20
Q

what is cor pulmonale

A

right cardiomegaly –> indicative of pulmonary hypertension (chronic pulmonary disease for ex. IPF)

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21
Q

what can be heard on auscultation with cor pulmonale

A

velcro crackles

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22
Q

what radiographic changes are seen with cor pulmonale

A

interstitial or broncho-interstitial lung pattern

rounding of right side of heart

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23
Q

what changes are seen here and what is ddx

A

rounding of right side of heart

cor pulmonale

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24
Q

what changes are seen here and what is ddx

A

some rounding of right heart

cor pulmonale

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25
Q

when is thoracic ultrasonography useful for coughing

A

masses

pleural effusion

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26
Q

when is echocardiography useful

A

when trying to rule out cardiac causes for cough

can confirm mitral valve disease, cardiac chamber enlargement, etc

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27
Q

when is endoscopy useful

A

direct observation of airway

look at larynx, trachea, etc

foeign bodies, laryngeal collapse, tracheal collapse

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28
Q

what is bronchoscopy used for

A

evidence of pneumonia

parasites (lungworm)

chronic bronchitis (roughening and thickening of mucosa)

foreign body

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29
Q

what is bronchoalveolar lavage

A

using endoscope and flusing saline

definitive diagnosis of lower airway disease (pneumonia, eosinophilic bronchitis, Bordetella)

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30
Q

what is FNA lung mass

A

if there is a mass in the lungs that’s adjacent to the chest wall

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31
Q

what is CT useful for

A

interstitial lung disease (ex. pulmonary fibrosis which doesn’t show up on radiographs)

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32
Q

what are the main causes of coughing in kitties (4)

A
  1. infectious
  2. inflammatory/allergic
  3. neoplastic
  4. parasitic/fungal/protozoal
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33
Q

what are the infectious & inflammatory causes of cough in cats (4)

A
  1. cat flu: URT infection
  2. pneumonia
  3. chronic bronchopulmonary disease
  4. pulmonary fibrosis
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34
Q

what are the infectious causes of feline upper resp tract infections (6)

A
  1. feline rhinotracheitis virus (FHV)
  2. feline calici virus (FCV)
  3. feline corona virus
  4. Bordetella bronchiseptica
  5. mycoplasma spp
  6. chlamydophila felis
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35
Q

what medications are used to treat feline URT infections

A

amoxycillin clavulanate

doxycycline

antivirals? famciclovir (FHV)

interferon (give in early infection)

36
Q

what are supportive treatments of feline URT infections (5)

A
  1. good nursing
  2. appetite stimulants
  3. mucolytics
  4. decongestants
  5. nebulized air
37
Q

are bacterial/viral pneumonia common in cats

A

uncommon

look for underlying cause (aspiration, immunosuppression)

38
Q

when can pneumonia occur in association with in cats

A

chronic bronchitis/asthma

39
Q

what will BAL fluid cytology show if there is a bacterial/viral pneumonia

A

increased neutrophils

40
Q

what antibiotics are used to treat bacterial/viral pneumonia in cats

A

based on culture and sensitivity

but empirical: amoxicillin clavulanate/doxycycline

41
Q

what are the supportive therapies for bacteria/viral pneumonias in cats (5)

A
  1. IV fluids
  2. oxygen
  3. coupage
  4. airway humidification
  5. bronchodilators
42
Q

what are the clinical features of chronic bronchitis (5)

A
  1. coughing for at least 2 months
  2. dyspneic episodes may occur if concurrent asthma
  3. pyrexia
  4. lethargy
  5. inappetence if concurrent bronchopneumonia
43
Q

how is chronic bronchitis/chronic airway disease treated (6)

A
  1. glucocorticosteroids: oral or inhaled
  2. bronchodilators: oral or inhaled
  3. antibacterial therapy
  4. mucolytics
  5. control of environmental pollutants
  6. physiotherapy
44
Q

what is the long term management of chronic bronchitis/chronic airway disease (3)

A
  1. bronchodilators
  2. antibiotics
  3. corticosteroids
45
Q

what bronchodilators used to treat chronic bronchitis/chronic airway disease (4)

A
  1. salbutamol (albuterol) inhaled
  2. salmeterol (serevent) inhaled
  3. terbutaline
  4. theophylline
46
Q

what antibiotics used to longterm treat chronic bronchitis/chronic airway disease (3)

A
  1. doxycycline
  2. enrofloxacin
  3. clindamycin
47
Q

what corticosteroids are used to longterm treat chronic bronchitis/chronic airway disease (4)

A
  1. prednisolone: 0.25-2 mg/kg PO q 12 hours for 7-14 days then taper dose
  2. fluticasone (inhaled)
  3. budesonide (inhaled)
  4. beclomethasone (inhaled)
48
Q

what are the radiographic signs of chronic bronchitis

A

collapsed middle lung lobe

49
Q

what changes are seen here and ddx

A

chronic bronchitis or feline asthma

collapsed middle lung lobe

50
Q

what changes are seen and ddx (3)

A
  1. generalized bronchial pattern with more markings than usual
  2. soft tissue density
  3. rounding of lung lobes
51
Q

what neoplasia is more common in the lung primary or secondary

A

secondary more common

52
Q

what tumours can cause coughing

A

tumours of pharynx, trachea and mediastinum

53
Q

what are the parasitic causes of coughing in cats (3)

A
  1. Aeluronstrongylus abstrusus
  2. Capillaria aerophilia
  3. Dirofilaria immitis
54
Q

what are fungal causes of coughing in cats

A
  1. cryptococcus neoformans (mainly nasal)
  2. aspergillus
  3. histoplasma
  4. blastomyces
55
Q

what are the protozoal causes of cough in cats

A

toxoplasmosis

56
Q

what are the causes of coughing in dogs (6)

A
  1. infectious
  2. inflammatory/allergic
  3. neoplastic
  4. paraisitc/fungal/protozoal
  5. structural
  6. cardiac
57
Q

what are infectious causes of kennel cough (infectious laryngotracheitis) in dogs (6)

A
  1. bordetella bronchiseptica
  2. parainfluenza III
  3. canine distemper virus
  4. canine adenovirus II
  5. canine herpes virus
  6. mycoplasma spp
58
Q

what are the clinical signs of kennel cough (4)

A
  1. harsh easily elicited non-productive cough
  2. +/- pyrexia
  3. inappetence
  4. nasal discharge
59
Q

how is kennel cough managed in dogs (5)

A
  1. restrict exercise (& isolate)
  2. harness instead of collar
  3. avoid dusty/smoky environment
  4. +/- tetracyclines/potentiated sulphonamides
  5. +/- antitussives
60
Q

what are the clinical features of chronic bronchitis/CAD in dogs (12)

A
  1. small toy and terrier breeds
  2. coughing for at least 2 months
  3. +/- crackles on auscultation
  4. +/- tachypnea
  5. +/- dyspnea
  6. +/- exercise intolerance
  7. +/- pyrexia
  8. +/- lethargy
  9. +/- inappetance
  10. bronchoscopic diagnosis
  11. bronchopneumonia complication
  12. eventual respiratory failure (fibrosis, pulmonary hypertension)
61
Q

how is chronic bronchitis treated (11)

A
  1. avoid obesity
  2. harness
  3. corticosteroids: oral, inhaled
  4. bronchodilators: oral, inhaled
  5. antibacterial therapy (intermittent)
  6. mucolytics
  7. nebulization
  8. rest and exercise control
  9. control of environmental pollutants
  10. physiotherapy
  11. antitussives (esp if concurrent tracheal collapse)
62
Q

what are the causes of allergic pulmonary disease in dogs (pulmonary infiltrate with eosinophils (PIE)/eosinophilic bronchopneumonopathy (EBP) (3)

A
  1. parasites
  2. hypersensitivity to parasites
  3. inhaled allergens
63
Q

what are the findings of allergic pulmonary disease in dogs (pulmonary infiltrate with eosinophils (PIE)/eosinophilic bronchopneumonopathy (EBP) in dogs (5)

A
  1. cough
  2. tachypnea
  3. dyspnea
  4. younger dogs
  5. eosinophilia (blood & BAL)
64
Q

how is eosinophilic bronchopneumonopathy (EBP) treated (2)

A
  1. oxygen, cage rest
  2. corticosteroids
65
Q

how is eosinophilic bronchopneumonopathy (EBP) chronically managed (6)

A
  1. fenbendazole
  2. environmental management
  3. corticosteroids (oral, inhaled gradual taper)
  4. harness
  5. control obestiy
  6. other immunosuppressive therapies
66
Q

what are airway/lung/heart parasites in dogs that cause a cough (5)

A
  1. oslerus osleri
  2. crenosoma vulpis
  3. angiostrongylus vasorum
  4. capillaria aerophilia
  5. dirofilaria immitis
67
Q

how is Oslerus osleri transfered

A

dam to offspring

68
Q

how is crenosoma vulpis transfered

A

intermediate host (mollusc), fox feces

69
Q

how is angiostrongylus vasorum transfered

A

intermediate host mollusc

70
Q

how is capillaria aerophillia transfered

A

disease of foxes, rare in dogs

71
Q

how is a parasitic cough presented (5)

A
  1. dyspnea if infection is widespread
  2. peripheral eosinophilia
  3. pulmonary hypertension (may lead to right sided CHF in A. vasorum and D. immitis)
  4. clotting disorders with A. vasorum
72
Q

how are parasitic coughs treated

A

fenbendazole for 12-21 days

concurrently with prednisolone to prevent reaction to dying worms

73
Q

how is coughing treated in cardiac patients

A
  1. cardiac meds for CHF
  2. antitussives: codeine, butorphanol
  3. prednisolone if concurrent CAD present
74
Q

what is the age of onset usually in tracheal collapse

A

young to middle age toy breeds

75
Q

what is the cough heard in tracheal collapse

A

goose honk sound

aggravated by lead pulling

76
Q

what secondary resp diseases can be seen with tracheal collapse

A

tracheitis

chronic bronchitis

pneumonia

77
Q

how is tracheal collapse acutely managed (5)

A
  1. acetylpromazine
  2. oxygen
  3. cool environment
  4. short acting corticosteroids
  5. opioids (buprenorphine, butorphanol)
78
Q

how is tracheal collapse chronically managed (6)

A
  1. control obesity
  2. use harness
  3. environmental hygiene
  4. avoid prolonged barking
  5. avoid excessive excitement
  6. avoid resp tract infections
79
Q

what are the antitussives used in tracheal collapse

A
  1. butorphanol
  2. codeine phosphate
80
Q

what are the bronchodilators used in treatment of tracheal collapse

A
  1. methylxanthines
  2. beta-adrenergic agonists
81
Q

what are the functions of methylxanthines (3)

A
  1. bronchodilation
  2. increased mucociliary clearance
  3. decreased diaphragmatic fatigue
82
Q

what other medications are used to treat chronic tracheal collapse

A
  1. antitussives
  2. bronchodilators
  3. anti-inflammatory: corticosteroids
  4. antibiotics: secondary infeciton
83
Q

what are the radiological interventions in tracheal collapse

A

self-expanding nitinol stents

84
Q

what are the types of discrete foreign bodies in the airway

A

grass seeds, twigs, stones, other small solid objects

85
Q

what are the clinical signs of airway foreign bodies (3)

A
  1. acute cough/choke
  2. developing to persistent cough
  3. halitosis
86
Q

what are the complications to airway foreign bodies (3)

A
  1. pleural contamination
  2. lung lobe consolidation
  3. pulmonary abscess
87
Q

how are foreign bodies in the airway treated (3)

A
  1. bronchoscopic retrieval
  2. exploratory thoracotomy: retrieval of foreign body or lung lobectomy
  3. antibacterial therapy

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