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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
when is thoracic ultrasonography useful for coughing
masses pleural effusion
26
when is echocardiography useful
when trying to rule out cardiac causes for cough can confirm mitral valve disease, cardiac chamber enlargement, etc
27
when is endoscopy useful
direct observation of airway look at larynx, trachea, etc foeign bodies, laryngeal collapse, tracheal collapse
28
what is bronchoscopy used for
evidence of pneumonia parasites (lungworm) chronic bronchitis (roughening and thickening of mucosa) foreign body
29
what is bronchoalveolar lavage
using endoscope and flusing saline definitive diagnosis of lower airway disease (pneumonia, eosinophilic bronchitis, Bordetella)
30
what is FNA lung mass
if there is a mass in the lungs that's adjacent to the chest wall
31
what is CT useful for
interstitial lung disease (ex. pulmonary fibrosis which doesn't show up on radiographs)
32
what are the main causes of coughing in kitties (4)
1. infectious 2. inflammatory/allergic 3. neoplastic 4. parasitic/fungal/protozoal
33
what are the infectious & inflammatory causes of cough in cats (4)
1. cat flu: URT infection 2. pneumonia 3. chronic bronchopulmonary disease 4. pulmonary fibrosis
34
what are the infectious causes of feline upper resp tract infections (6)
1. feline rhinotracheitis virus (FHV) 2. feline calici virus (FCV) 3. feline corona virus 4. Bordetella bronchiseptica 5. mycoplasma spp 6. chlamydophila felis
35
what medications are used to treat feline URT infections
amoxycillin clavulanate doxycycline antivirals? famciclovir (FHV) interferon (give in early infection)
36
what are supportive treatments of feline URT infections (5)
1. good nursing 2. appetite stimulants 3. mucolytics 4. decongestants 5. nebulized air
37
are bacterial/viral pneumonia common in cats
uncommon look for underlying cause (aspiration, immunosuppression)
38
when can pneumonia occur in association with in cats
chronic bronchitis/asthma
39
what will BAL fluid cytology show if there is a bacterial/viral pneumonia
increased neutrophils
40
what antibiotics are used to treat bacterial/viral pneumonia in cats
based on culture and sensitivity but empirical: amoxicillin clavulanate/doxycycline
41
what are the supportive therapies for bacteria/viral pneumonias in cats (5)
1. IV fluids 2. oxygen 3. coupage 4. airway humidification 5. bronchodilators
42
what are the clinical features of chronic bronchitis (5)
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
how is chronic bronchitis/chronic airway disease treated (6)
1. glucocorticosteroids: oral or inhaled 2. bronchodilators: oral or inhaled 3. antibacterial therapy 4. mucolytics 5. control of environmental pollutants 6. physiotherapy
44
what is the long term management of chronic bronchitis/chronic airway disease (3)
1. bronchodilators 2. antibiotics 3. corticosteroids
45
what bronchodilators used to treat chronic bronchitis/chronic airway disease (4)
1. salbutamol (albuterol) inhaled 2. salmeterol (serevent) inhaled 3. terbutaline 4. theophylline
46
what antibiotics used to longterm treat chronic bronchitis/chronic airway disease (3)
1. doxycycline 2. enrofloxacin 3. clindamycin
47
what corticosteroids are used to longterm treat chronic bronchitis/chronic airway disease (4)
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
what are the radiographic signs of chronic bronchitis
collapsed middle lung lobe
49
what changes are seen here and ddx
chronic bronchitis or feline asthma collapsed middle lung lobe
50
what changes are seen and ddx (3)
1. generalized bronchial pattern with more markings than usual 2. soft tissue density 3. rounding of lung lobes
51
what neoplasia is more common in the lung primary or secondary
secondary more common
52
what tumours can cause coughing
tumours of pharynx, trachea and mediastinum
53
what are the parasitic causes of coughing in cats (3)
1. Aeluronstrongylus abstrusus 2. Capillaria aerophilia 3. Dirofilaria immitis
54
what are fungal causes of coughing in cats
1. cryptococcus neoformans (mainly nasal) 2. aspergillus 3. histoplasma 4. blastomyces
55
what are the protozoal causes of cough in cats
toxoplasmosis
56
what are the causes of coughing in dogs (6)
1. infectious 2. inflammatory/allergic 3. neoplastic 4. paraisitc/fungal/protozoal 5. structural 6. cardiac
57
what are infectious causes of kennel cough (infectious laryngotracheitis) in dogs (6)
1. bordetella bronchiseptica 2. parainfluenza III 3. canine distemper virus 4. canine adenovirus II 5. canine herpes virus 6. mycoplasma spp
58
what are the clinical signs of kennel cough (4)
1. harsh easily elicited non-productive cough 2. +/- pyrexia 3. inappetence 4. nasal discharge
59
how is kennel cough managed in dogs (5)
1. restrict exercise (& isolate) 2. harness instead of collar 3. avoid dusty/smoky environment 4. +/- tetracyclines/potentiated sulphonamides 5. +/- antitussives
60
what are the clinical features of chronic bronchitis/CAD in dogs (12)
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
how is chronic bronchitis treated (11)
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
what are the causes of allergic pulmonary disease in dogs (pulmonary infiltrate with eosinophils (PIE)/eosinophilic bronchopneumonopathy (EBP) (3)
1. parasites 2. hypersensitivity to parasites 3. inhaled allergens
63
what are the findings of allergic pulmonary disease in dogs (pulmonary infiltrate with eosinophils (PIE)/eosinophilic bronchopneumonopathy (EBP) in dogs (5)
1. cough 2. tachypnea 3. dyspnea 4. younger dogs 5. eosinophilia (blood & BAL)
64
how is eosinophilic bronchopneumonopathy (EBP) treated (2)
1. oxygen, cage rest 2. corticosteroids
65
how is eosinophilic bronchopneumonopathy (EBP) chronically managed (6)
1. fenbendazole 2. environmental management 3. corticosteroids (oral, inhaled gradual taper) 4. harness 5. control obestiy 6. other immunosuppressive therapies
66
what are airway/lung/heart parasites in dogs that cause a cough (5)
1. oslerus osleri 2. crenosoma vulpis 3. angiostrongylus vasorum 4. capillaria aerophilia 5. dirofilaria immitis
67
how is Oslerus osleri transfered
dam to offspring
68
how is crenosoma vulpis transfered
intermediate host (mollusc), fox feces
69
how is angiostrongylus vasorum transfered
intermediate host mollusc
70
how is capillaria aerophillia transfered
disease of foxes, rare in dogs
71
how is a parasitic cough presented (5)
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
how are parasitic coughs treated
fenbendazole for 12-21 days concurrently with prednisolone to prevent reaction to dying worms
73
how is coughing treated in cardiac patients
1. cardiac meds for CHF 2. antitussives: codeine, butorphanol 3. prednisolone if concurrent CAD present
74
what is the age of onset usually in tracheal collapse
young to middle age toy breeds
75
what is the cough heard in tracheal collapse
goose honk sound aggravated by lead pulling
76
what secondary resp diseases can be seen with tracheal collapse
tracheitis chronic bronchitis pneumonia
77
how is tracheal collapse acutely managed (5)
1. acetylpromazine 2. oxygen 3. cool environment 4. short acting corticosteroids 5. opioids (buprenorphine, butorphanol)
78
how is tracheal collapse chronically managed (6)
1. control obesity 2. use harness 3. environmental hygiene 4. avoid prolonged barking 5. avoid excessive excitement 6. avoid resp tract infections
79
what are the antitussives used in tracheal collapse
1. butorphanol 2. codeine phosphate
80
what are the bronchodilators used in treatment of tracheal collapse
1. methylxanthines 2. beta-adrenergic agonists
81
what are the functions of methylxanthines (3)
1. bronchodilation 2. increased mucociliary clearance 3. decreased diaphragmatic fatigue
82
what other medications are used to treat chronic tracheal collapse
1. antitussives 2. bronchodilators 3. anti-inflammatory: corticosteroids 4. antibiotics: secondary infeciton
83
what are the radiological interventions in tracheal collapse
self-expanding nitinol stents
84
what are the types of discrete foreign bodies in the airway
grass seeds, twigs, stones, other small solid objects
85
what are the clinical signs of airway foreign bodies (3)
1. acute cough/choke 2. developing to persistent cough 3. halitosis
86
what are the complications to airway foreign bodies (3)
1. pleural contamination 2. lung lobe consolidation 3. pulmonary abscess
87
how are foreign bodies in the airway treated (3)
1. bronchoscopic retrieval 2. exploratory thoracotomy: retrieval of foreign body or lung lobectomy 3. antibacterial therapy

Module 15 (27 decks)

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