Exam 2 - Diseases of the Pharynx & Larynx

Question 1

what are the most common clinical signs of pharyngeal disease?

Answer 1

stertor, reverse sneezing, gagging, retching, & dysphagia

Question 2

diseases of the larynx typically result in what clinical signs?

Answer 2

stridor & respiratory distress

Question 3

T/F: a change in voice is diagnostic for laryngeal disease

Answer 3

true

Question 4

what is the general pathogenesis of laryngeal disease?

Answer 4

exacerbating event results in a sudden worsening of signs

increased inspiratory effort causes increased negative pressure in the upper airways, & soft tissue is sucked inward

this leads to tissue edema & inflammation

can lead to cyanosis, collapse, & even death

Question 5

what does stertor indicate?

Answer 5

indicates turbulent flow in the upper airways

Question 6

what does stridor indicate?

Answer 6

indicates laryngeal disease

Question 7

what does reverse sneezing indicate?

Answer 7

nasopharyngeal irritation

Question 8

T/F: respiratory distress is typically in the inspiratory phase

Answer 8

true

Question 9

to evaluate the pharynx & larynx, what meds can be given?

Answer 9

anesthesia with a short-acting sedative!!! no pre-med!!!

want to achieve a depth where the larynx can be evaluated but deep spontaneous respirations are present

Question 10

what would be expected of arytenoid movement during normal respiration?

Answer 10

arytenoids should abduct widely & symmetrically during inspiration & return to a resting position during expiration

Question 11

what is the positioning used for radiographs when evaluating the larynx & pharynx?

Answer 11

head is held with the neck extended without rotation, lateral views, and ventrodorsal views

Question 12

why is culture from the pharynx or larynx not helpful?

Answer 12

diverse bacterial population is normal

Question 13

what is obstructive laryngitis?

Answer 13

non-neoplastic infiltration of the larynx with inflammatory cells causing irregular thickening, hyperemia, & swelling - signs of obstruction results

Question 14

what is the common name for canine infectious respiratory disease complex?

Answer 14

kennel cough

Question 15

what organisms are associated with causing kennel cough?

Answer 15

canine adenovirus-2
parainfluenza virus
bordetella bronchiseptica
mycoplasma

Question 16

what is the shedding period of canine adenovirus-2?

Answer 16

<14 days

Question 17

what is the pathogenesis of canine adenovirus-2?

Answer 17

infects URT including tonsillar crypts & can infect type 2 alveolar cells causing interstitial pneumonia

Question 18

what is the shedding period for canine parainfluenza virus?

Answer 18

shed for up to 10 days

Question 19

where does parainfluenza virus infect in the respiratory system?

Answer 19

infection is restricted to the upper respiratory tract

Question 20

what is the pathogenesis of parainfluenza virus?

Answer 20

denudes the epithelium of cilia

Question 21

what kind of organism is bordetella bronchiseptica?

Answer 21

gram negative rod

Question 22

what is the pathogenesis of bordetella bronchiseptica?

Answer 22

colonizes the upper respiratory tract epithelium (trachea, bronchi, bronchioles, & pulmonary interstitium)

paralyzes the cilia decreasing mucociliary clearance & secretes toxins that impair phagocytic function

Question 23

T/F: mycoplasma can be apart of normal flora in the upper respiratory tract of dogs & cats

Answer 23

true

Question 24

what is the shedding period for mycoplasma?

Answer 24

chronic shedding for months

Question 25

what is the pathogenesis of mycoplasma?

Answer 25

colonizes lower respiratory tract epithelium predominantly

Question 26

in kennel cough, how do you identify the causative agent?

Answer 26

you don't - clinically indistinguishable

Question 27

how is kennel cough spread?

Answer 27

aerosolized droplets, dog-dog transmission

Question 28

T/F: an animal needs to be immunocompromised to get kennel cough

Answer 28

false - highly contagious disease where 50% of the dogs in the environment are affected

Question 29

what is the incubation period of kennel cough?

Answer 29

3-10 days

Question 30

T/F: an animal with kennel cough can have preclinical shedding

Answer 30

true

Question 31

what is the shedding period for kennel cough?

Answer 31

2 weeks-3 months post infection

Question 32

what is the most common presentation of kennel cough?

Answer 32

BAR, honking cough, may gag/retch when coughing, if present, serous nasal discharge, & a change in bark from laryngitis/tonsilitis

Question 33

how long is an animal affected by kennel cough?

Answer 33

resolves after 7-14 days with no long term consequences

Question 34

when can there be complications associated with kennel cough in dogs?

Answer 34

unvaccinated dogs, very young dogs, poor overall health

Question 35

if kennel cough becomes complicated, what clinical signs may be seen? what disease do you need to rule out?

Answer 35

progressive cough, lethargy, fever, mucopurulent nasal discharge rule out distemper!!!

Question 36

how is kennel cough diagnosed?

Answer 36

presumptive diagnosis based on clinical signs & recent exposure, radiographs if pneumonia is suspected, PCR panels are available but often not necessary in most cases

Question 37

when may PCR be pursued in an animal with kennel cough?

Answer 37

trying to document an outbreak

Question 38

what should be included in the supportive care for kennel cough?

Answer 38

outpatient when possible - isolate them! feed warm, soft food, appetite stimulants, clean nasal discharge, nebulize, & avoid antitussives in complicated cases

Question 39

what are the proposed benefits using antibiotics for a kennel cough patients?

Answer 39

may decreased symptomatic days & risk of secondary pneumonia - 10 day course of doxycycline, amoxicillin-clavulanate, trimethoprim-sulfa

Question 40

why should you avoid cough suppressants in pneumonia patients?

Answer 40

may impede airway clearance

Question 41

how is pneumonia treated?

Answer 41

if patient is stable - perform an airway wash for culture & susceptibility empirical antibiotics while results are pending - doxycycline & amoxicillin-clavulanate, & may require hospitalization

Question 42

T/F: glucocorticoids shorten the duration of clinical signs & bronchodilators improve clinical signs in patients with kennel cough

Answer 42

false

Question 43

how is kennel cough prevented?

Answer 43

vaccines!! IN vaccine with bordetella and/or CPiV given atleast 1 week prior to boarding & within 6 months of boarding

Question 44

why is the vaccine for canine influenza virus used?

Answer 44

killed vaccine used to reduce clinical signs & reduce viral shedding

Question 45

what is the series of canine influenza vaccines?

Answer 45

2-dose initial series & annual booster

Question 46

if there is an outbreak of kennel cough in your clinic, what should be your next steps?

Answer 46

admit only dogs that are up-to-date on vaccines isolate affected dogs immediately clean everything & ensure adequate ventilation ideally, close the population for 2 weeks treat animals symptomatically

Question 47

what is the minimum database for the coughing patient?

Answer 47

thoracic rads, heartworm test, & CBC

Question 48

what may coughing be mistaken for in dogs and cats?

Answer 48

dogs - owner may mistake cough as normal cats - hairballs

Question 49

what is coughing?

Answer 49

sudden expulsion of air, glottis is closed, & used to expel material from the airway

Question 50

what are some examples of differentials for a non-productive cough?

Answer 50

post-nasal drip, respiratory irritant, neoplasia, foreign body, pleural effusion

Question 51

what are some examples of differentials for a productive cough?

Answer 51

cardiogenic edema, non-cardiogenic edema, pneumonia

Question 52

what is hemoptysis?

Answer 52

coughing up blood

Question 53

what are some examples of differentials for hemoptysis?

Answer 53

heartworm disease, neoplasia, PTE, fungal disease, trauma, or systemic bleeding disorder

Question 54

tracheal collapse generally affects what animals?

Answer 54

small breed dogs

Question 55

when should antitussives be used?

Answer 55

for non-productive coughs to palliate & break the cough cycle

Question 56

what is the mechanism of action of opiods used as antitussives?

Answer 56

opiods act at peripheral receptors & centrally at the cough center

Question 57

what are 2 options of opioids that can be used for antitussives?

Answer 57

oral hydrocodone & oral butorphanol

Question 58

why would expectorants & mucolytics be used in the coughing patient?

Answer 58

loosen mucus congestion

Question 59

why should you not use acetylcysteine in cats?

Answer 59

causes bronchospasm

Question 60

why not used guaifenesin in cats?

Answer 60

some forms contain acetaminophen

Question 61

what are b1 & b2 receptors responsible for?

Answer 61

b1 - heart rate & strength of contraction b2 - bronchodilator

Question 62

what are the side effects associated with bronchodilators?

Answer 62

tachycardia, agitation, & gi upset

Question 63

what are some examples of b-receptor agonists used?

Answer 63

albuterol - oral or inhaled terbutaline - oral or injectable, selective B2

Question 64

what is the mechanism of action for theophylline extended-release? how does it help your patient

Answer 64

unknown - but may improve the strength of diaphragmatic contraction & respiratory muscle strength & improve mucociliary clearance

Question 65

what drug should be avoided when using theophylline extended release?

Answer 65

enrofloxacin

Question 66

T/F: theophylline can be used in both dogs & cats

Answer 66

false - only dogs

Question 67

what are some examples of corticosteroids & sedatives that can be used in coughing patients?

Answer 67

corticosteroids - injectable dexamethasone, oral pred, inhaled fluticasone, & temaril-p sedatives - trazodone, butorphanol, gabapentin

Question 68

how is a diagnosis of obstructive laryngitis made?

Answer 68

upper airway exam & laryngeal biopsy

Question 69

what is the prognosis for an uncomplicated case of kennel cough?

Answer 69

recovery within 2 weeks