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SA DX & TX I > Exam 2 - Pulmonary Parenchymal Disease > Flashcards

Exam 2 - Pulmonary Parenchymal Disease Flashcards

1
Q

what are some differentials for canine eosinophilic airway/pulmonary disease?

A

allergic bronchitis/eosinophilic bronchopneumopathy

parasites/heartworms

fungal

rarely neoplasia

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2
Q

what are the anatomic components that are commonly affected in pulmonary parenchymal disease?

A

alveoli. interstitium, & sometimes pulmonary vasculature

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3
Q

what was eosinophilic bronchopneumopathy formerly called?

A

pulmonary infiltrate with eosinophils

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4
Q

what is included in the syndrome of idiopathic eosinophilic lung disease?

A

allergic bronchitis

eosinophilic bronchopneumopathy

eosinophilic granulomatosis - intraluminal mass lesions

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5
Q

what is the underlying cause of eosinophilic bronchopneumopathy?

A

unknown

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6
Q

how is eosinophilic bronchopneumopathy characterized?

A

eosinophilic infiltration of lung & bronchial mucosa

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7
Q

what are the common clinical signs associated with eosinophilic bronchopneumopathy?

A

cough, exercise intolerance, tachypnea, & dyspnea

less commonly - nasal discharge & systemic signs such as lethargy & inappetance

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8
Q

what may owners mistake eosinophilic bronchopneumopathy for?

A

gagging/retching problem

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9
Q

what dogs are typically affected by eosinophilic bronchopneumopathy?

A

wide age range, but often young adult dogs

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10
Q

are signs of eosinophilic bronchopneumopathy often progressive or static?

A

progressive

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11
Q

T/F: in animals with eosinophilic bronchopneumopathy, 50% of cases will have a peripheral eosinophilia

A

true

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12
Q

what may be seen on thoracic radiographs on a dog with suspected eosinophilic bronchopneumopathy?

A

bronchointerstitial pattern, diffuse interstitial pattern, patchy alveolar pattern, & rare nodular pattern

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13
Q

how is eosinophilic bronchopneumopathy diagnosed?

A

cytology & excluding other differentials

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14
Q

what may be heard on auscultation of a patient with suspected eosinophilic bronchopneumopathy?

A

normal or may have crackles

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15
Q

T/F: radiographic changes associated with eosinophilic bronchopneumopathy are often more severe in pattern when compared to chronic bronchitits

A

true

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16
Q

T/F: eosinophilic bronchopneumopathy is a diagnosis of exclusion

A

true

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17
Q

what diagnostics may be run when trying to rule out eosinophilic bronchopneumopathy?

A

fecal float, baermann test, culture of airway wash fluid, heartworm test, histoplasma antigen EIA test

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18
Q

what is the general treatment used when treating eosinophilic bronchopneumopathy?

A

prednisone 1mg/kg PO every 12 hours for 2 weeks then tapered off over 3 months

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19
Q

what medication is avoided when treating eosinophilic bronchopneumopathy?

A

cough suppressants

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20
Q

what is the prognosis of eosinophilic bronchopneumopathy dependent on?

A

severity of the disease

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21
Q

T/F: many patients with eosinophilic bronchopneumopathy may require lifelong therapy

A

true

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22
Q

what are 4 host defenses against bacterial pneumonia?

A
  1. nasoturbinate filtration
  2. protective airway reflexes (sneezing, coughing, bronchoconstriction)
  3. mucociliary clearance
  4. phagocytosis & killing by macrophages
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23
Q

what are some common causes of aspiration pneumonia?

A

vomiting, swallowing disorder, regurgitation, or iatrogenic causes

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24
Q

what are the main ways bacterial pneumonia occurs?

A

hematogenous or secondary

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25
Q

what are some rare funguses that can cause fungal pneumonia?

A

cryptococcus, aspergillus, & sporothrix

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26
Q

what are some common fungal causes of fungal pneumonia?

A

histo, blasto, & coccidioides

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27
Q

what is a causative organism of protozoal pneumonia?

A

toxoplasmosis

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28
Q

what are some organisms that commonly cause viral pneumonia?

A

kennel cough, distemper, FIP, & rare calicivirus

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29
Q

what are some organisms that commonly cause parasitic infections leading to pneumonia?

A

heart worms, lung worms, & aberrant migration

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30
Q

what is bacterial bronchitis?

A

infection is limited to airways & peribronchial tissues

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31
Q

what is bronchopneumonia?

A

infection of airways, peribronchial tissue, & lung

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32
Q

what is hematogenous pneumonia?

A

infection that spreads to the lungs via the bloodstream

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33
Q

what is aspiration pneumonia?

A

infectious and/or chemical pneumonia resulting from aspiration of material into the lungs

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34
Q

about 1/2 of the cases of bacterial pneumonia seen in puppies are caused by what agent? what other 2 agents are also common?

A

bordetella bronchiseptica

streptococcus species & mycoplasma

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35
Q

what are some examples of underlying causes of bacterial pneumonia?

A

kennel cough, bronchiectasis, foreign material, neoplasia, or ciliary dyskinesis

36
Q

what are the common clinical signs seen with bacterial pneumonia?

A

soft cough, purulent nasal discharge, tachypnea/dyspnea, crackles on auscultation, & sometimes fever

SIRS may occur

37
Q

what diagnostic test is commonly used when bacterial pneumonia is suspected?

A

transtracheal wash - run cytology

38
Q

what is the classic distribution of hematogenous pneumonia?

A

caudodorsal - increased blood flow to these lung lobes

39
Q

hematogenously-borne pneumonia typically involves what?

A

alveolar infiltrates

40
Q

what may be seen on cytology with a hematogenous pneumonia?

A

neutrophils, may be degenerate

bacteria found in <50% of samples

41
Q

what additional diagnostic should be run in suspected cases of hematogenous pneumonia?

A

culture & susceptibility testing

42
Q

what is the treatment used for hematogenous pneumonia?

A

supportive therapy based off of severity of symptoms, & antibiotics for 1-2 weeks beyond clinical & radiographic remission

43
Q

what are some common causes of bacterial pneumonia from immune dysfunction?

A

congenital immunodeficiency disorders

FeLV/FIV

primary ciliary dyskinesis

44
Q

what causes aspiration pneumonia?

A

inhalation of liquid or solid material into the lungs

45
Q

aspiration pneumonia may lead to what other 2 pneumonias?

A

bacterial and/or chemical

46
Q

why can aspirated gastric contents be problematic?

A

the acid causes tissue necrosis, edema, & hemorrhage

47
Q

what pattern is almost pathognomic for aspiration pneumonia?

A

cranioventral distribution

48
Q

T/F: bronchoconstriction can occur as a result of aspiration pneumonia

A

true

49
Q

what are the clinical signs associated with aspiration pneumonia?

A

acute severe signs

may be coughing/systemically sick

crackles may be heard upon auscultation

50
Q

how is aspiration pneumonia diagnosed?

A

usually presumptive based on radiographic changes

51
Q

when may radiographic changes be seen in patients with aspiration pneumonia?

A

24-48 hours after the event

52
Q

if the patient is stable, what diagnostic test may be used?

A

tracheal wash - help guide antibiotic therapy

53
Q

what should be apart of your evaluation when looking for a cause of aspiration pneumonia?

A

history of vomiting, seizures, regurgitation

neurological problems

esophagus problems

54
Q

T/F: bronchoscopy is used for diagnosing aspiration pneumonia

A

false - usually avoided

55
Q

what are some examples of a systemic neuromuscular disorders causing aspiration?

A

myasthenia gravis, polyneuropathy

56
Q

what are some examples of a iatrogenic mechanisms causing aspiration?

A

force-feeding or misplaced feeding tube

57
Q

what are some examples of decreased mentation causing aspiration?

A

post-anesthesia/sedation

post-seizure

CNS disease

metabolic disease

58
Q

what are some examples of oropharyngeal disorders causing aspiration?

A

cricopharyngeal dyssynchrony

pharyngeal mass

BOAS

59
Q

what are some examples of laryngeal disorders causing aspiration?

A

laryngeal paralysis & laryngoplasty

60
Q

what are some examples of esophageal disorders causing aspiration?

A

megaesophagus, dysmotility, & obstruction

61
Q

what is included in emergency management of a patient with aspiration pneumonia?

A

if under anesthesia - suction airway

oxygen supplementation, treat shock if present, & can try bronchodilators

62
Q

how are antibiotics used in treating aspiration pneumonia?

A

IV - immediately if severe respiratory distress or sepsis

IV fluids to maintain hydration - don’t over-hydrate patients, can cause pulmonary edema

nebulize & coupage, turn recumbent patients

63
Q

what medications should be avoided in aspiration pneumonia patients?

A

diuretics - would dry up lungs

cough suppressants - don’t want to suppress the patient’s ability to cough

64
Q

how is aspiration pneumonia monitored?

A

clinical status, radiographic improvement, recheck rads after 1 week, & treat for 1 week beyond radiographic/clinical resolution

65
Q

how is non-cardiogenic pulmonary edema determined to be non-cardiogenic?

A

physical exam, thoracic rads, & +/- echo

66
Q

what is the mechanism of non-cardiogenic pulmonary edema?

A

increased capillary permeability & changes in hydrostatic & oncotic pressure

67
Q

what are some underlying diseases associated with non-cardiogenic pulmonary edema?

A

post-seizures, head trauma, upper airway obstruction, near-drowning, electrocution, smoke inhalation, & pulmonary thromboembolisms

68
Q

what is acute respiratory distress syndrome?

A

form of non-cardiogenic pulmonary edema with a peracute onset that is associated with severe underlying inflammatory processes

69
Q

T/F: acute respiratory distress syndrome affects cats more than dogs

A

false - dogs more than cats

70
Q

what are the components involved in possible causes of SIRS?

A

sepsis, pneumonia, aspiration, pancreatitis, heatstroke, or multi-systemic trauma

71
Q

what is the diagnostic criteria for acute respiratory distress syndrome?

A

acute onset of <72 hours of tachypnea & labored breathing

known risk factors

evidence of pulmonary capillary leakage without increased pulmonary capillary pressure

evidence of hypoxemia

evidence of pulmonary inflammation - neutrophilic inflammation on airway wash

72
Q

what is the common pattern of non-cardiogenic pulmonary edema?

A

interstitial to alveolar lung pattern in caudodorsal lung fields

73
Q

T/F: neurogenic pulmonary edema occurs within minutes of the inciting incident

A

true

74
Q

how is acute respiratory distress syndrome managed?

A

treat underlying disorders, fluid therapy to avoid hypotension, oxygen therapy, early nutritional support, & mechanical ventilation

75
Q

what are the conditions that cause a hypercoagulable state?

A
  1. activation of vascular endothelium - vessel wall injury
  2. procoagulant states - hypercoagulability
  3. stasis of blood flow
76
Q

what diseases are associated with pulmonary thromboembolism?

A

PLN, HAC, IMHA, HW disease, sepsis, pancreatitis, SIRS, surgery, & neoplasia

77
Q

what is the mechanism of pulmonary thromboembolism?

A

occlusion of pulmonary vasculature by a clot

impairs oxygen transport from the lungs - ventilation perfusion mismatch

78
Q

how are pulmonary thromboembolisms diagnosed?

A

usually presumptive & difficult to confirm

79
Q

what clinical signs are associated with pulmonary thromboembolism?

A

acute onset of tachypnea/dyspnea, can develop cough/hemoptysis/cyanosis, or collapse, may hear crackles

hypoxemia seen on arterial blood gas & hyperventilation (low PaCO2)

80
Q

if you have a low d-dimers results, are you more or less likely to have a pulmonary thromboembolism?

A

less likely

81
Q

what is the test of choice for diagnosing pulmonary thromboembolism?

A

CT angiogram

82
Q

how is a patient with a suspected pulmonary thromboembolism managed?

A

supportive care, treating underlying condition, & inhibit further clot formation

83
Q

what platelet inhibitor can be used for treating PTE?

A

clopidogrel

84
Q

how to anticoagulant drugs work in treating PTE?

A

inactivate factors IIa & Xa by competing with antithrombin

85
Q

what is the most common cause of bacterial pneumonia?

A

aspiration

86
Q

neurogenic non-cardiogenic pulmonary edema most commonly occurs with what?

A

seizures, head trauma, upper airway obstruction, or electrocution

87
Q

what is it called when acute respiratory distress syndrome occurs as an adverse reaction to a blood transfusion?

A

tranfusion-related lung injury

SA DX & TX I (59 decks)

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