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RUSVM SAM 1 > Laryngeal Paralsysis And Nasopharyngeal Disorders > Flashcards

Laryngeal Paralsysis And Nasopharyngeal Disorders Flashcards

1
Q

What is the normal function of the larynx ?

A

Regulate airflow
Project trachea from aspiration during swallowing
Control phonation

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2
Q

What nerve innervates all but 1 of the intrinsic laryngeal muscles. Where does it branch from?

A

Caudal laryngeal nerve, from the recurrent laryngeal, from the vagus

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3
Q

Contraction of what muscle results in the abduction of the arytenoid cartilages?

A

Cricoarytenoideus dorsalis muscle

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4
Q

What is the etiology of laryngeal paralysis?

A

Aqueduct in dogs- dysfunction of recurrent laryngeal nerve or intrinsic laryngeal muscle

Polyneuropathy

Polymyopathy
Trauma
Mass
Idiopathic

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5
Q

Geriatric onset of laryngeal paralysis-polyneuropathy is most common in what breed?

A

Labrador retrievers

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6
Q

Congenital LP has been reported in what breeds?

A

Bouviers does Flanders
Bull terriers
Huskies

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7
Q

What is the signalment for laryngeal paralysis?

A

Older and giant breeds

Labrador retrievers, golden retriever, St. Bernard, Newfoundland, Irish setter, Brittany spaniel

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8
Q

How do dogs with laryngeal paralysis present ?

A

Noisy inspiration
Exercise intolerance
Voice change
Coughing/gagging (low grade laryngospasm or tracheitis)

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9
Q

Signs of laryngeal paralysis are often exacerbated by what conditions?

A

Heat
Humidity
Exercise
Stress

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10
Q

Some dogs with laryngeal paralysis can also present with pelvic limb defects and esophageal dysfunction. What would be the cause ?

A

Polyneuropathy

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11
Q

T/F: stridor localizes a respiratory problem to the larynx or extrathoracic trachea

A

True

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12
Q

What causes stridor and when doe it occur?

A

Loud respiratory noise that occurs because airflow is obstructed

During inspiration

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13
Q

What diagnostics do you do on an old large breed dog presenting for noisy inspiration, exercise intolerance, and coughing/gaging ?

A

Neurological and orthopedic exam

Minimum database and thyroid testing

Thoracic radiographs —>evaluate for aspiration pneumonia, megaesophagus, cardiac disease, and lower airway disease

Definitive diagnosis of laryngeal paralysis requires laryngeal exam

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14
Q

T/F: dogs with severe laryngeal paralysis can develop non-cardiogenic pulmonary edema

A

True

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15
Q

What is the treatment for laryngeal paralysis?

A

If unilateral —> conservative treatment
-weight loss and lifestyle/environmental modifications

Bilateral with moderate to severe clinical signs —> surgical
-unilateral arytenoid lateralization

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16
Q

A dog comes into your clinic in severe respiratory distress due to laryngeal paralysis. What do you do?

A 
Supplemental O2 
Corticosteroid 
Sedation 
Minimize stress and handling 
Cooling if hyperthermia

Severe—> incubated and mechanically ventilate (may bee emergency surgery)

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17
Q

What is the cause of laryngeal paralysis in cats?

A

Neoplastic infiltration
Trauma
Iatrogenic (post-thyroidectomy)
Idiopathic

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18
Q

T/F: clinical signs can be severe in cats even with unilateral paralysis

A

True

Tiny cat, tiny trachea

Cats with laryngeal paralysis are managed like dogs

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19
Q

What are the primary defects in brachycephalic airway obstruction syndrome (BAOS)?

A

Stenotic nares
Elongated soft palate

Can also be present: narrowed nasal cavities, distorted turbinates, aberrant turbinates, macroglossia, thickened soft palate, redundant pharyngeal folds, tracheal hypoplasia

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20
Q

What defects can arise secondary to brachycephalic airway obstruction?

A

Exerted laryngeal ventricles (saccules)

Laryngeal collapse

Bronchial collapse

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21
Q

T/F: concurrent gastrointestinal diseases are common with brachycephalic airway obstruction syndrome

A

True

  • esophageal deviation
  • gastroesophageal reflux
  • gastric stasis
  • pyloric hypertrophy
  • inflammation
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22
Q

What is the pathophysiology of brachycephalic airway obstruction?

A

Narrowed and deformed airways result in increased resistance and turbulent airflow

—> neg inspiratory pressure draws tissues into airway lumen
—>create inflammation/swelling/edema

—>exacerbate airflow obstruction —> increased velocity and turbulent flow —> worsen swelling —> secondary changes

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23
Q

What is the signalment of BAOS?

A

Any brachycephalic cat or dog

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24
Q

How can patients with BAOS present?

A

Noisy breathing
Snoring
Gagging/coughing
Exercise/heat/stress intolerance

Stertor
Stridor

Inspiration dyspnea

Cyanosis, syncope, and death
Respiratory distress

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25
Q

How is brachycephalic airway obstruction syndrome diagnosed?

A

Stenotic nares on PE

Cervical and thoracic radiographs to evaluate tracheal, bronchopulmonay abnormalities, and hiatal hernia

Laryngeal exam for abnormalities of the oropharynx and larynx

Endoscopy or CT —> diagnose nasal, pharyngeal, largyneal, tracheal, bronchial abnormalities

26
Q

How do you treat BOAS?

A

Surgical correction

  • rhinoplasty
  • soft palate reception
  • laser-assisted tubinectomy
  • ventriculectomy

To avoid complications, surgery is indicate early in disease

Client education and environmental management —> avoid heat, humidity, strenuous exercise, over excitement, and stress

Treat GI disease if present

27
Q

Why do you commonly see otitis with nasopharyngeal disorders?

A

Linked to middle ear via auditory tube

28
Q

What is a nasopharyngeal polyp?

A

Fibromuscular connective tissue arising from musical lining of the nasopharynx

29
Q

T/F: polyps are more common in dogs than in cats

A

False

Cats more commonly

30
Q

What are causes of nasopharyngeal polyps?

A

Cat: congenital defect, chronic inflammation, viral infection

Dog: usually secondary to chronic inflammation/ rhinitis

31
Q

How do animals with nasopharyngeal polyps present?

A

Stertor (localized to upper airway)

May present in respiratory distress —> open mouth breathing and cheek puffing

Nasal discharge 
Excessive swallowing 
Gagging
Coughing 
Dysphasia 
Voice/phonation change

Reverse sneezing (dog)

32
Q

What areas of the respiratory system does sneezing and reverse sneezing localize respiratory diseases?

A

Sneezing (expiratory) —> nasal or sinus disease

Reverse (inspiratory) —> nasopharyngeal, caudal nasal, or sinus disease

33
Q

What is the treatment of nasal polyps?

A

Traction-avulsion +corticosteroid

OR

Ventral bulla osteotomy if bulla is involved

34
Q

How do you diagnose a nasal polyp?

A

Tentative: General anesthesia, retract soft palate rostrally to visualize polyp

Requires histopathology to definitively diagnose polyp vs neoplasia

35
Q

Clinical signs usually seen with foreign body?

A 
Reverse sneezing 
Pawing at face 
Excessive swallowing 
Gagging 
Dysphasia
Coughing 
Nasal discharge 
Halitosis
36
Q

How can you diagnose foreign bodies?

A

Radiographs—> radiopaque

Direct visualization
Endoscopy
CT

37
Q

What are causes of nasopharyngeal stenosis?

A

Regurgitation (esp under anesthesia)

Chronic inflammation

Post-surgical
Trauma
Congenital anomaly
Mass

38
Q

What is the treatment for nasopharyngeal stenosis ?

A

Balloon dilation most effective

39
Q

What is the most common cause of fungal rhinitis in cats?

A

Cryptococcus

Other possible: aspergillus and rhinosporidium

40
Q

What is the signalment for feline fungal rhinitis?

A

Usually younger but can be any age

41
Q

Clinical signs of feline fungal rhinitis?

A

Sneezing and nasal discharge (mucoid/purulent)

Polyploid masses in nares and ulcers/nodules on planum or bridge (crypto)

Mass causes—> decreased or absent nasal airflow, exopthalmos, facial asymmetry, stertor, mass/ulcer in pterygopalantine fossa

42
Q

What diagnostics do you do if you suspect a fungal rhinitis?

A

MDB

FeLV/FIV —> predisposing cause

Thoracic radiographs

Cytology and culture of nasal discharge 
Serology 
CT
Rhinoscopy with biopsy 
Dental probing—> periodontal disease/tooth root abcess
43
Q

How can CT help differentiate between neoplasia and cryptococcus?

A

Neoplasia usually causes turbinate lysis/bony destruction, crypto does not

44
Q

How do you treat cryptococcus??

A 
Ora fluconazole (or itraconazole—> more adverse effects) 
—> treat until antigen latex agglutination test is 0 and then recheck a month after treatment

Can debulk granuloma if severe

45
Q

What are the adverse effects of fluconazole?

A

Inappetance

Hepatotoxicity

46
Q

How do you treat aspergillus?

A

Oral posaconazole or itraconazole

47
Q

What is the prognosis of fungal rhinitis?

A

Good if no CNS involvement

Poor for sino-orbital aspergillus (more invasive and usually affects CNS)

48
Q

What is the signalment for chronic rhinosinusitis?

A

Unknown

  • feline herpesvirus 1 has been implicated
  • may have some bacterial involvement
49
Q

What is the signalment of chronic rhinosinusitis?

A

Cat
Any age
Sneezing and nasal discharge
Nasal airflow is usually preserved

50
Q

T/f: Chronic rhinosinusitis is a diagnosis of exclusion

A

True

MDB, FeLV/FIV, thoracic radiographs
CT: variable degree of turbinate lysis and increased fluid density
Laryngoscopes, rhinoscopy, and biopsy to rule out other causes
Dental probing to rule out dental disease

51
Q

What is the treatment of chronic rhinosinusitis ?

A

Antibiotic -choice based on culture or historical data (usually doxycyline)

Anti-inflammatory —> NSAID or glucocorticoids

Antiviral —> lysine or famciclovir

Treat nasal discharge—> nasal flush, humidification, N-acetylcystine

52
Q

What are the common nasal tumor types?

A 
Lymphoma 
Adenocarcinoma 
Squamous cell carcinoma a
Undifferentiated carcinoma 
Fibrosarcoma
53
Q

What is the most common cause of canine fungal rhinosinusitis?

A

Aspergillus

54
Q

What is the signalment of nasal aspergillus in dogs?

A

Young to middle age

Dolichocephalic

55
Q

Clinical signs of nasal aspergillosis in dog?

A

Nasal discharge
Sneezing
Facial pain, depigmentation, and ulceration may be present

56
Q

How do you treat nasal aspergillosis in dogs?

A

Topical infusion if cribriform plate is intact —> clotrimazole or enilconazole

Oral antifungal agent alone if cribriform plate is NOT intact —> itraconazole or terbinafine for 3-6months

57
Q

What are suspected causes/contributing factors to idiopathic lymphoplasmic rhinitis?

A

Abberant immune response

Inhaled allergen and irritant

Hypersensitivity to native organisms

58
Q

What is the signalment for idiopathic lymphoplasmic rhinitis ?

A

Young to middle aged dolichocephaic and mesaticephalic large breeds and dachshunds

—> dachshunds commonly have dental disease, rule this out

59
Q

What are clinical signs associated with idiopathic lymphosplama cystic rhinitis?

A

Uni or bilateral nasal discharge, mucoid/mucopurulent

Epistaxis
Excessive mucus/mucosal edema May obstruct airflow

60
Q

What must you rule out to diagnose idiopathic lymphoplasmacytic rhinitis?

A

Fungal
Neoplasia
Chronic foreign body

61
Q

What is the treatment of idiopathic lymphoplasmacytic rhinitis?

A

Avoidance of smoke and potential allergens

Long term antibiotic with immunomodulatory effects + NSAID
-doxycline and azithromycin + piroxicam

In refractory cases, itraconazole may be effective

62
Q

What is the prognosis of idiopathic lymphplasmacytic rhinitis?

A

Fair, cure rarely achieved

Frustrating if discharge can not be controlled

RUSVM SAM 1 (26 decks)

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