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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
How is brachycephalic airway obstruction syndrome diagnosed?
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
How do you treat BOAS?
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
Why do you commonly see otitis with nasopharyngeal disorders?
Linked to middle ear via auditory tube
28
What is a nasopharyngeal polyp?
Fibromuscular connective tissue arising from musical lining of the nasopharynx
29
T/F: polyps are more common in dogs than in cats
False Cats more commonly
30
What are causes of nasopharyngeal polyps?
Cat: congenital defect, chronic inflammation, viral infection Dog: usually secondary to chronic inflammation/ rhinitis
31
How do animals with nasopharyngeal polyps present?
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
What areas of the respiratory system does sneezing and reverse sneezing localize respiratory diseases?
Sneezing (expiratory) —> nasal or sinus disease Reverse (inspiratory) —> nasopharyngeal, caudal nasal, or sinus disease
33
What is the treatment of nasal polyps?
Traction-avulsion +corticosteroid OR Ventral bulla osteotomy if bulla is involved
34
How do you diagnose a nasal polyp?
Tentative: General anesthesia, retract soft palate rostrally to visualize polyp Requires histopathology to definitively diagnose polyp vs neoplasia
35
Clinical signs usually seen with foreign body?
``` Reverse sneezing Pawing at face Excessive swallowing Gagging Dysphasia Coughing Nasal discharge Halitosis ```
36
How can you diagnose foreign bodies?
Radiographs—> radiopaque Direct visualization Endoscopy CT
37
What are causes of nasopharyngeal stenosis?
Regurgitation (esp under anesthesia) Chronic inflammation Post-surgical Trauma Congenital anomaly Mass
38
What is the treatment for nasopharyngeal stenosis ?
Balloon dilation most effective
39
What is the most common cause of fungal rhinitis in cats?
Cryptococcus Other possible: aspergillus and rhinosporidium
40
What is the signalment for feline fungal rhinitis?
Usually younger but can be any age
41
Clinical signs of feline fungal rhinitis?
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
What diagnostics do you do if you suspect a fungal rhinitis?
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
How can CT help differentiate between neoplasia and cryptococcus?
Neoplasia usually causes turbinate lysis/bony destruction, crypto does not
44
How do you treat cryptococcus??
``` 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
What are the adverse effects of fluconazole?
Inappetance | Hepatotoxicity
46
How do you treat aspergillus?
Oral posaconazole or itraconazole
47
What is the prognosis of fungal rhinitis?
Good if no CNS involvement Poor for sino-orbital aspergillus (more invasive and usually affects CNS)
48
What is the signalment for chronic rhinosinusitis?
Unknown - feline herpesvirus 1 has been implicated - may have some bacterial involvement
49
What is the signalment of chronic rhinosinusitis?
Cat Any age Sneezing and nasal discharge Nasal airflow is usually preserved
50
T/f: Chronic rhinosinusitis is a diagnosis of exclusion
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
What is the treatment of chronic rhinosinusitis ?
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
What are the common nasal tumor types?
``` Lymphoma Adenocarcinoma Squamous cell carcinoma a Undifferentiated carcinoma Fibrosarcoma ```
53
What is the most common cause of canine fungal rhinosinusitis?
Aspergillus
54
What is the signalment of nasal aspergillus in dogs?
Young to middle age | Dolichocephalic
55
Clinical signs of nasal aspergillosis in dog?
Nasal discharge Sneezing Facial pain, depigmentation, and ulceration may be present
56
How do you treat nasal aspergillosis in dogs?
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
What are suspected causes/contributing factors to idiopathic lymphoplasmic rhinitis?
Abberant immune response Inhaled allergen and irritant Hypersensitivity to native organisms
58
What is the signalment for idiopathic lymphoplasmic rhinitis ?
Young to middle aged dolichocephaic and mesaticephalic large breeds and dachshunds —> dachshunds commonly have dental disease, rule this out
59
What are clinical signs associated with idiopathic lymphosplama cystic rhinitis?
Uni or bilateral nasal discharge, mucoid/mucopurulent Epistaxis Excessive mucus/mucosal edema May obstruct airflow
60
What must you rule out to diagnose idiopathic lymphoplasmacytic rhinitis?
Fungal Neoplasia Chronic foreign body
61
What is the treatment of idiopathic lymphoplasmacytic rhinitis?
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
What is the prognosis of idiopathic lymphplasmacytic rhinitis?
Fair, cure rarely achieved Frustrating if discharge can not be controlled

RUSVM SAM 1 (26 decks)

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