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Cardiopulmonary (Estrada-Fall 2014) > Lecture 14: Diagnostic Procedures for Resp. Problems (Specht) > Flashcards

Lecture 14: Diagnostic Procedures for Resp. Problems (Specht) Flashcards

1
Q

diagnostic plan based on:

A

problem list and differential dx

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2
Q

diagnostic plan factors

A
  • goal
  • probabilities of differentials
  • sensitivtiy and specificity
  • expense, invasiveness, risk
  • significance of problem/usefulness of info
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3
Q

minimum data base is likely/unlikely to provide dx

A

unlikely. (i.e. chem, cbc, urinalysis)

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4
Q

how should cats be tested for HW?

A

Ag and Ab tests

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5
Q

T/F: any chronic coughing p should be tested for HW*

A

T

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6
Q

have infections with FelV/FIV been directly linked to resp CS?*

A

NO (they cause immunosuppression/opportunistic infection)

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7
Q

run fecal with p with chronic cough? why?*

A

Yes. multiple parasites cause cough. Use float/Baermann

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8
Q

Baermann test

A

incubate feces and let larval stage hatch then look for live larvae

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9
Q

types of infectious disease testing

A
  • serology
  • PCR
  • isolation
  • culture, etc.
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10
Q

3 ways to evaluate blood gas

A
  • pulse oximetry
  • arterial blood gas (ABG)
  • capnography
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11
Q

advantage/disadvantage of blood gas evaluation

A

advantages:
-help determine severity
-differentiate pulmonary dz from hypoventilation
-monitor response to tx
disadvantage:
-not very specific - resp. compromise must be severe to detect abnormalities

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12
Q

pulse oximetry

A

device on tongue to measure SATURATION (not total content) of oxygen in the red cells

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13
Q

ABG

A

collect blood from artery and look at dissolved conc. of oxygen and CO2 to tell how resp. system is functioning

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14
Q

capnography

A

tells you how much CO2 is getting OUT of the system

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15
Q

steps of evaluating blood gas

A

1) confirm test accuracy

2) identify abnormalities and interpret in context of case

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16
Q

FiO2:PaO2 ratio

A

percentage of oxygen patient is breathing compared to percent of oxygen in patient’s blood (simple and helpful way to tell you if patient’s resp. system is working well)

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17
Q

Hgb dissociation curve

A

Plots PaO2 vs. SaO2. sigmoid shape w/ plateau at higher PaO2. When PaO2 is w/n normal range, Hg completely saturated. PaO2 should be 84 or higher.

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18
Q

rads don’t usually provide specific dx

A

T

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19
Q

nasal rads insensitive for most nasal dz

A

:)

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20
Q

dental rads can dx:

A

tooth root abcess, oronasal fistula

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21
Q

what kind of rad accentuates pulmonary vessels?

A

D/V

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22
Q

what kind of rads if collapsing airway suspected?

A

inspiratory/expiratory

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23
Q

basic pulmonary patterns (5)

A
  • alveolar (fluid/tissue w/n alveolar spaces)
  • interstitial (inc. tissue in interstitium)
  • bronchial (obvious bronchial markings such as donuts)
  • nodular
  • pleural space
24
Q

when do cervical rads?

A

laryngeal or tracheal dz suspected

25
Q

when do fluoroscopy?

A

identify dynamic collapse

26
Q

when do angiography?

A

help identify PTE or other problems related to lung perfusion. Involves contrast injections

27
Q

when do scintigraphy?

A

to assess ventilation and perfusion. radioactive material put into veins and airways to see if they match up.

28
Q

CT =

A

computed tomography

29
Q

disadvantages of CT/MRI

A
  • expensive
  • can’t get dx
  • requires general anesthesia
  • limited availability
30
Q

advantages/disadvantages of oropharyngeal exam

A

advantages:
-can identify CS localized to upper resp. tract
-identify palatal problems, oropharyngeal masses, dental or periodontal disease, etc.
disadvantage:
-requires anesthesia

31
Q

ad/disad. of nasal cytology

A 
ad:
-easy
-may be helpful for fungal rhinitis or neoplasia
disad:
-usually of little or no benefit
32
Q

are bacteria normal in nasal cytology?

A

yes

33
Q

3 types of nasal cytology

A

1) FNA/impression smear of mass
2) FNA of regional lymph nodes
3) nasal flush samples

34
Q

rhinoscopy def. and uses

A 
direct visualization of nasal cavity using tube or otoscope. Use for:
-suspect foreign bodies
-nasopharyngeal dz
-facilitate sample collection
\+/- neoplasia, infections
35
Q

disad. of rhinoscopy

A
  • gen. anesthesia
  • bleeding
  • don’t perform before rads/CT/MRI
  • can’t provide dx except for foregin bodies and nasal mites
36
Q

best test to get a specific dx for most primary nasal diseases*

A

nasal biopsy

37
Q

advantages/disad. of nasal biopsy

A 
Ad:
-specific dx*
-little equip. needed
-reasonable cost
Disad:
-gen. anesthesia
-invasive, bleeding
-could biopsy brain
38
Q

if no distinct lesion identified prior to nasal biopsy, what should you biopsy?

A

take multiple biopsies from various areas

39
Q

what to look for in nasal culture

A

VERY HIGH colony counts or SINGLE ISOLATES assoc. with neutrophilic inflamm.
-normal individuals yield multiple bacterial isolates and deep cultures may be positive in 50% of normal dogs

40
Q

nasal virus usually minimally or non-responsive to tx

A

:)

41
Q

bronchoscopy def. and ad/disad:

A 
direct visualization of airway interiors
ad: 
-facilitates sample collection from lower RT
-allows you to look at dynamic change, such as during different phases of breathing
disad:
-gen. anesthesia
-equipment/skills
-still just a pic
42
Q

tracheal washing def and ad/disad.:

A

sample of fluid and cells from large airways
ad:
-useful for large airway and severe diffuse alveolar dz
disad:
-limited use in interstitial or focal disease

43
Q

2 methods of tracheal washing

A

1) transtracheal wash (saline inserted and withdrawn from trachea through catheter; can do awake)
2) endotracheal lavage (incision b/w tracheal rings, saline in catheter and withdrawn; requires anesthesia)

44
Q

bronchoalveolar lavage

A

sample take from small airways and alveoli either by bronchoscopy-guided or endotracheal lavage

45
Q

only procedure that doesn’t involve anesthesia

A

TTW

46
Q

disad. of TTW and BAL

A
  • transient hypoxemia
  • crackles
  • specimens degrade quickly
47
Q

what type of cells should predominate in normal TW/BAL cytology?

A

large mononuclear cells

abnormalities inlcude increased neuts, eos, parasite ova, larvae, fungus, neoplastic cells

48
Q

T/F: funus is ALWAYS abnormal in the lung

A

T

49
Q

T/F: mycoplasma is ALWAYS abnormal in the lung

A

F. can be normal or abnormal

50
Q

what type of bacteria predominate in airway isolates?

A

aerobes (anaerobes found very infrequently)

51
Q

trans-thoracic aspiration indications

A

used for cytology and/or culture. Best in patients with solitary lung mass, or diffuse dz. Best to do when mass lies close to chest wall. Complications common and potentially serious.

52
Q

Thoracocentesis

A
  • useful dx and THERAPEUTIC technique*

- removes fluid/air from thorax

53
Q

reasons for negative tap

A
  • no fluid/air present
  • fluid deeper than needle
  • fluid walled-off, or on contralateral side of chest
  • fluid very thick
  • most commonly, animal is fat and you aren’t in the pleural space
54
Q

how is thoracocentesis fluid analyzed?

A

cytologically

  • gives info on protein lvls, cell counts/morphology, etc.
  • may be able to dx neoplasia or infection*
55
Q

intra-thoracic biopsy ad./disad.

A 
ad:
-may be necessary for definitive dx*
-can be therapeutic and diagnostic
disad:
-invasive
-costly
56
Q

2 main methods of intra-thoracic biopsy

A

thoracoscopy

thoracotomy

Cardiopulmonary (Estrada-Fall 2014) (9 decks)

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