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FA2 Respiratory > Lecture 28 11/19/24 > Flashcards

Lecture 28 11/19/24 Flashcards

1
Q

What are the differential diagnoses for parenchymal diseases?

A

-pneumonia
-pulmonary hemorrhage
-pulmonary edema
-neoplasia
-pulmonary thromboembolism

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2
Q

What are the characteristics of infectious pneumonia?

A

-lung inflammation caused by infection
-air sacs are inflamed and may fill with phlegm or pus
-infection can occur via airways, bloodstream, or secondary to trauma

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3
Q

What are the infectious etiologies for pneumonia?

A

-fungal
-bacterial/Rickettsial
-viral
-protozoal
-parasitic

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4
Q

Which fungal infections are most likely to lead to pneumonia?

A

-blastomycosis
-histoplasmosis
-coccidioidomycosis
-cryptococcosis

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5
Q

How are fungal infections/fungal pneumonia be transmitted?

A

-infection through inhalation
-infection established in lung and then disseminated throughout body via blood/lymph

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6
Q

What are the clinical findings in blastomycosis?

A

-loss of appetite
-weight loss
-fever
-possible cough
-respiratory abnormalities
-lymph node enlargement
-draining skin tracts
-lasts for days to months

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7
Q

What are the clinical findings in histoplasmosis?

A

-respiratory signs
-GI disease
-joint and/or bone infections

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8
Q

What are the clinical findings in coccidioidomycosis?

A

-asymptomatic or mild disease common
-acute/subchronic resp. disease
-fever
-weight loss
-skin, eye, bone, and pericardium infection
-latent infections that can reactivate

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9
Q

What are the clinical findings in cryptococcus?

A

-upper resp. signs
-pulmonary signs
-mediastinal lymphadenopathy
-pleural effusion
-CNS, eye, and skin infection

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10
Q

How are fungal infections diagnosed?

A

-history
-clinical signs/physical exam
-radiology
-cytology
-hematology
-serum chem
-serology
-culture

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11
Q

What are the characteristics of radiology for fungal infection diagnosis?

A

-blasto can cause many different radiographic patterns
-can see miliary/snowstorm pattern, granulomas, lymphadenomegaly, etc.

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12
Q

Which samples can be used for fungal diagnosis on cytology?

A

-fine needle aspirate of lymph nodes
-exudate from draining skin lesions
-TTW/ETW
-nasal exudate
-CSF
-anterior chamber aspirate
-rectal scraping

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13
Q

What are the characteristics of hematology for diagnosis of histoplasma?

A

-non-specific
-leukopenia
-thrombocytopenia
-anemia
-organisms in monocytes or neutrophils

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14
Q

What are the characteristics of serum chem. for diagnosis of blasto or histoplasma?

A

-increased polyclonal globulins
-decreased albumin
-potential for increased calcium

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15
Q

What are the characteristics of fungal culture?

A

-dangerous outside of specialized labs
-requires special media
-results take days to weeks

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16
Q

Which serology/urine tests are available for fungus?

A

-blasto: antibody; urine antigen
-histo: antibody; urine antigen
-coccidioides: antibody
-crypto: blood antigen

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17
Q

Which antifungals are used to treat fungal infections in dogs and cats?

A

-itraconazole
-fluconazole
-amphotericin B/itraconazole combo for severe cases

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18
Q

What are the characteristics of histo/blasto treatment?

A

-minimum of 6 months of antifungal treatment
-treat until resolution of clinical signs and diagnostic imaging abnormalities
-want a negative urine antigen test
-re-test animal 6 to 12 months are stopping therapy
-monitor anti-fungal drug levels during treatment

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19
Q

What are the characteristics of fungal infection prognosis?

A

-depends on disease severity, systemic signs, and owner willingness to treat/monitor
-resp signs may get worse before animal gets better on treatment
-severe cases may require corticosteroids and hospitalization

20
Q

What are the characteristics of systemic aspergillosis?

A

-GSDs at higher risk due to hereditary IgA deficiency/dysfunction
-guarded prognosis
-can also develop cavitary lung lesions, diskospondylitis, and osteomyelitis

21
Q

What are the characteristics of bacterial pneumonia?

A

-lungs are not sterile and can have bacteria when healthy
-bacteria can reach lung via inhalation, aspiration, opportunistic invasion, or bloodstream
-animal may have underlying cause/comorbidity

22
Q

What predisposes an animal to bacterial pneumonia development?

A

-other lung disease
-parasites
-aspiration of GI contents/aerodigestive disorder
-severe debilitation/recumbency/malnutrition
-sequela to trauma or surgery
-immunosuppression
-IV catheter sepsis/urinary catheter infection
-anatomic or functional abnormality

23
Q

What are the characteristics of bacterial pneumonia presentation?

A

-can range from subclinical to life-threatening
-acute and chronic presentations possible
-often presents with non-specific signs

24
Q

What are the common isolates from bacterial pneumonia?

A

-Strep. zooepidemicus
-E. coli
-Pasteurella
-Staph.
-Pseudomonas
-Enterococcus
-Mycoplasma
-Klebsiella

25
Q

What are the clinical signs of bacterial pneumonia?

A

-productive cough
-fever
-depression
-anorexia
-dyspnea/resp. distress
-nasal discharge

26
Q

What sounds heard on auscultation can be indicative of bacterial pneumonia?

A

-crackles
-increased breath sounds
-wheezes
-silent areas

27
Q

How is bacterial pneumonia diagnosed?

A

-history
-clinical signs/physical exam
-radiology
-bloodwork
-hematology
-serum chem.
-blood gas
-TTW/ETW

28
Q

Why is it beneficial to run a C reactive test during bloodwork?

A

-routine bloodwork can look completely normal in a bacterial pneumonia case
-C reactive protein is a positive acute phase protein in dogs that indicates inflammation

29
Q

What are the characteristics of radiology as a diagnostic tool for bacterial pneumonia?

A

-does not give definitive diagnosis
-can see a mixed interstitial or alveolar infiltrate pattern
-lobar consolidation
-want to look at hilar lymph nodes

30
Q

What are the characteristics of TTW/ETW as a diagnostic tool for bacterial pneumonia?

A

-done after radiographs to prevent fluid from interfering with imaging
-want to do before antibiotics when possible
-fluid used for cytology and culture
-want to run mycoplasma, aerobic, anaerobic, and fungal cultures

31
Q

What are the goals of treatment for bacterial pneumonia?

A

-eliminate bacteria
-eliminate lung inflammation
-treat/address predisposing factors
-treat patient aggressively

32
Q

What are the components of treatment for bacterial pneumonia?

A

-cage rest
-oxygen therapy
-nebulization
-turning of recumbent animals
-coupage
-hydration and nutrition
-antibiotics

33
Q

What are the characteristics of antibiotic treatment in bacterial pneumonia?

A

-begin with broad spectrum antibiotics
-base treatment of culture/sensitivity results
-antibiotics can be IV or oral
-want antibiotics that can cross blood-bronchus barrier

34
Q

What should be avoided in the treatment of bacterial pneumonia?

A

-corticosteroids
-diuretics
-cough suppressants

35
Q

Which values can be monitored to determine if a patient is responding to bacterial pneumonia treatment?

A

-temp.
-WBC count
-radiographs
-C reactive protein
-clinical signs/appetite

36
Q

What are the characteristics of bacterial pneumonia treatment?

A

-minimum duration of antibiotic treatment is 2 weeks
-animals should be re-evaluated 10-14 days after starting treatment
-further treatment is based on animal’s re-assessment and response

37
Q

What are the characteristics of surgery for treatment of bacterial pneumonia?

A

-best for foreign body-related pneumonia cases
-considered only after aggressive medical treatment is unsuccessful
-pulmonary lobectomy is performed

38
Q

What are the characteristics of aspiration pneumonia?

A

-occurs when foreign material is inspired into the lungs
-can be iatrogenic
-severity depends on frequency, volume, character of aspirate, pH of aspirate, and host immune response

39
Q

What are the underlying causes of aspiration pneumonia?

A

-cleft palate/anatomic abnormality
-abnormal consciousness
-neurologic disease
-severe debilitation
-megaesophagus
-vomiting; especially while muzzled

40
Q

Why is vomit especially bad for the lungs?

A

-contains gastric acid
-pH is less than 3.5
-often large volumes
-particles are present
-bacteria are present
-presence of food can exacerbate inflammation

41
Q

What is the pathophysiology of aspiration pneumonia?

A

phase 1: airway response
-immediate
-direct damage
-bronchoconstriction
-airway edema
phase 2: inflammatory response
-4 to 6 hrs after aspriatioin
-increased capillary permeability
-increased neutrophils
-pulmonary edema
phase 3: secondary bacterial infection
-does not occur in all cases

42
Q

What are the clinical signs of acute aspiration?

A

-cough
-dyspnea
-tachypnea
-cyanosis

43
Q

What are the clinical signs of chronic aspiration?

A

-cough
-anorexia
-depression
-weight loss

44
Q

What are the characteristics of aspiration pneumonia on radiographs?

A

-no immediate changes
-alveolar infiltrates seen 12-36 hours after aspiration event
-gravity will cause settlement in cranial ventral and right middle lung lobe areas

45
Q

What are the steps of aspiration pneumonia treatment?

A

-suction/establish airway
-provide O2
-hydration
-bronchodilators
-possible antibiotics

46
Q

What should be avoided in aspiration pneumonia treatment?

A

-corticosteroids
-lavage; pushes material deeper

FA2 Respiratory (33 decks)

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