Lower Respiratory Tract Dz - Corrigan Flashcards
1
Q
Lower Resp Tract - Anatomical structures
A
- Trachea
- Bronchi
- Bronchioles
- Alveoli
- Interstitium
- Vasculature
2
Q
**What is the most common clinical sign of lower resp. dz? **
A
**Coughing **
3
Q
C/S of lower resp dz: Coughing + _______
A
- Resp distress
- Cyanosis
- Syncope
- Fever
- Anorexia
- Etc.
4
Q
Why is coughing generally important to the body?
A
Generally a protective mechanism
5
Q
What kind of descriptions should you obtain about a Pt’s cough?
A
- **Productive or Non-productive **
- **+ Hemoptysis **
- Inducible
- **Sound **
- Time of day
- After exercising
- While sleeping
6
Q
A 4 year old Pom. presents to your clinic for coughing. During your physical exam, you assign a BCS of 4.5/5 and you hear a goose honk cough. You are then able to induce the cough. Based on the information above, what is your primary rule-out?
A
Collapsing trachea
7
Q
A 2 year old mixed breed dog presents to your clinic for coughing.
During your PE, the P goes into a “coughing fit”, and it sounds harsh.
Based upon the given information, what is your primary rule out?
A
Bronchitis
(cough- harsh and paroxsymal)
8
Q
An 11 year old Golden Retriever present to your clinic for respiratory issues/coughing. During your PE, the cough is soft, moist.
Based on the information given, what are your primary rule-outs?
A
- Pneumonia
- Pulmonary edema
9
Q
With a productive cough, how can you classify the phlegm (what you cough up)?
A
- Edema
- Mucous or exudate
- Hemoptysis (bloody saliva)
10
Q
A patient presents with a productive cough → coughing up clear fluid.
What are your primary rule-outs?
A
Clear fluid = edema
- CHF
- Non-cardiogenic pulmonary edema
11
Q
A patient presents for a productive cough →coughing up mucous or exudative substance. What are some of your rule-outs?
A
**Mucous or exudate = infections, allergies, idiopathic **
- Canine infectious bronchitis
- Canine chronic bronchitis
- Idiopathic feline bronchitis
- Allergic bronchitis
- Bacterial bronchitis or pneumonia
- Parasitic infection
- Aspiration pneumonia
- Fungal pneumonia
12
Q
A patient presents with a productive cough with hemoptysis.
What are some of your rule outs?
A
- Heartworms
- Pulmonary neoplasia
- Fungal
- FB
- Severe CHF
- **TBE/thromboembolism **
- Torsions
- Bleeding disorders
- DIC
13
Q
An 8 year old Curr presents to your clinic for acute onset of dyspnea. Before you can get the oxygen ready for your patient, it suddenly drops dead.
What do you think might be the cause?
A
TBE/thromboembolism
14
Q
DDx for trachea and bronchi issues?
A
- K9 infectious tracheobronchitis/kennel cough
- K9 chronic bronchitis
- Collapsing trachea
- Feline bronchitis/asthma
- Bacterial and Mycoplasma infections
- *Oslerus osleri *
- Neoplasia
- Trauma/tracheal tears
15
Q
You take rads of a patient, and you notice that the bronchi appear compressed.
What can cause this?
A
- Left atrial enlargement
- Hilar lymphadenopathy
- Neoplasia
16
Q
Give examples of diseases that affect the Pulmonary Parenchyma.
A
- Infectious (viral, bact, fungal, parasitic, protozoal)
- Aspiration pneumonia
- Eosinophilic lung dz
- Idiopathic Interstial Pneumonias
- Neoplasia
- Contusions
- Pulmonary hypertension
- PTE/pulmonary thromboembolism
- Pulmonary edema
17
Q
You dx your patient with Infectious Parenchymal dz due to virus.
What viruses do you suspect?
A
- Canine influenza
- Canine distemper
- Calicivirus
- FIP
18
Q
How do you calculate the A-a gradient?
A
A-a gradient = PAO2 - PaO2
19
Q
How do you calculate PAO2?
A
PAO2= 150 mm Hg - PaCO2/0.8
20
Q
What are the agents responsible for Fungal Infectious Parenchymal dz?
A
- *Blastomycosis *
- Histoplasmosis
- *Coccidiomycosis *
21
Q
Calculate this Lab’s A-a gradient.
- PaO2 = 80 mm Hg
- PaCO2= 45 mm Hg
Is this normal?
A
A-a grad = PAO2 - PaO2
- PAO2= 150 mm Hg - Paco2/0.8
- = 150 - 45 mmHg/0.8= 93.75 mm Hg
- A-a gradient = PAO2 - Pao2
- 93.75 mm Hg - 80 mm Hg = 13.75 mm Hg
Yes!
(Normal < 15 mm Hg)
22
Q
Parasitic causes of Infectious Parenchymal dz.
A
- Heartworm
- Paragonimus
- *Aelurostrongylous *
- *Capillaria *
- Crenesoma
23
Q
Bacterial causes of Infectious Parenchymal dz.
A
- Any
- Mycoplasma
24
Q
Protozoal causes of infectious parenchymal dz
A
Toxoplasmosis
25
When a Pt presents for resp issues esp. lower resp., what should you observe?
* **Resting rate**
* **Pattern**
* Inspiratory effort
* Expiratory effort
* Abdominal component
* **Effort **
26
What are your diagnostics for Pt with Lower Resp. Tract issues?
* Observation
* Complete PE (MM, CRT)
* Careful auscultation
* CBC
* Anemia
* _+_ Inflammation
* _+_ Hypoxia
* Function
27
In a Pt with Lower Resp. Tract issues, what should you be looking for on their **CBC**?
* Anemia
* _+_ Inflammation
* _+_ Hypoxia
28
Calculate this Bulldog's A-a gradient.
P**_a_**O2 = 75 mm Hg
PaCO2 = 50 mm Hg
Is this animal Hypoxic?
1. P**A**O2= 150 mm Hg - PaCO2/0.8
* 150 mm Hg - (50 mm Hg/0.8)
* PAO2 = 87.5 mm Hg
2. **A-a gradient =** P**A**O2 - P**_a_**O2
* 87.5 mm Hg - 75 mm Hg = 12.5 mm Hg
No
29
**What should you remember when evaluating the CBC of a patient with pneumonia?**
**50% of pneumonias will have Neutrophilia + Left shift**
**..... and the other 50% won't**
30
What do you use to assess function in lower resp tract Pt?
* Pulse ox
* ABG
31
**What is this?**
**Describe what is happening?**
**(TQ)**
**_Oxygen Hemoglobin Dissociation Curve_**
* **Left shifted**
* **towards lungs → easier to upload O2**
* **Left shift near muscles → doesn't help you**
* **Right shifted**
* **towards muscles →easier to offload O2**
* **rt shift near lungs → doesn' t help you**
32
What is your minimum database for an animal has a **Chylothorax**?
* CBC/Chem
* UA
* HW test
33
What is the progression of DX steps for a **Chylothorax**,
after you have gotten your minimum database?
1. Cytology
2. U/S (prior to fluid removal if possible)
3. Thoracic Rads (after fluid removal)
4. Lymphangiography
34
**What does Arterial Blood Gas (ABG) allow you to calculate?**
**(TQ)**
**Allows you to calculate Aa-gradient → V/Q mismatch **
35
**What should you always do when you suspect a Chylothorax**?
**Compare tryglycerides in the fluid & serum!**
36
**What parameters do you measure in an ABG?**
* PaO2
* PaCO2
* HCO3
* pH
37
A 4 year old F/S Lab comes in to your clinic. Owner complains that she has been losing weight and won't eat. Yesterday she collapsed while on a hunting trip & was slow to recover. You percuss the chest & hear "thump". You perform and thoracocentisis & pull off this fluid.
What do you suspect it to be?
How would you TX this?
Pyothorax
1. Perform a Thoracotomy & lavage the thoracic cavity (want to get that stuff out)
2. Chest tube for continued drainage
3. **ABX (depending on culture)**
* Anaerobic bact → Potentiated penicillin or Clindamycin
* ***Nocardia* → Trimethoprim sulfa**
38
**What lung pattern is seen in the picture?**
**What can cause this pattern?**
**Bronchial Pattern - donuts and tram lines**
* Canine chronic bronchitis
* Feline bronchitis/asthma
* Allergic bronchitis
* Canine infectious tracheobronchitis
* Bacterial and mycoplasma infections
* Parasites
39
What diseases will commonly cause a **Non-Septic Exudate**?
* FIP
* Neoplasia
* Diaphragmatic hernia
* Lung lobe torsion
40
What conditions can commonly cause a **Hemorrhagic Effusion**?
* Trauma
* Bleeding disorders
* Neoplasia
* Lung lobe torsion
41
**What is the normal flow rate through the Tricuspid Valve on an Echocardiograph?**
**\< 2.7 m/sec**
42
**What is the normal flow rate through the Pulmonic Valve on an Echocardiograph?**
**\< 2 m/sec**
43
When a patient has **Pulmonary Hypertension**, which part of the heart experiences the largest increase in pressure?
Implications?
* Right Ventricle!
* Right sided HF is more common in patients with Pulmonary **Hyper**tension
44
How can a patient get Pulmonary Hypertension?
* Increased pulmonary blood flow
* Increased blood viscosity
* Increased pulmonary vascular resistance (PVR)
* Luminal narrowing
45
What are some reasons you can have increased Pulmonary Vascular Resistance?
* **Decreased drainage of the L heart (Increased afterload to the R heart)**
* Pulmonary thromboembolism
* HW dz.
* **Hyper**adrenocorticism
* IMHA
* Sepsis
* Neoplasia
* Nephrotic syndrome
* Pulmonary Heart Dz (Cor pulmonale)
* Chronic Upper Airway Dz
46
Anatomic reasons for Luminal Narrowing?
* Eisemenger's (congenital L→R shunt)
* HW dz.
* 1° Pulmonary Hypertension
47
What are the DI modalities that can be used to DX **PTE**?
* CT
* Angiography (CVMs & big referral clinics)
* Nuclear perfusion scanning
* PET scan
48
**List the top 3 most malignant 1° Pulmonary Neoplasias.**
1. Bronchoalveolar carcinomas
2. Adenocarcinomas
3. SCC
49
List 3 Neoplasias that are Mulitcentric.
* Lymphoma
* Dissesminated Histiocytic Sarcoma (Bernese Mtn. Dog)
* Mastocytoma
50
C/S of **Pulmonary Neoplasia**?
* Any to none
* Hemorrhage, edema, inflammation, infection, airway occlusion
* Any radiographic lung pattern
51
**What are the 2 types of cancer that you should always assume have metastasized once you DX them?**
* **Osteosarcoma**
* **Insulinoma**
52
Idiopathic Pulmonary Fibrosis is a DX of \_\_\_\_\_\_\_\_.
Who gets it?
* Exclusion
* Middle age to older cats & dogs (Westie)
53
Animals with Idiopathic Pulmonary Fibrosis typically have _______ & \_\_\_\_\_\_\_.
* Crackles
* Diffiuse interstitial radiographic pattern
54
What does **Idiopathic Pulmonary Fibrosis** look like on Histopath?
What other disease does it's histopathology resemble?
* Fibrosis, fibroblast proliferation, alveolar epithelial metaplasia, & inflammation
* Can appear similar to Carcinoma
55
What pattern is seen in the image?
What causes it?
Interstititial pattern
* Infections (viral, bacterial, toxoplasmosis, mycotic, parasitic)
* Neoplasia
* Eosinophilic lung dz
* Idiopathic pulmonary fibrosis
* Hemorrhage
56
What is a human drug that we use to TX Pulmonary Hypertension?
Viagra or Cialis
57
Why do we not give CATS Azathioprine (Imuran®)?
They are extremely sensitive to the side effect of BM suppression!
58
Types of interstitial patterns (2)
Nodular and Reticular
59
What pattern is seen below?
What causes it?
Alveolar lung pattern
* Pulmonary edema
* Sever inflammatory dz
* Bacterial pneumonia
* Aspiration pneumonia
* Hemorrhage
* Contussions
* PTE
* Neoplasia
* Fungal pneumonia
* Coagulopathy/DIC
60
Eosinophilic Lung Dz attacks what part of the respiratory system?
Airways & interstitium
61
What 3 drugs should you avoid using when TXing Pneumonia?
* Diuretics
* Cough suppresants
* Corticosteroids
62
Protocol for **Pneumonia** TX?
* O2
* Airway hydration (systemic fluids & nebulization)
* Broad spectrum ABXs (dead bugs don't mutate!)
* Physiotherapy
* Coupage
* Turn recumbent animals
* Bronchodilators
63
When is it definately time to do a BAL on an **Pneumonia** patient?
If it doesn't respond to ABX w/in 3 days!!!
64
**Ways you can get Aspiration Pneumonia?**
**TQ!!**
* Esophageal disorders
* Localized oropharyngeal abnormalities
* Systemic neuromuscular disorders
* Decreased mentation (GA!!)
* Iatrogenic
* force feeding & stomach tubes
65
C/S of **Bacterial Pneumonias**?
* Respiratory + Systemic signs
* Cough
* Nasal discharge
* Excercise intolerance
* Crackles
* Fever, depression, lethargy & wt. loss
66
How do you DX **Bacterial Pneumonia**?
* CBC
* Thoracic Rads
* BAL → cytology & culture
67
Predisposing Causes for **Bacterial Pneumonia**?
* Megaesophagus
* Aspiration
* Cleft palate
* Decreased clearance
* Ciliary dyskinesia
* Chronic bronchitis
* Bronchiectasis
* Immunosuppresions (animals on steroids)
* FeLV, FIV, CDV, influenza, fungal dz.
* FB
* Neoplasia
68
How do you go about DXing **Viral Pneumonia**?
* Rads → Bronchointerstitial to Alveloar pattern
* BAL or other wash technique
* Go looking for the cause
* Paired serology, ELISA, VI, PCR
69
Computeed Tomography/MRI is really helpful with seeing what in the lungs?
* Really nice for bullae and blebs
* \< 3 mm masses
70
Which conditions does fluoroscopy help you diagnose (lower resp tract)?
Dynamic tracheal collapse
Helps in placing stents as well
71
Why are some proposed reasons that a cat develops hyper-responsiveness to allergens & gets **Idiopathic Feline Bronchitis** (Asthma) ?
* Adrenergic/cholinergic imbalance
* Narrowing of the airways
* Abnormal mucus production
* Mucociliary apparatus dysfxn
* Mast cells & eosinophils
72
How can you collect pulmonary samples?
* transtracheal/endotracheal wash
* transthoracic aspiration/biopsy
* bronchoscopy
* thoracostomy/scopy
73
What is a concern you have when collecting pulmonary samples?
Contamination
(in general, mouth bugs are different from the bugs the bugs that live in throat)
74
Pulmonary diagnostics
* serology
* fecal exam
75
Which condition affecting the lung can you send off for a urine antigen serology test?
Blastomycosis
76
What is the doctor word for **Collapsing Trachea**?
Tracheobronchomalacia
77
Classic sign of Tracheobronchomalacia?
Inducible "goose honk" cough
78
Your patient suffers from **Extra-thoracic Tracheobronchomalacia**.
When is their trachea more likely to collapse?
During inspiration
79
You patient suffers from **Intra-thoracic Tracheobronchomalacia**.
When is their trachea more likely to collapse?
On expiration
80
You can perform serology for feline coronavirus +/- \_\_\_\_\_
PCR
(drawback = more expensive; advantage = more sensitive and specific)
81
What is the GS for DXing Tracheobronchomalacia?
Why?
* Endoscopy
* Only way to assign a "grade"
82
What is the common name for canine infectious tracheobronchitis?
Kennel cough
83
What does kennel cough cause?
Highly contagious, acute airway dz
84
Agents of kennel cough
* Canine adenovirus
* Parainfluenza virus
* Canine respiratory coronavirus
* *Bordetella bronchiseptica *
85
Tracheobronchomalacia is a _______ dz.
Medical therapy will result in \_\_\_\_\_% having resolution of signs for at least 1 yr.
* progressive
* 71%
86
Which patients benefit greatly from Cough Suppressants (Hydrocodone or Butorphanol)?
Patients w/ Tracheobronchomalacia
(they don't need to cough→ only hastens the progression of the dz.
87
An client comes in after their vacation. They bored their 2 yr old German Shorthaired Pointer while they were gone. They noticed that since they have been back, he has had a non-productive cough that worsens when he get excited. What is your primary rule out based on the information?
Kennel Cough/Canine Infectious Tracheobronchitis
88
Your fancy client read about using Self-expanding Stents to treat Collapsing Tracheas on the internet.
She wants you to perform this on her 5 year old F/S Pekinese, Pookie!
You perform a bronchoscopy and determine that the dog's main stem bronchus has collapsed.
What do you tell her when you go back into the room?
Stents are very expensive and are likely not going to help Pookie b/c she has main stem bronchus collapse.
89
How would you treat a P with kennel cough?
* Rest
* +/- cough suppressants --\> not if productive and only give at night
* Antibiotics --\> only if you know you have a 2 º bacterial infection
90
Name some cough suppressants you can use
* Dextromethorphan
* Butorphanol
* Hydrocodone
91
How do you make a diagnosis of Chronic Canine Bronchitis
* Frequent cough \>2 m
* Abscence of other dz
* BAL to rule everything else out
DIAGNOSIS OF EXCLUSION!!!!!!
92
A 9 yr old cocker spaniel presents with a loud harsh cough. The clients say the cough has been ongoing for a couple of months. Looking at the dogs records from another clinic, the dog was prescribed a cough suppressant 2.5 m ago. The rest of your PE is within normal limits. Based on the info given, what is your primary rule out?
Canine Chronic Bronchitis
93
How will the sympathetic NS relax a part of the body?
does it through an Beta 2 receptor
94
What does the **PNS** (via **Cholinergic** receptors) control in the airways?
* Glandular secretion
* Contraction of bronchiolar musculature
* Increased mucus production
* Vasodilation
95
What is the *Sympathetic* NS (via *Adrenergic* receptors) responsible for in the airways?
Activation causes bronchial relaxation & decreased mucus production (via Beta 2)
96
What are concurrent dzs that may be seen with canine chronic bronchitis?
* Bronchial compression
* Mitral endocardiosis
* Collapsing trachea
* CHF
97
List 4 complications associated w/ **K9 Chronic Bronchitis**.
* Tracheobronchomalacia
* Pulmonary hypertension
* Bact/*Mycoplasma* infection
* Brochiectasis
98
What can predispose a dog to canine chronic bronchitis?
* 2º infection
* Pulmonary hypertension
* Bronchiectasis →dilated = pulled apart → won't be able to oxygenate as efficiently
99
What lower respiratory issue can long term irritation lead to?
Canine chronic bronchitis
100
Treatment of canine chronic bronchitis
* Symptomatically
* Bronchodilators
* Glucocorticoids
* Cough Suppressants
101
You perform a bronchoscopy on a middle aged Cocker Spaniel with a consistent, chronic cough.
You see this.
What do you think, Doc?
How do you want to TX?
K9 Chronic Bronchitis
TX:
* Symptomatically
* HYDRATE!!!
* Nebulize w/ Gentamycin
* No diuretics
* Wt loss!
* Dental care
* Bronchodilators
* Glucocorticoids
* Cough Suppressants
102
**What kind of bronchodilators do you want to use to TX K9 Chronic Bronchitis?**
* **Methyxanthines** (-phylline)
* Theophylline
* Aminophylline
* **Sympathomimetics (Beta 2 agonists)**
* Terbutaline
* Albuterol
