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Small Animal Med. I > Lower Respiratory Tract Dz - Corrigan > Flashcards

Lower Respiratory Tract Dz - Corrigan Flashcards

1
Q

Lower Resp Tract - Anatomical structures

A
  • Trachea
  • Bronchi
  • Bronchioles
  • Alveoli
  • Interstitium
  • Vasculature
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2
Q

**What is the most common clinical sign of lower resp. dz? **

A

**Coughing **

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3
Q

C/S of lower resp dz: Coughing + _______

A
  • Resp distress
  • Cyanosis
  • Syncope
  • Fever
  • Anorexia
  • Etc.
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4
Q

Why is coughing generally important to the body?

A

Generally a protective mechanism

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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
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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

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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)

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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
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9
Q

With a productive cough, how can you classify the phlegm (what you cough up)?

A
  • Edema
  • Mucous or exudate
  • Hemoptysis (bloody saliva)
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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
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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
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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
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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

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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
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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
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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
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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
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18
Q

How do you calculate the A-a gradient?

A

A-a gradient = PAO2 - PaO2

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19
Q

How do you calculate PAO2?

A

PAO2= 150 mm Hg - PaCO2/0.8

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20
Q

What are the agents responsible for Fungal Infectious Parenchymal dz?

A
  • *Blastomycosis *
  • Histoplasmosis
  • *Coccidiomycosis *
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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

  1. PAO2= 150 mm Hg - Paco2/0.8
    • = 150 - 45 mmHg/0.8= 93.75 mm Hg
  2. A-a gradient = PAO2 - Pao2
    • 93.75 mm Hg - 80 mm Hg = 13.75 mm Hg

Yes!

(Normal < 15 mm Hg)

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22
Q

Parasitic causes of Infectious Parenchymal dz.

A
  • Heartworm
  • Paragonimus
  • *Aelurostrongylous *
  • *Capillaria *
  • Crenesoma
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23
Q

Bacterial causes of Infectious Parenchymal dz.

A
  • Any
  • Mycoplasma
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24
Q

Protozoal causes of infectious parenchymal dz

A

Toxoplasmosis

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25
Q

When a Pt presents for resp issues esp. lower resp., what should you observe?

A
  • Resting rate
  • Pattern
    • Inspiratory effort
    • Expiratory effort
    • Abdominal component
  • **Effort **
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26
Q

What are your diagnostics for Pt with Lower Resp. Tract issues?

A
  • Observation
  • Complete PE (MM, CRT)
  • Careful auscultation
  • CBC
    • Anemia
    • + Inflammation
    • + Hypoxia
  • Function
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27
Q

In a Pt with Lower Resp. Tract issues, what should you be looking for on their CBC?

A
  • Anemia
  • + Inflammation
  • + Hypoxia
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28
Q

Calculate this Bulldog’s A-a gradient.

PaO2 = 75 mm Hg

PaCO2 = 50 mm Hg

Is this animal Hypoxic?

A
  1. PAO2= 150 mm Hg - PaCO2/0.8
    • 150 mm Hg - (50 mm Hg/0.8)
    • PAO2 = 87.5 mm Hg
  2. A-a gradient = PAO2 - PaO2
    • 87.5 mm Hg - 75 mm Hg = 12.5 mm Hg

No

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29
Q

What should you remember when evaluating the CBC of a patient with pneumonia?

A

50% of pneumonias will have Neutrophilia + Left shift

….. and the other 50% won’t

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30
Q

What do you use to assess function in lower resp tract Pt?

A
  • Pulse ox
  • ABG
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31
Q

What is this?

Describe what is happening?

(TQ)

A

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
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32
Q

What is your minimum database for an animal has a Chylothorax?

A
  • CBC/Chem
  • UA
  • HW test
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33
Q

What is the progression of DX steps for a Chylothorax,

after you have gotten your minimum database?

A
  1. Cytology
  2. U/S (prior to fluid removal if possible)
  3. Thoracic Rads (after fluid removal)
  4. Lymphangiography
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34
Q

What does Arterial Blood Gas (ABG) allow you to calculate?

(TQ)

A

**Allows you to calculate Aa-gradient → V/Q mismatch **

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35
Q

What should you always do when you suspect a Chylothorax?

A

Compare tryglycerides in the fluid & serum!

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36
Q

What parameters do you measure in an ABG?

A
  • PaO2
  • PaCO2
  • HCO3
  • pH
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37
Q

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?

A

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
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38
Q

What lung pattern is seen in the picture?

What can cause this pattern?

A

Bronchial Pattern - donuts and tram lines

  • Canine chronic bronchitis
  • Feline bronchitis/asthma
  • Allergic bronchitis
  • Canine infectious tracheobronchitis
  • Bacterial and mycoplasma infections
  • Parasites
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39
Q

What diseases will commonly cause a Non-Septic Exudate?

A
  • FIP
  • Neoplasia
  • Diaphragmatic hernia
  • Lung lobe torsion
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40
Q

What conditions can commonly cause a Hemorrhagic Effusion?

A
  • Trauma
  • Bleeding disorders
  • Neoplasia
  • Lung lobe torsion
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41
Q

What is the normal flow rate through the Tricuspid Valve on an Echocardiograph?

A

< 2.7 m/sec

42
Q

What is the normal flow rate through the Pulmonic Valve on an Echocardiograph?

A

< 2 m/sec

43
Q

When a patient has Pulmonary Hypertension, which part of the heart experiences the largest increase in pressure?

Implications?

A
  • Right Ventricle!
  • Right sided HF is more common in patients with Pulmonary Hypertension
44
Q

How can a patient get Pulmonary Hypertension?

A
  • Increased pulmonary blood flow
  • Increased blood viscosity
  • Increased pulmonary vascular resistance (PVR)
  • Luminal narrowing
45
Q

What are some reasons you can have increased Pulmonary Vascular Resistance?

A
  • Decreased drainage of the L heart (Increased afterload to the R heart)
  • Pulmonary thromboembolism
  • HW dz.
  • Hyperadrenocorticism
  • IMHA
  • Sepsis
  • Neoplasia
  • Nephrotic syndrome
  • Pulmonary Heart Dz (Cor pulmonale)
  • Chronic Upper Airway Dz
46
Q

Anatomic reasons for Luminal Narrowing?

A
  • Eisemenger’s (congenital L→R shunt)
  • HW dz.
  • 1° Pulmonary Hypertension
47
Q

What are the DI modalities that can be used to DX PTE?

A
  • CT
  • Angiography (CVMs & big referral clinics)
  • Nuclear perfusion scanning
  • PET scan
48
Q

List the top 3 most malignant 1° Pulmonary Neoplasias.

A
  1. Bronchoalveolar carcinomas
  2. Adenocarcinomas
  3. SCC
49
Q

List 3 Neoplasias that are Mulitcentric.

A
  • Lymphoma
  • Dissesminated Histiocytic Sarcoma (Bernese Mtn. Dog)
  • Mastocytoma
50
Q

C/S of Pulmonary Neoplasia?

A
  • Any to none
  • Hemorrhage, edema, inflammation, infection, airway occlusion
  • Any radiographic lung pattern
51
Q

What are the 2 types of cancer that you should always assume have metastasized once you DX them?

A
  • Osteosarcoma
  • Insulinoma
52
Q

Idiopathic Pulmonary Fibrosis is a DX of ________.

Who gets it?

A
  • Exclusion
  • Middle age to older cats & dogs (Westie)
53
Q

Animals with Idiopathic Pulmonary Fibrosis typically have _______ & _______.

A
  • Crackles
  • Diffiuse interstitial radiographic pattern
54
Q

What does Idiopathic Pulmonary Fibrosis look like on Histopath?

What other disease does it’s histopathology resemble?

A
  • Fibrosis, fibroblast proliferation, alveolar epithelial metaplasia, & inflammation
  • Can appear similar to Carcinoma
55
Q

What pattern is seen in the image?

What causes it?

A

Interstititial pattern

  • Infections (viral, bacterial, toxoplasmosis, mycotic, parasitic)
  • Neoplasia
  • Eosinophilic lung dz
  • Idiopathic pulmonary fibrosis
  • Hemorrhage
56
Q

What is a human drug that we use to TX Pulmonary Hypertension?

A

Viagra or Cialis

57
Q

Why do we not give CATS Azathioprine (Imuran®)?

A

They are extremely sensitive to the side effect of BM suppression!

58
Q

Types of interstitial patterns (2)

A

Nodular and Reticular

59
Q

What pattern is seen below?

What causes it?

A

Alveolar lung pattern

  • Pulmonary edema
  • Sever inflammatory dz
    • Bacterial pneumonia
    • Aspiration pneumonia
  • Hemorrhage
    • Contussions
    • PTE
    • Neoplasia
    • Fungal pneumonia
    • Coagulopathy/DIC
60
Q

Eosinophilic Lung Dz attacks what part of the respiratory system?

A

Airways & interstitium

61
Q

What 3 drugs should you avoid using when TXing Pneumonia?

A
  • Diuretics
  • Cough suppresants
  • Corticosteroids
62
Q

Protocol for Pneumonia TX?

A
  • O2
  • Airway hydration (systemic fluids & nebulization)
  • Broad spectrum ABXs (dead bugs don’t mutate!)
  • Physiotherapy
    • Coupage
    • Turn recumbent animals
  • Bronchodilators
63
Q

When is it definately time to do a BAL on an Pneumonia patient?

A

If it doesn’t respond to ABX w/in 3 days!!!

64
Q

Ways you can get Aspiration Pneumonia?

TQ!!

A
  • Esophageal disorders
  • Localized oropharyngeal abnormalities
  • Systemic neuromuscular disorders
  • Decreased mentation (GA!!)
  • Iatrogenic
    • force feeding & stomach tubes
65
Q

C/S of Bacterial Pneumonias?

A
  • Respiratory + Systemic signs
    • Cough
    • Nasal discharge
    • Excercise intolerance
    • Crackles
    • Fever, depression, lethargy & wt. loss
66
Q

How do you DX Bacterial Pneumonia?

A
  • CBC
  • Thoracic Rads
  • BAL → cytology & culture
67
Q

Predisposing Causes for Bacterial Pneumonia?

A
  • Megaesophagus
  • Aspiration
  • Cleft palate
  • Decreased clearance
    • Ciliary dyskinesia
    • Chronic bronchitis
    • Bronchiectasis
  • Immunosuppresions (animals on steroids)
  • FeLV, FIV, CDV, influenza, fungal dz.
  • FB
  • Neoplasia
68
Q

How do you go about DXing Viral Pneumonia?

A
  • Rads → Bronchointerstitial to Alveloar pattern
  • BAL or other wash technique
  • Go looking for the cause
    • Paired serology, ELISA, VI, PCR
69
Q

Computeed Tomography/MRI is really helpful with seeing what in the lungs?

A
  • ​Really nice for bullae and blebs
  • < 3 mm masses
70
Q

Which conditions does fluoroscopy help you diagnose (lower resp tract)?

A

Dynamic tracheal collapse

Helps in placing stents as well

71
Q

Why are some proposed reasons that a cat develops hyper-responsiveness to allergens & gets Idiopathic Feline Bronchitis (Asthma) ?

A
  • Adrenergic/cholinergic imbalance
  • Narrowing of the airways
  • Abnormal mucus production
  • Mucociliary apparatus dysfxn
  • Mast cells & eosinophils
72
Q

How can you collect pulmonary samples?

A
  • transtracheal/endotracheal wash
  • transthoracic aspiration/biopsy
  • bronchoscopy
  • thoracostomy/scopy
73
Q

What is a concern you have when collecting pulmonary samples?

A

Contamination

(in general, mouth bugs are different from the bugs the bugs that live in throat)

74
Q

Pulmonary diagnostics

A
  • ​serology
  • fecal exam
75
Q

Which condition affecting the lung can you send off for a urine antigen serology test?

A

Blastomycosis

76
Q

What is the doctor word for Collapsing Trachea?

A

Tracheobronchomalacia

77
Q

Classic sign of Tracheobronchomalacia?

A

Inducible “goose honk” cough

78
Q

Your patient suffers from Extra-thoracic Tracheobronchomalacia.

When is their trachea more likely to collapse?

A

During inspiration

79
Q

You patient suffers from Intra-thoracic Tracheobronchomalacia.

When is their trachea more likely to collapse?

A

On expiration

80
Q

You can perform serology for feline coronavirus +/- _____

A

PCR

(drawback = more expensive; advantage = more sensitive and specific)

81
Q

What is the GS for DXing Tracheobronchomalacia?

Why?

A
  • Endoscopy
  • Only way to assign a “grade”
82
Q

What is the common name for canine infectious tracheobronchitis?

A

Kennel cough

83
Q

What does kennel cough cause?

A

Highly contagious, acute airway dz

84
Q

Agents of kennel cough

A
  • Canine adenovirus
  • Parainfluenza virus
  • Canine respiratory coronavirus
  • *Bordetella bronchiseptica *
85
Q

Tracheobronchomalacia is a _______ dz.

Medical therapy will result in _____% having resolution of signs for at least 1 yr.

A
  • progressive
  • 71%
86
Q

Which patients benefit greatly from Cough Suppressants (Hydrocodone or Butorphanol)?

A

Patients w/ Tracheobronchomalacia

(they don’t need to cough→ only hastens the progression of the dz.

87
Q

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?

A

Kennel Cough/Canine Infectious Tracheobronchitis

88
Q

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?

A

Stents are very expensive and are likely not going to help Pookie b/c she has main stem bronchus collapse.

89
Q

How would you treat a P with kennel cough?

A
  • Rest
  • +/- cough suppressants –> not if productive and only give at night
  • Antibiotics –> only if you know you have a 2 º bacterial infection
90
Q

Name some cough suppressants you can use

A
  • Dextromethorphan
  • Butorphanol
  • Hydrocodone
91
Q

How do you make a diagnosis of Chronic Canine Bronchitis

A
  • Frequent cough >2 m
  • Abscence of other dz
  • BAL to rule everything else out

DIAGNOSIS OF EXCLUSION!!!!!!

92
Q

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?

A

Canine Chronic Bronchitis

93
Q

How will the sympathetic NS relax a part of the body?

A

does it through an Beta 2 receptor

94
Q

What does the PNS (via Cholinergic receptors) control in the airways?

A
  • Glandular secretion
  • Contraction of bronchiolar musculature
  • Increased mucus production
  • Vasodilation
95
Q

What is the Sympathetic NS (via Adrenergic receptors) responsible for in the airways?

A

Activation causes bronchial relaxation & decreased mucus production (via Beta 2)

96
Q

What are concurrent dzs that may be seen with canine chronic bronchitis?

A
  • Bronchial compression
  • Mitral endocardiosis
  • Collapsing trachea
  • CHF
97
Q

List 4 complications associated w/ K9 Chronic Bronchitis.

A
  • Tracheobronchomalacia
  • Pulmonary hypertension
  • Bact/Mycoplasma infection
  • Brochiectasis
98
Q

What can predispose a dog to canine chronic bronchitis?

A
  • 2º infection
  • Pulmonary hypertension
  • Bronchiectasis →dilated = pulled apart → won’t be able to oxygenate as efficiently
99
Q

What lower respiratory issue can long term irritation lead to?

A

Canine chronic bronchitis

100
Q

Treatment of canine chronic bronchitis

A
  • Symptomatically
  • Bronchodilators
  • Glucocorticoids
  • Cough Suppressants
101
Q

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?

A

K9 Chronic Bronchitis

TX:

  • Symptomatically
    • HYDRATE!!!
      • Nebulize w/ Gentamycin
      • No diuretics
    • Wt loss!
    • Dental care
  • Bronchodilators
  • Glucocorticoids
  • Cough Suppressants
102
Q

What kind of bronchodilators do you want to use to TX K9 Chronic Bronchitis?

A
  • Methyxanthines (-phylline)
    • Theophylline
    • Aminophylline
  • Sympathomimetics (Beta 2 agonists)
    • Terbutaline
    • Albuterol

Small Animal Med. I (18 decks)

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