Module 8 (Weeks 12-13) Flashcards
1
Q
Module 8A: Diseases of the Nasal Cavity (Byron)
A
Module 8A: Diseases of the Nasal Cavity (Byron)
2
Q
- Extends from the nares to the choanae
- Surrounded by bone and divided in half by a cartilaginous and boney septum
A
The Nasal Cavity
3
Q
What increases the surface area of the nasal passages?
A
Scroll-loke turbinate system (nasal conchae)
- Protect the lower respiratory tract
4
Q
Term:
Air passageways occupying the space between the nasal conchae
A
Meatii
5
Q
What is located in the region of the ethmoturbinates and ventral nasal conchae?
A
Specialized olfactory area
6
Q
(T/F) Diseases of nasal cavity can extend into nasopharynx and vice versa
A
True
7
Q
Communicates with
- Frontal sinuses
- Entry for eustacian tubes in pharynx
- Caudal nasal cavity
A
Nasopharynx
8
Q
List the causes for chronic nasal discharge:
A
- Infectious
- Neoplasia
- Inflammatory
- Foreign Body
- Oronasal fistula
9
Q
What is generously supplied by blood vessels and nerves that acts to increase the surface area of the nasal passages?
A
Scroll-loke turbinate-system, the nasal conchae
10
Q
(T/F) The nose is a giant filter and humidifier
A
True
11
Q
Where is the specialized olfactory area located?
A
ethmoturbinates and ventral nasal conchae
12
Q
What transmits olfactory information to the brain through the cribriform plate?
A
Olfactory Nerves (Cranial Nerve I)
13
Q
(T/F) There is no correlation between nasal disease and anorexia
A
False, animals with severe nasal disease - anorexia may result owing to their inability to smell food
14
Q
Most of the airways, including the nasal passages and nasopharynx are covered by:
A
Mucociliary transport system
- Ciliated pseudo-columnar epithelium
- Respiratory epithelium
- serous and mucous glands
15
Q
List the two parts the mucous layer is made up of:
A
- Outer viscous layer
-
Inner water mucous layer
- cilia of the respiratory epithelium are embedded in the more watery layer
16
Q
The cilia beats in a direction toward the __________ to carry the viscous outer mucous layer with trapped particles for swallowing
A
Pharynx
17
Q
What plays a role in the defense mechanism of the upper respiratory tract?
A
Production of local secretory immunoglobulin (IgA) by epithelial cells
18
Q
List what the paranasal sinuses in the dog include:
A
- Frontal sinus
- Maxillary recess
- is not enclosed in the maxilla, and not a true sinus - Sphenoidal sinus
CATS
- There are the frontal and sphenoidal sinuses
19
Q
Term:
Is sort of a defined space that sits at the crossroads between the entry to the lower respiratory tract and the upper gastrointestinal tract
A
Nasopharynx
20
Q
What disease in what area is often associated with reverse sneezing?
A
Nasopaharynz
- nasopharyngeal problem (foreign body, mass, etc)
21
Q
List the most common diseases that we see causing chronic signs:
A
- Cats: Idiopathic chronic rhinosinusitis
- often secondary infection with FCV or FHV - Dogs: Lymphoplasmacytic rhinitis
- chronic nasal discharge - Neoplasia in BOTH species
22
Q
Nasopharyngeal polyps are common causes of chronic upper respiratory signs in what species?
A
Cats and kittens
23
Q
What is an important cause of acute signs in cats and young dogs?
A
Viral rhinitis
24
Q
(T/F) Bacterial infections are primary nasal disease
A
False, Rarely cause primary nasal disease but plays a significant role as a secondary problem
25
Fill in the Blanks:
Most commonly implicated pathogen for Fungal rhinitis ...
- Dogs: ______
- Cats: _______
- Aspergillus = affects the frontal sinuses
- German Shepard Dogs and other dolichocephalic breeds may be at increased risk of fungal sinonasal disease
- Topical therapy
- Cryptococcus = affects the nasal cavity and leads to deformity of the bones of the nose
- Cryptococcus is the only reason to look at a nasal swab
- Oral therapy
26
What may indicate a possible *secondary bacterial component* to the nasal disease?
Presence of "Pus"
27
What brings a neoplastic process, coagulopathy, foreign body, fungal disease, or idiopathic chronic rhinosinusitis to the top of the differential list?
BLOOD
28
Term:
Snoring, sniffing, rustling, or gurgling sound that is synchronous with inspiration, expiration, or both indicating disease within the *nasal cavity or nasopharynx*
Stertor
- think Pug
29
Term:
Is a wheeze or whistling sound usually heard on the inspiration that indicates disease of the *larynx*
Stridor
- think Dark Vader
30
When can an animal have epiphora?
Nasolacrimal duct is obstructed
31
What is seen as a component of *upper respiratory disease*?
Cough
- from post nasal drip
32
What is something that may be more indicative of a *nasopharyngeal mass*?
Gagging or vomiting
33
(T/F) Cats with viral rhinitis, especially calicivirus can be febrile
True
34
Palpation of what lymph nodes are important?
Submandibular lymph nodes
35
What is the *least sensitive method* of imaging the nasal cavity and sinuses?
Skull Radiography/Dental Radiography
- Dorsoventral intraoral projection = both sides of the nasal cavity
- Rostrocaudal view = frontal sinuses
- Lateral skill = evidence of cribriform plate involvement
36
What is the *most useful method* of imaging the sinuses and nasal cavities?
CT
37
Instruments are measured to the level of the:
Medial canthus of the eye, marked by tape
38
What would be most useful to obtain large bits of tissue from masses or tumors within the nasal cavity?
"Traumatic Flush" method
39
(T/F) Swab and culture of the nasal mucosa and secretions is rarely of diagnostic value
True
- Nose acts as a giant filter
40
What is the *primary benefit* of nasal cytology?
Finding of *Cryptococcus* species, which should NEVER be present in the nose
41
List the most common cause of nasal disease in the cat:
- Feline herpes virus-1 (FHV)
- Feline Calicivirus (FCV)
*Cats with active disease frequently develop secondary bacterial infections and with chronicity, this may lead to osteomyelitis and destruction of the turbinates. In addition, some cats with chronic, recurrent infections can develop choanal stenosis secondary to severe inflammation and ulceration of the mucosa.*
42
Cats:
What has been demonstrated to reduce the severity of clinical signs but not eliminate the virus?
- Famcyclovir
- L-lysine
43
What is the most commonly identified viral cause of nasal disease in dogs?
Canine distemper virus (CDV)
- Prevalence has declined with widespread vaccination
44
List the most common nasal neoplasia in the dog:
- Carcinoma
- Adenocarcinoma
- Squamous cell carcinoma
45
Term:
- Benign inflammatory masses arising from the mucosa of the middle ear or Eustachian tube.
- They are often associated with *bulla disease* and may extend into the *nasopharynx or the external ear canal*.
Nasopharyngeal polyps
- Most commonly in young cats
46
(T/F) The presence of chronic disease rules out a foreign body
False, some foreign bodies have been found after months of clinical signs
47
Module 8B: Obstructive Diseases of the Canine and Feline Upper Airways
Module 8B: Obstructive Diseases of the Canine and Feline Upper Airways
48
Clinical Signs:
Stertor
Often associated with obstruction in the ...
Nares & Nasal Cavity
49
Clinical Signs:
Reverse sneezing, swallowing, and sometimes dysphagia
Often associated with obstruction in the ...
Nasopharynx
50
Clinical Signs:
Stridor
Often associated with obstruction in the ...
Larynx
51
Clinical Signs:
Cough (Goose Honk) and Inspiratory effort
Often associated with obstruction in the ...
Trachea
52
Clinical Signs:
The inspiratory effort, Long Inhalation, Lack of nasal Airflow, Sucking in of thoracic inlet
Often associated with obstruction in the ...
General Upper Airway Obstruction
53
Describe the Emergency Procedures for Upper Airway Obstruction:
- Immediately provide oxygen, either in a cage (preferred) or via flow-by or mask
- Sedate if needed with *butorphanol or acepromazine*
- Observe but try not to stress the patient
- Cooling if needed (Lar Par cases, BOAS)
- Have an endotracheal tube and Ambu bag ready if needed
- Limited exam and delay diagnostics until more stable and calm
54
What is the most common disease process, that is potentially life-threatening, in the brachycephalic breed?
Brachycephalic obstructive airway syndrome (BOAS)
55
(T/F) The genetics of brachycephaly is being worked out and basically affects the boney length of the muzzle without altering the volume of soft tissue structures.
True
56
List the major features of BOAS:
- Stenotic nares
- Soft palate hyperplasia and elongation
- Everted laryngeal saccules
- Tracheal hypoplasia
- Aberrant turbinates in the nasopharynx
57
Brachycephalic Obstructive Airway Syndrome (BOAS):
What can lead to gastroesophageal reflux, hiatal hernia, regurgitation, and esophageal dysmotility?
The *negative pressure* in the pleural space
58
Brachycephalic Obstructive Airway Syndrome (BOAS):
What is a common complication, especially post-anesthesia, and there is evidence that these dogs experience 'micro-aspirations' on a daily basis?
Aspiration pneumonia
59
List what chronic medical therapy consists of:
- Keeping them cool
- Stress-reduction
- Gastric acid reduction
60
Brachycephalic Obstructive Airway Syndrome (BOAS):
List the surgeries to correct abnormalities:
- Alar fold resection
- Soft palate shortening
- Sacculectomy
61
(T/F) Regurgitating Frenchie needs airway surgery, not a GI work up
True
62
Term:
Dorsoventral flattening of the tracheal rings with stretching of the dorsal membrane in dogs
Tracheal Collapse
- most commonly seen in middle-aged to older toy and miniature breeds
- The collapse can occur in the cervical r thoracic trachea and may also affect the primary bronchi (bronchomalacia)
- Classic sign is a *honking cough* which may be intermittent and can lead to *paroxysmal* episodes which may become severe or life-threatening
63
(T/F) *Bronchomalacia* alone can be seen in any size breed of dog
True
64
Tracheal collapse:
How is diagnosis generally made?
Signalment and presentation, as well as ruling out other causes of cough. The history is generally chronic with progressive exercise intolerance, ‘honking’ cough, and obesity in some patients.
-> Due to the age of the animal there may be other comorbidities like mitral valve disease, but a direct relationship with tracheal collapse has not been established.
65
Tracheal collapse:
What may a physical examination reveal?
- Tracheal sensitivity
- Possibly inspiratory and expiratory crackles from collapsed bronchi
- Possible lung herniation through the thoracic inlet
66
If the collapse is *dynamic* it might be missed depending on the phase of respiration you get in a ...
Radiographs
67
Treatment for Tracheal Collapse:
- Reducing the cough
- Improving exercise tolerance
- Weight loss
- Stress reduction
- Cough suppressants
- Steroids = may be used if the cough cannot be managed (some dogs have chronic bronchitis)
- Antibiotics = only needed if secondary infection is suspected
- Stenting of the trachea = only considered in cases where all medical management has been exhausted
68
Term:
Is the unilateral or bilateral loss of abduction of the *arytenoid cartilages* during inspiration.
- recurrent laryngeal nerve
Laryngeal paralysis
69
(T/F) Laryngeal paralysis is most commonly seen in dogs and is rarely seen in the cat
True
70
Laryngeal paralysis:
The acquired form is most often seen in _________________ large and giant breed dogs and although not completely understood, likely is an early manifestation of a peripheral polyneuropathy or poly myopathy, however, we still call them idiopathic.
middle-aged to older
71
Term:
refers to having an abnormal voice
Dysphonia
72
List what obstructions of the airways may lead to:
- Dysphonia
- Stridorous breathing
- Cough
- Heat
- Exercise intolerance (can't pant)
- Hyperthermia
- Risk of aspiration pneumonia
73
What is the definitive diagnosis of Laryngeal Paralysis?
A laryngeal exam under heavy sedation or light plane of anesthesia with propofol and pre-meds
74
What can be given to increase respiratory effort and improve the contrast between normal and abnormal, if the animal won't breathe at the plane of sedation?
Doxapram (Dopram-V)
75
Describe medical management:
- Weight management
- Keeping the pet cool
- Reducing stress
- Exercise reduction
- Occasionally, sedation or anti-inflammatory drugs may be needed to reduce tissue swelling
76
(T/F) Surgery is generally performed when the quality of life for the dog and owner are untenable with medical management alone
True
77
Module 8C: Noninfective Canine and Feline Pulmonary Diseases
Module 8C: Noninfective Canine and Feline Pulmonary Diseases
78
- Tend to be inflammatory, or fibrotic in nature
- An aberrant reaction to an environmental factor or abnormal response to injury
- Result in damage to the large and small airways, and eventually impacts either the aeration of alveoli or movement of oxygen across the membranes
NIPDs
79
- Chronic inflammatory disease that results in cough (2 months of cough on most days)
- infectious (fungal) or non-infectious
- *Small breed dogs* (Cocker spaniels, Terriers, Poodles)
- *Middle-aged to older dogs*
- It can occur in any breed
- Inflammation of the lower airways with excessive mucus production filled with neutrophils and macrophages, edema and inflammatory infiltration of the bronchial walls, plugging of small airways with thick mucus resulting in air trapping and hyperinflation and bronchial wall malacia
- Physical examination may be normal or an
expiratory wheeze may be noted on auscultation.
- Tracheal sensitivity may also be present
Canine Chronic Bronchitis (CCB)
80
(T/F) Bronchoconstriction *is* an issue in dogs as much as in cats and humans
False, NOT an issue
81
What disrupts and impedes the function of the mucociliary apparatus and prevents the mucus from being removed?
Inflammatory process
- These dogs may get *secondary pneumonia* with this failure to clear irritants and infectious agents
82
List other diseases that can cause cough:
- Heartworm disease
- Lung parasites
- Cardiac disease
83
(T/F) *Radiographs* of CCB patients are very useful and show bronchial thickening (tramlines and donuts), and sometimes bronchiectasis (associated with more severe and long-standing disease), and possible hyperinflation
True
- Patchy areas of pneumonia may also be present
84
What is a more *definitive method* of diagnosis that shows irregular mucosa, excessive mucus, and bronchomalacia?
Bronchoscopy
- It is not essential for diagnosis but should be considered if the diagnosis is in question
85
What does the cytology of the airway reveal?
- Mucus with mainly neutrophils and smaller numbers of macrophages, small lymphocytes and eosinophils
86
(T/F) Bacterial culture may not be clinically significant
True
87
List the treatment goals:
- reduce inflammation
- Limit cough
- Improve exercise tolerance
- Slow progression
88
What is the *primary treatment* for CCB?
Glucocorticoids tapered to the lowest effective dose
- Oral (prednisone)
- Inhaled (Fluticasone)
**Cough suppressants (hydrocodone) may be helpful to improve the dog's and owner's quality of life, however, a balance must be struck between cough control and sedation
*Goal is to improve quality of life, not completely get rid of the cough*
89
Why is there little evidence that bronchodilators are effective in CCB dogs?
Because they do not have the bronchoconstriction seen in cats and humans
90
What is the most common *lower airway disease* in cats?
Feline asthma (Feline Bronchial Disease)
- Inflammatory process
- Allergen-induced eosinophilic inflammation of the bronchi
- Excessive mucus production
- Airway hyperresponsiveness
- Bronchoconstriction (mucus plugs)
91
Describe the classic presentation of Feline Asthma:
- Chronic moist cough
- Young to middle-aged cat
- Siamese
- Wheezing (maybe)
- Increased respiratory effort or rate
- Radiographs can be normal in less chronic cases, but often show diffuse bronchial or bronchointerstitial pattern
- Bronchoscopy and airway cytology may be helpful in some cases to diagnose asthma
(similar to heartworm disease in cats)
92
(T/F) Role of *Mycoplasma* in feline asthma is still somewhat unclear, but it may be tested for
True
93
What must be done in order to suppress the inflammation?
Glucocorticoids must be given life-long even when cat is asymptomatic
94
What drug is preferred, especially in overweight cats?
*Inhaled* Steroids (Fluticasone), because of lower risk of side effects like diabetes seen with systemic steroids
95
Term:
Difficult, painful breathing or shortness of breath
Dyspneic
96
What will *decrease* lung function over time?
Progressive airway remodeling
97
Sudden death is a possibility in cats ...
without treatment or from acute mucus plugging
98
Term:
is an idiopathic inflammatory disease characterized by severe infiltration of eosinophils into the lung parenchyma and airways, the production of large amounts of yellow/green mucus, and bronchomalacia.
Eosinophilic Bronchopneumonopathy (EBP)
99
- Young adults (seen in dogs as old as 13 yrs)
- More common in female dogs (unproven)
- Cough (most common sign)
- Harsh and productive w/ gagging and retching
- Nasal discharge
- May have exercise intolerance
- systemically healthy
- Pulmonary auscultation: normal or reveal crackles, wheezes, or increased lung sounds
Eosinophilic bronchopneumonopathy (EBP)
100
EBP:
What is needed for *a definitive diagnosis*?
Cytology of airway wash
- increased total cell count and increased eosinophils as the predominant cell type
101
EBP:
Treatment consists of ...
- Oral immunosuppressive steroids
(Inhaled steroids have been investigated, but were found to be *less effective* than oral steroids)
*Most dogs will respond to treatment but some will require life-long steroids and the relapse rate is around 30%*
102
What can affect dogs and rarely cats, but the vast majority are West Highland white Terriers or their crosses?
Canine Idiopathic *Pulmonary Fibrosis*
103
- Middle age to older dogs (8-13 years)
- Slow chronic onset
- Genetic, epigenetic, and environmental factors
- Uniform fibrosis of the *alveolar wall of variable severity and multifocal areas of more cellular fibrosis*
- Inflammation is only *mild*
- Cough and exercise intolerance (most common)
- May have significant respiratory distress or cyanosis if severely affected
- Serum chem and CBC are generally normal
- Arterial blood gas will show *low PaO2* and *high alveolar-arterial O2 gradient*
- Median survival is 32 months (2-51m) from onset of clinical signs and 11 months (0-40m) from diagnosis
Canine Idiopathic *Pulmonary Fibrosis* (CIPF)
104
What does physical examination reveal for Canine Idiopathic Pulmonary Fibrosis?
Bilateral *inspiratory* 'Velcro' crackles and Wheezes
- Right-sided murmur may be heard if there is significant pulmonary hypertension
105
What is something that is not necessary for diagnosis in most cases and can have significant risks associated with them?
Bronchoscopy
106
(T/F) There are currently *no effective treatments* for CIPF
True
- Combination treatment w/ steroids and theophylline to reduce cough are advised at this time, but will not slow the disease process
107
Module 8D: Pleural Effusions in Dogs and Cats
Module 8D: Pleural Effusions in Dogs and Cats
108
List the types of pleural effusion, Based on TNCC and TP:
- Transudate -> Non- degenerative neutrophils, macrophages, mesothelial cells
- Cause = Low protein (usually albumin +/- globulin) from PLE, PLN, liver disease, CHF
- TP = < 2.5 g/dL
- TNCC = < 2500 cells/uL
- Modified Transudate -> Non-degenerative neutrophils, macrophages, mesothelial cells, *neoplastic cells, lymphocytes*
- Cause = CHF, Heartworm disease, pericardial tamponade, neoplasia, chyle, FIP, chylothorax, lung lobe torsion, PTE
- TP = 2.5 - 7.0 g/dL
- TNCC = 1000 - 7000 cells/uL
- Exudate -> Variable cell types
- Cause = Neoplasia, pyothorax, hemorrhage, FIP, chylothorax
- TP = > 7.0 g/dL
- TNCC = > 7000 cells/uL
109
List the types of pleural effusion, Based on etiology:
- Transudative -> changes in the hydrostatic or oncotic pressure lead to fluid *shifts from the vasculature to the pleural space*
- Exudative -> *Increased vascular permeability* due to *inflammation or neoplasia*
110
Normally the pressure in the pleural space is (positive/negative) ______________
negative (-5mmHg)
111
(T/F) Pleural effusion is a *clinical sign, not a diagnosis*
True
112
*90%* of pleural effusion in *CATS* is caused by:
- CHF (*most common*, present w/ lower body temperature)
- Neoplasia
- Pyothorax
- Idiopathic chylothorax
- FIP
113
*Pleuropneumonia* is the most common cause in ...(dogs/cats/horses)
Horses
114
- neoplasia
- Migrating foreign body
- Right Heart Failure
- Chylothorax
Are the most common causes of pleural effusion in ...
Dogs
115
List the respiratory complaints:
- Dyspnea
- Shallow breathing
- Open-mouth breathing
- Cough
- Tachypnea (abnormally rapid breathing)
- Restlessness
- Unwillingness to lie down
116
List the *basic approach* to the patient with pleural effusion:
- Stabilize - sedation, oxygen
- Obtain fluid for therapy and diagnostics - thoracocentesis, Place fluid in EDTA (*purple top*) tube and also make slides that are fresh
- Submit for fluid analysis/cytology, aerobic/anaerobic culture
- Imaging (CT is best, but radiographs will do)
- If fluid production is ongoing, the patient may need a thorocostomy tube placed
117
Check serum albumin and globulin levels, and consider *liver* function testing (decreased albumin synthesis), if albumin is decreased, look for loss in urine and gut. Also, consider evaluation for cardiac disease or lung lobe torsion.
This fluid analysis best represents a ....
Transudate
118
Evaluate for *heart failure or pericardial disease*, perform heartworm test, NT pro-BNP SNAP test in cats (heart disease), caval thrombus search with imaging, lung lobe torsion
This fluid analysis best represents a ....
Modified Transudate
119
Common differentials include *FIP* (High protein, fibrin strands), neoplasia, pyothorax from a bite (esp. cats), or *foreign material*
This fluid analysis best represents a ....
Exudate
120
- Septic inflammation of the pleura
- Pus in the pleural space
- Patient may be febrile
- Lots of degenerative neutrophils, bacteria
- Bad odor, white, yellow, green, red, brown colored cloudy/opaque fluid, may have 'Sulphur granules'
- May be acute or more likely chronic (days to months)
Pyothorax
*Cats*
- Pasteurella multocida
- Actinomyces
- Other oral Anaerobes
- Streptococcus**
- Stapylococcus**
- Chlamydia**
*Dogs*
- Nocardia asteroids
- Other Anaerobes
- Streptococcus**
- Stapylococcus**
- Chlamydia**
121
List the most common causes of Pyothorax in cats:
- Cat bites
- Systemic infection
122
List the most common causes of Pyothorax in dogs:
- Inhaled or penetrating foreign body migration
- Penetrating trauma
123
What is the treatment for Pyothorax?
- Mediacal -> Broad spectrum antibiotics for 4-6 wks at least
- Placement of thoracostomy tubes (chest tubes) for intermittent drainage
- Surgical drainage and resection of necrotic tissue/abscesses, most common to perform in the dog, less frequent in cats
*Prognosis*
- Guarded to good
- Dogs: 83% survival
- Cats: 62% survival
- Better if survive the first 48h
124
- Lymphatic fluid leaking into pleural space
- Obstruction of the thoracic duct or of thoracic lymphatic drainage
- *White to pink milky fluid*
- *High in protein, triglycerides/chylomicrons ('cram cap')
- Triglycerides *2X greater than serum* or > *100 mg/dL*
- Variable cell count, mostly small lymphocytes
Chylothorax
*Diagnosis*
- Evaluate for cardiac disease, especially in cats
- Imaging to look for neoplasia
- Heartworm testing
125
What is the treatment of Chylothorax?
- *Treat underlying disease if found*
- Chyle is very irritating and leads to pleural *thickening and lung entrapment*
- Like Shrink Wrap on the lungs
- Eventually, restrict breathing
- Some idiopathic cases will spontaneously resolve
- Surgical -> Thoracic duct ligation and partial pericardectomy
- Medical -> Low fat diet, Rutin
- Benzopyrone
126
- Effusion that has a *PCV > 20% or is at least 50% of the blood PCV*
- Trauma, Neoplasia, Rodenticide Toxicity (ask the owner about exposure)
- Check PT/PTT *before* tapping chest if it is suspected
- May only need to tap once if the bleeding stops
Hemothorax
127
- Clear to cloudy, yellow fluid
- High fluid protein (globulin), variable cell number
- Lots of fibrin
- More common in *younger cats*. than other causes of effusion
- High serum globulin
FIP - Feline Infectious Peritonitis
- Poor Prognosis
- limited to tapping chest as needed, giving steroid, supportive care
