Nasal Cavity Flashcards
What are 5 potential characteristics of nasal discharge?
- Unilateral
- Bilateral
- Mucoid
- Purulent
- Bloody
What should be considered as a potential etiology if depigmentation of the nasal area is noted?
Aspergillosis
What is the most important diagnostic test to perform when a dog/cat presents with nasal discharge?
Imaging
If we want to know more about what other organ systems or systemic conditions might be causing the nasal discharge, what can be done?
Blood work
What are 7 differential diagnoses for nasal discharge?
- Foreign body
- Rhinitis
- Dental disease
- Neoplasia
- Trauma
- Ciliary dyskinesia
- Systemic disorders
What are 3 things to take into consideration when diagnosing a nasal foreign body?
- Signalment
- History
- Clinical signs
What are 5 nasal cavity clinical signs?
- Nasal discharge
- Sneezing
- Pawing at face
- Respiratory difficulty on inspiration
- Stertor (noisy respiration)
Sudden onset, acute sneezing, gagging, reverse sneezing, pawing at the nose and nasal discharge can all be seen with what?
Nasal foreign body
Wha is the diagnotic method of choice for nasal foreign bodies?
Radiographs
When performing a rhinoscopy, where should the cuffed tracheal tube be pre-measured to?
Medial canthus
Inflammation of the nasal cavity is known as what?
Rhinitis
What are four possible causes of rhinitis?
- Infectious
- Parasitic
- Allergic
- Lymphocytic plasmacytic
90% of feline upper respiratory disease cases are caused by what 2 viruses?
- Feline herpesvirus
- Feline calicivirus
10% of feline upper respiratory disease cases are caused by what 4 organisms?
- Chlamydophila felis
- Mycoplasma
- Coronavirus
- Bordetella
Ulcerative keratitis with punctate or dendritic ulcers are a hallmark of which feline virus?
Feline herpesvirus
Ulcers on the nose, tongue, or hard palate seen with pneumonia and lameness is characteristic of what feline virus?
Feline calicivirus
Severe conjunctivitis with chemosis is seen with what feline agent?
Chlamydophilia felis
Which virus in a carrier state can shed the virus with stress?
Feline herpesvirus
Which 2 feline agents can be shed in a carrier state with or without stress?
- Feline Calicivirus
- Chlamydophila felis
What does feline herpes virus cause?
Feline viral rhinotracheitis
What are 2 ways feline herpes virus can be spread?
- Direct contact
- Fomites
What are 3 types of secretions herpes virus can be shed in?
- Ocular
- Nasal
- Pharyngeal
The serous discharge seen with feline viral rhinotracheitis can progress to mucopurulent due to what?
Secondary bacterial infection
T/F: Feline herpesvirus establishes a temporary latency in the trigeminal ganglia.
False - It establishes a LIFELONG latency in the trigeminal ganglia.
What are 3 aspects used to diagnose feline herpes virus?
- Clinical signs
- Viral isolation
- PCR
Treatment of feline herpes virus is mainly what?
Supportive
What are 5 examples of supportive treatments that can be used with feline herpes virus?
- Humidify air
- Topical decongestants
- Systemic antibiotics
- Topical antibacterial
- Antiviral eye ointments
What are 3 possible sequelae that can be seen with feline herpes virus?
- Chronic rhinitis/sinusitis (feline chronic rhinosinusitis)
- Chronic conjunctivitis
- Fibrosis of lacrimal ducts leading to epiphora
An overflow of tears due to excessive secretion of the lacrimal glands or obstruction of the lacrimal ducts is known as what?
Epiphora
Feline chronic rhinosinusitis is common in what type of cats?
Short nosed breeds
Turbinate damage caused by feline chronic rhinosinusitis predisposes the cats to what?
What are these cats called?
- Secondary bacterial infections of the nasal cavity
- “Snufflers”
80% of cats recovered from feline herpes virus are what which do what?
- Carriers
- Shed when stressed
What can be given for the treatment of feline herpesvirus that may reduce viral replication and recrudescence?
Oral lysine
What are 2 oral antivirals that can be given to treat feline herpes virus?
- Famciclovir
- Acyclovir
What is the trade name for Famciclovir?
Famvir
What is the trade name for Acyclovir?
Zovirax
Since mucus gets thicker and is harder to remove in a dehydrated patient, what should be included with supportive care?
Fluid therapy
T/F: The feline herpesvirus vaccine does not prevent infection.
True
T/F: The feline herpesvirus vaccine does not reduce severity.
False - It DOES reduce severity.
What are 2 ways the feline herpesvirus vaccine can be administered?
- Parenteral
- Intranasal
Which vaccine administration route for the feline herpesvirus vaccine can be blocked by maternal antibodies and does not prevent the carrier state?
Parenteral
Which administration route for the feline herpesvirus vaccine can be useful in outbreaks, is not blocked by maternal antibodies, can have post vaccine sneezing, may prevent the carrier state and is shed?
Intranasal
Which can survive longer in the environment, feline herpesvirus or calicivirus?
Feline Calicivirus
Which feline virus is resistant to routine disinfectants?
Feline calicivirus
Does feline calicivirus have a low or high mutation rate?
High mutation rate
Do new mutation strains of feline calicivirus have cross protection from vaccines or other strains?
No
What are 2 ways feline calicivirus can be transmitted?
- Direct transmission
- Fomites
What is the incubation period for feline calicivirus?
2-4 days
Feline calicivirus (FCV) has similar clinical signs to feline viral rhinotracheitis (FVR) except for the formation of ulcers in what 2 locations with FCV?
- Oral
- Nares
What are 3 ways in which FCV is different from feline herpes virus?
- Pneumonia more common with FCV
- FCV can cause GI signs
- FCV can cause lameness
50% of cats with calicivirus shed the virus up to how many days post-infection?
75 days
Do cats require stress to shed calicivirus?
No
Lameness, ulcers on paws and sore joints are clinical signs seen with what syndrome caused by what virus?
- Limping kitten syndrome
- Feline calicivirus
What are the 2 distinct syndromes that can be seen with feline calicivirus?
- Limping kitten syndrome
- Virulent hemorrhagic systemic syndrome
A mutation of the feline calicivirus can cause what syndrome?
Virulent hemorrhagic systemic syndrome
Edema, hepatitis, diarrhea, pustular dermatitis and hemorrhagic cystitis can be found with which syndrome associated with feline calicivirus?
Virulent hemorrhagic systemic syndrome
What is the mortality rate for the FCV virulent hemorrhagic systemic syndrome?
40-60%
What is the main type of treatment used with feline calicivirus?
Largely supportive
What are 4 possible sequelae seen with feline calicivirus?
- Chronic rhinitis
- Sinusitis
- Conjunctivitis
- Carrier state
An abnormal condition resulting from a previous disease is known as a what?
Sequelae
What is the hallmark clinical sign seen with Chlamydohila felis?
Conjunctivitis with chemosis
The swelling of the conjunctiva is known as what?
Chemosis
What is an intracellular bacteria that presents with similar signs to feline herpesvirus and feline calicivirus?
Chlamydophila felis
What are 2 possible ways to diagnose Chlamydophila felis?
- Conjunctival smear to look for intracytoplasmic inclusion bodies
- PCR a conjunctiva sample
What are 2 examples of topical treatments for a Chlamydophila felis infection?
- Tetracycline
- Erythromycin
What are 2 antibiotics that can be used with there are systemic signs associated with a Chlamydophila felis infection?
- Doxycycline
- Azithromycin
Is the vaccine for Chlamydophila felis a core vaccine?
Why?
- No
- Cats tend to have more vaccine reactions compared to other antigens.
If a cat presents with upper respiratory signs, where should it be treated ideally?
Outpatient if possible; isolation if in hospital.
Is it ok to remove the crusts form the nose and eyes of a cat presenting with upper respiratory signs?
Yes
What is the preferred topical decongestant for cats with upper respiratory signs?
What is an alternative?
- Phenylephrine
- Pseudoephedrine
Is bacterial rhinitis commonly a cause of upper respiratory disease?
No
Mucopurulent or purulent nasal discharge with transient antibiotic response can be seen with what possible upper respiratory condition?
Bacterial rhinitis
Is bacterial rhinitis more commonly a primary or secondary disease process?
Consider it always secondary
What are 5 possible primary causes that can lead to a a secondary bacterial rhinitis infection?
- Foreign body
- Abscessed tooth
- Chronic viral infection
- Fungal infection
- Neoplasia
Nasal ulceration and depigmentation with possible facial distortion can be seen with what upper respiratory condition?
Nasal Aspergillosis
How is nasal airflow usually affected with nasal aspergillosis in the dog?
Turbinates?
- Nasal airflow usually ok
- Turbinate destruction
T/F: Most cases of nasal aspergillosis are systemically ok.
True
What diagnostic tests should be done before rhinoscopy or nasal flush?
Which are more helpful? Why?
- Imaging
- CT/MRI: more helpful since radiographs can’t distinguish between neoplasia and fungal rhinitis.
Cultures and smears for nasal aspergillosis should be done from what type of sample?
What should not be used?
- Plaque
- Not discharge
What is done first, if necessary, to treat nasal aspergillosis?
Debridement
What are 2 things that can be infused into the nasal cavity for the treatment of nasal aspergillus?
For how long?
- 1% clotrimazole or 2% enilconazole
- Over 1 hour
What are 2 possible risks associated with the treatment of nasal aspergillus?
- Aspiration pneumonia
- Neural signs
What is a contraindication for the treatment of nasal aspergillus?
Damaged cribriform plate
Treatment of nasal aspergillus should be repeated if signs persist for longer than what?
2 weeks
What is the most common cause of fungal rhinitis in dogs?
Aspergillosis
What is the most common cause of fungal rhinitis in cats?
Cryptococcosis
What are 2 common signalments of aspergillosis in dogs?
- Dolichocephalic
- Young adults
What is the percent chance of seeing hyphae on the cytology of nasal discharge with aspergillosis?
20%
Chorioretinitis can be seen with what type of fungal rhinitis in cats?
Cryptococcosis
Where can cryptococcosis samples be taken from in cats?
Nasal discharge
What can be given to treat cryptococcosis?
Conazoles systemically
What is Pneumonyssus caninum?
Canine nasal mite
Is Pneumonyssus caninum found in cats?
No
what are 2 clinical signs associated with Pneumonyssus caninum?
- Sneezing
- Reverse sneezing
What are 3 possible drugs that can be used to treat Pneumonyssus caninum?
- Ivermectin
- Milbemycin
- Selamectin
Do you see Pneumonyssus caninum in dogs on hearworm prevention?
No
Chronic inflammatory rhinitis characterized by lymphocytic-plasmacytic infiltration of nasal mucosa in the absence of an obvious underlying etiology is known as what?
Lymphoplasmacytic Rhinitis (LPR)
What are 3 proposed mechanisms of LPR?
- Infectious
- Allergic
- Immune-mediated
What is the usual signalment of dogs presenting with LPR?
Medium to large breed with long noses.
What is the most common clinical sign seen with LPR?
Uni or bi-lateral nasal discharge
What are 2 other differentials to consider when LPR is on the list?
- Aspergillosis
- Neoplasia
If destruction of nasal septum, frontal sinus or cribriform plate are detected on CT/MRI, is this likely caused by LPR?
No
How does the mucosa of an LPR case appear with rhinoscopy?
Red, edematous, bleeds easily
What is needed for the diagnosis of LPR?
Biopsy and histopathology
What is the recommended treatment for LPR?
No effective protocols at this time.
What should be avoided with LPR?
Any type of smoke.
Continuous dosing of what drug robs the body of substance P which can lead to what?
- Cerenia (maropitant)
- Tremors
Progressive unilateral nasal discharge that may become bilateral can be a clinical sign of what?
Nasal Cancer
Loss of airflow due to mass effect is often caused by what?
Nasal Cancer
Sneezing, facial deformity, epiphora, exophthalmia, dyspnea, open mouth breathing and dysphagia are clinical signs that can be associated with what?
Nasal Cancer
What can seen if the cribriform plate is invaded by nasal cancer?
Neurological signs
The clinical signs seen with nasal cancer can’t be distinguished from the signs seen with what other upper respiratory disease cause?
Fungal rhinitis
Can a carcinoma in the nasal cavity be distinguished from an aspergillus infection based on radiographs?
No
What is a nice option for diagnosing nasal cancer that is not always available?
Rhinoscopy
What are 5 possible diagnostic tools that can be used to diagnose nasal cancer?
- Nasal discharge cytology
- FNA of ipsilateral nearby lymph nodes
- Imaging
- Rhinoscopy
- Tissue biopsy
Chemotherapy is not effective for the treatment of nasal cancer except for which type of cancer?
Lymphosarcoma
Will surgery cure the nasal cancer?
Unlikely, it is usually palliative.
Does surgery prolong survival times with nasal cancer?
Not unless used with radiation.
What is the treatment of choice for many nasal tumors?
Radiation
What is the estimated survival time for nasal cancer treated with radiation and surgical debulking?
12-16 months
What is the average survival time for nasal cancer with no treatment?
3-6 months
What are 3 possible causes of death resulting from nasal cancer?
- Airway obstruction
- Euthanasia due to labored respirations
- Persistent epistaxis or nasal discharge
Nasal cancer patients with adenocarcinomas and sarcomas have a better survival time after what?
Radiation
What are 2 types of nasal cavity tumors that have a shorter survival time?
- Undifferentiated carcinomas
- Squamous cell carcinomas
Which species lives longer with radiation therapy, cats or dogs?
Cats
What signalment of dog is more prone to nasal neoplasia?
Long nosed breeds greater than 8 years old
T/F: Most nasal tumors are benign.
False - Most are malignant.
Are nasal tumors locally invasive?
Yes, they can also metastasize to regional lymph nodes.
What are the 2 most common types of nasal neoplasia seen in dogs?
- Adenocarcinoma
- Squamous cell carcinoma
What are the 2 most common types of nasal tumors in cats?
- Lymphoma
- Adenocarcinoma
What is needed for a diagnosis of nasal neoplasia?
Tissue biopsy
An inherited autosomal recessive defect with structural and functional changes of the cilia of the respiratory tract resulting in poor clearance of mucus from airways leading to chronic mucus plugging and inflammation is known as what?
Primary ciliary dyskinesia (PCD)
What are 3 areas affected by PCD?
- Nasal cavities
- Trachea
- Lower airways
What is the classic presentation of PCD?
Young, purebred dog with recurrent respiratory tract infections/signs.
Bronchiectasis with complete transposition of viscera (situs inversus) and chronic rhinosinusitis is known as what syndrome?
This syndrome is associated with what inherited disorder?
- Kartagener’s syndrome
- PCD (primary ciliary dyskinesia)
Diagnosis of primary ciliary dyskinesia requires what?
Culturing ciliated cells from biopsy samples and using transmission electron microscopy to see ciliary structure abnormalities.
Is there any treatment for PCD?
No
T/F: Nasal neoplasia can result in exophthalmia, facial distortion and sneezing.
True
T/F: The main clinical sign associated with nasal mites is sneezing.
True
T/F: Nasal aspergillus does not respond to systemic antifungal therapy.
True
