Nasal Disease Flashcards
How does hypoxia differ from hypoxemia?
Hypoxia = decreased O2 delivered to tissue Hypoxexmia = decreased O2 content in blood (PaO2 below ref range)
How does tachypnea differ from hyperpnea vs. hyperventilation?
Tachypnea = increased rate/frequency Hyperpnea = increased depth/airflow Hyperventilation = increased minute volume of alveolar airflow
Define apneustic breathing
Deep, long inspiration followed by breath-holding, then rapid exhalation
Define ataxic or agonal breathing
Continuous irregular shifts of hyper- and hypo-ventilation and apnea
Define paradoxic breathing
Different parts of the resp support apparatus moving in opposition
Define Kussmaul (air hunger)
Regular deep (and rapid?) breathing
Define Cheyne-Stokes
Regularly irregular, with alternating periods of progressive or waxing/waning hyperpnea and apnea
Define Biot’s respiration
Irregularly irregular, with alternating periods of identical-depth hyperpnea and apnea
Describe bronchial (tracheal) respiratory sounds
Intermediate/high pitch, “tubular/hollow”, sound produced by turbulent airflow in trachea; hear over trachea, thoracic inlet, maybe peri-hilar; timing/duration of sound: both I and E w/ I about same length of E and pause in between; Intensity: I>E
Describe vesicular respiratory sounds
Low pitch, “soft rustling’ sound from turbulent airflow in large bronchi, heard over most of thorax; Timing/Duration: both I and E w/ I»E; Intensity: I»E
Describe bronchovesicular respiratory sounds
Intermediate pitch combination sound, hear over peri-hilar region, Timing/Duration: I about same as E with pause in between, Intensity: I>E
Define stertor
Snoring sound produced by partial obstruction of nose/nasopharynx
Define stridor
High pitched, harsh, vibratory noise caused by partial obstruction of the upper airway (oropharynx/larynx/trachea)
Define crackles
Discontinuous bubbling/popping sounds as air passes thru fluid or forces collapsed airway/alveolar walls open
Define wheezes
Continuous whistling sounds caused by air turbulence in narrowed airways
Define end-expiratory grunts
May indicate air-trapping associated with bronchoconstriction
Define pleural rubs
May indicate irregular pleural surface scraping against another surface
Define fluid lines
Typically muffled sounds centrally
Causes of unilateral nasal discharge
FB, neoplasia, tooth root abscess, fungal rhinitis
Causes of bilateral nasal discharge
Viral/bacterial infections, allergic rhinitis, advanced neoplasia/fungal rhinitis
Causes of serous nasal discharge
Allergens, irritants, ocular inflammation, viral rhinitis, neoplasia, nasal mites
Causes of mucoid nasal discharge
Mycotic rhinitis, neoplasia
Causes of mucopurulent or purulent nasal discharge
Viral/bacterial upper or lower respiratory tract infection, neoplasia, fungal infection, nasopharyngeal polyp, oronasal fistula, nasopharyngeal stenosis/stricture, pneumonia, primary ciliary dyskinesia, cleft palate, xerostomia, algal infection (prototheca)
Causes of hemorrhagic nasal discharge
Fungal disease, neoplasia, hypertension (pheo, Cushing’s), Rickettsial dz, thrombocytopenia/pathia, coagulopathy, trauma
In what situations would a cytology of nasal secretions be helpful?
Nasal cryptococcus (NOT for bacteria - presence is always normal)
When might serology be useful in diagnosing and monitoring treatment response of a nasal disease?
Nasal cryptococcosis
Which test is useful for Aspergillus testing?
Urine galactomannan -NOT specific, should improve with treatment
T or F: Nasal radiographs are highly useful in diagnosing most nasal diseases
False; difficult to achieve and time consuming for little result
What are some indications for rhinoscopy?
Suspected FBs, neoplasia, fungal rhinitis, nasopharyngeal disease (polyps) or for sample collection
What diagnostic test is most likely to yield a specific diagnosis if there is a primary disease (particularly if cost is an issue)?
Nasal biopsy (blind if cost is an issue)
How many biopsy samples minimum should be taken when sampling?
At least 6
What are the 3 methods of nasal biopsies and which one is least likely to cause massive hemorrhage?
Pinch, core, and traumatic nasal flushing; core (b/c you’re crushing, not sectioning)
What must you do prior to performing any type of nasal biopsy?
Measure the distance from the nostril to the medial canthus of the eye to prevent accidental penetration of the cribriform plate into the calvarium
What are the two most commonly cultured fungi from nasal swabs?
Aspergillus fumigatus (different from systemic species) and Penicillium spp.
Feline rhinotracheitis virus can cause what?
Corneal ulceration, abortion and neonatal death
Feline calicivirus can cause what?
Oral ulceration, pneumonia and polyarthritis
Chlamydial disease typically causes what?
Mild disease and conjunctivitis only
Antibiotics are indicated in treatment of feline URIs only if….
Chlamydia or Mycoplasma is suspected OR in very severe cases where secondary bacterial infections are suspected (Doxy, azithromycin, amoxicillin or ampicillin)
What are the most common types of nasal tumors in dogs? Are these typically benign or malignant?
Adenocarcinoma, SCC, and undifferentiated carcinoma; malignant
What are the most common types of nasal tumors in cats? Are these typically benign or malignant?
Lymphoma and adenocarcinoma; malignant
What is the treatment of choice for most malignant nasal tumors?
radiation
Palliative care for nasal tumors might include what?
NSAID’s (COX-2 selective) to decrease inflammation and pain
What are the clinical signs of a cat with a nasopharyngeal polyp?
Stertorous breathing, nasal D/C (serous to mucopurulent, often unilateral), upper airway obstruction, signs of otitis externa/media/interna (Horner’s, head tilt, nystagmus)
What are the clinical signs of Cryptococcosis?
Sneezing and nasal d/c (serous to mucopurulent and may be blood-tinged, uni or bilateral), +/- granulomatous lesions causing facial deformity or ulceration of nasal planum
What are the two methods of diagnosing Cryptococcus neoformans?
Cytology of nasal d/c or latex agglutination for antigen in serum, aqueous humor or CSF (highly sensitive and specific)
What is the treatment for Cryptococcosis?
Long term antifungals (Keto/Itra/Fluconazole, 5-flucytosine) or Amphotericin B in life threatening cases
What are the clinical signs of Aspergillosis?
Nasal d/c (serous, mucopurulent, sangiuno-purulent), epistaxis, nasal pain, ulceration of external nares
How might you differentiate nasal aspergillosis from nasal neoplasia on imaging?
Both cause turbinate destruction, but neoplasia does not cause as much radiolucency within the nostril as aspergillosis
How do you treat nasal aspergillosis?
Topical (intra-nasal) clotrimazole or enilconazole
T or F: Bacterial rhinitis is an extremely common primary nasal disease
False, highly uncommon although can be a SECONDARY complication in almost all other nasal dz (Bordetella and Mycoplasma are primary pathogens)
