Nasal Disease Flashcards by Payton Bayless

How does hypoxia differ from hypoxemia?

Hypoxia = decreased O2 delivered to tissue
Hypoxexmia = decreased O2 content in blood (PaO2 below ref range)

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How does tachypnea differ from hyperpnea vs. hyperventilation?

Tachypnea = increased rate/frequency 
Hyperpnea = increased depth/airflow
Hyperventilation = increased minute volume of alveolar airflow

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Define apneustic breathing

Deep, long inspiration followed by breath-holding, then rapid exhalation

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Define ataxic or agonal breathing

Continuous irregular shifts of hyper- and hypo-ventilation and apnea

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Define paradoxic breathing

Different parts of the resp support apparatus moving in opposition

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Define Kussmaul (air hunger)

Regular deep (and rapid?) breathing

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Define Cheyne-Stokes

Regularly irregular, with alternating periods of progressive or waxing/waning hyperpnea and apnea

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Define Biot’s respiration

Irregularly irregular, with alternating periods of identical-depth hyperpnea and apnea

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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

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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

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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

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Define stertor

Snoring sound produced by partial obstruction of nose/nasopharynx

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Define stridor

High pitched, harsh, vibratory noise caused by partial obstruction of the upper airway (oropharynx/larynx/trachea)

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Define crackles

Discontinuous bubbling/popping sounds as air passes thru fluid or forces collapsed airway/alveolar walls open

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Define wheezes

Continuous whistling sounds caused by air turbulence in narrowed airways

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Define end-expiratory grunts

May indicate air-trapping associated with bronchoconstriction

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Define pleural rubs

May indicate irregular pleural surface scraping against another surface

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Define fluid lines

Typically muffled sounds centrally

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Causes of unilateral nasal discharge

FB, neoplasia, tooth root abscess, fungal rhinitis

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Causes of bilateral nasal discharge

Viral/bacterial infections, allergic rhinitis, advanced neoplasia/fungal rhinitis

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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)