Nasal Disease

Question 1

How does hypoxia differ from hypoxemia?

Answer 1

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

Question 2

How does tachypnea differ from hyperpnea vs. hyperventilation?

Answer 2

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

Question 3

Define apneustic breathing

Answer 3

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

Question 4

Define ataxic or agonal breathing

Answer 4

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

Question 5

Define paradoxic breathing

Answer 5

Different parts of the resp support apparatus moving in opposition

Question 6

Define Kussmaul (air hunger)

Answer 6

Regular deep (and rapid?) breathing

Question 7

Define Cheyne-Stokes

Answer 7

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

Question 8

Define Biot’s respiration

Answer 8

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

Question 9

Describe bronchial (tracheal) respiratory sounds

Answer 9

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

Question 10

Describe vesicular respiratory sounds

Answer 10

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

Question 11

Describe bronchovesicular respiratory sounds

Answer 11

Intermediate pitch combination sound, hear over peri-hilar region, Timing/Duration: I about same as E with pause in between, Intensity: I>E

Question 12

Define stertor

Answer 12

Snoring sound produced by partial obstruction of nose/nasopharynx

Question 13

Define stridor

Answer 13

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

Question 14

Define crackles

Answer 14

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

Question 15

Define wheezes

Answer 15

Continuous whistling sounds caused by air turbulence in narrowed airways

Question 16

Define end-expiratory grunts

Answer 16

May indicate air-trapping associated with bronchoconstriction

Question 17

Define pleural rubs

Answer 17

May indicate irregular pleural surface scraping against another surface

Question 18

Define fluid lines

Answer 18

Typically muffled sounds centrally

Question 19

Causes of unilateral nasal discharge

Answer 19

FB, neoplasia, tooth root abscess, fungal rhinitis

Question 20

Causes of bilateral nasal discharge

Answer 20

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

Question 21

Causes of serous nasal discharge

Answer 21

Allergens, irritants, ocular inflammation, viral rhinitis, neoplasia, nasal mites

Question 22

Causes of mucoid nasal discharge

Answer 22

Mycotic rhinitis, neoplasia

Question 23

Causes of mucopurulent or purulent nasal discharge

Answer 23

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)

Question 24

Causes of hemorrhagic nasal discharge

Answer 24

Fungal disease, neoplasia, hypertension (pheo, Cushing’s), Rickettsial dz, thrombocytopenia/pathia, coagulopathy, trauma

Question 25

In what situations would a cytology of nasal secretions be helpful?

Answer 25

Nasal cryptococcus (NOT for bacteria - presence is always normal)

Question 26

When might serology be useful in diagnosing and monitoring treatment response of a nasal disease?

Answer 26

Nasal cryptococcosis

Question 27

Which test is useful for Aspergillus testing?

Answer 27

Urine galactomannan -NOT specific, should improve with treatment

Question 28

T or F: Nasal radiographs are highly useful in diagnosing most nasal diseases

Answer 28

False; difficult to achieve and time consuming for little result

Question 29

What are some indications for rhinoscopy?

Answer 29

Suspected FBs, neoplasia, fungal rhinitis, nasopharyngeal disease (polyps) or for sample collection

Question 30

What diagnostic test is most likely to yield a specific diagnosis if there is a primary disease (particularly if cost is an issue)?

Answer 30

Nasal biopsy (blind if cost is an issue)

Question 31

How many biopsy samples minimum should be taken when sampling?

Answer 31

At least 6

Question 32

What are the 3 methods of nasal biopsies and which one is least likely to cause massive hemorrhage?

Answer 32

Pinch, core, and traumatic nasal flushing; core (b/c you’re crushing, not sectioning)

Question 33

What must you do prior to performing any type of nasal biopsy?

Answer 33

Measure the distance from the nostril to the medial canthus of the eye to prevent accidental penetration of the cribriform plate into the calvarium

Question 34

What are the two most commonly cultured fungi from nasal swabs?

Answer 34

Aspergillus fumigatus (different from systemic species) and Penicillium spp.

Question 35

Feline rhinotracheitis virus can cause what?

Answer 35

Corneal ulceration, abortion and neonatal death

Question 36

Feline calicivirus can cause what?

Answer 36

Oral ulceration, pneumonia and polyarthritis

Question 37

Chlamydial disease typically causes what?

Answer 37

Mild disease and conjunctivitis only

Question 38

Antibiotics are indicated in treatment of feline URIs only if....

Answer 38

Chlamydia or Mycoplasma is suspected OR in very severe cases where secondary bacterial infections are suspected (Doxy, azithromycin, amoxicillin or ampicillin)

Question 39

What are the most common types of nasal tumors in dogs? Are these typically benign or malignant?

Answer 39

Adenocarcinoma, SCC, and undifferentiated carcinoma; malignant

Question 40

What are the most common types of nasal tumors in cats? Are these typically benign or malignant?

Answer 40

Lymphoma and adenocarcinoma; malignant

Question 41

What is the treatment of choice for most malignant nasal tumors?

Answer 41

radiation

Question 42

Palliative care for nasal tumors might include what?

Answer 42

NSAID’s (COX-2 selective) to decrease inflammation and pain

Question 43

What are the clinical signs of a cat with a nasopharyngeal polyp?

Answer 43

Stertorous breathing, nasal D/C (serous to mucopurulent, often unilateral), upper airway obstruction, signs of otitis externa/media/interna (Horner’s, head tilt, nystagmus)

Question 44

What are the clinical signs of Cryptococcosis?

Answer 44

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

Question 45

What are the two methods of diagnosing Cryptococcus neoformans?

Answer 45

Cytology of nasal d/c or latex agglutination for antigen in serum, aqueous humor or CSF (highly sensitive and specific)

Question 46

What is the treatment for Cryptococcosis?

Answer 46

Long term antifungals (Keto/Itra/Fluconazole, 5-flucytosine) or Amphotericin B in life threatening cases

Question 47

What are the clinical signs of Aspergillosis?

Answer 47

Nasal d/c (serous, mucopurulent, sangiuno-purulent), epistaxis, nasal pain, ulceration of external nares

Question 48

How might you differentiate nasal aspergillosis from nasal neoplasia on imaging?

Answer 48

Both cause turbinate destruction, but neoplasia does not cause as much radiolucency within the nostril as aspergillosis

Question 49

How do you treat nasal aspergillosis?

Answer 49

Topical (intra-nasal) clotrimazole or enilconazole

Question 50

T or F: Bacterial rhinitis is an extremely common primary nasal disease

Answer 50

False, highly uncommon although can be a SECONDARY complication in almost all other nasal dz (Bordetella and Mycoplasma are primary pathogens)