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clinical respiratory > Nasal & Nasopharyngeal Disorders in SA > Flashcards

Nasal & Nasopharyngeal Disorders in SA Flashcards

1
Q

Clinical signs of nasal/nasopharyngeal disorders

A

Sneezing (nasal dz/foreign material)
Reverse sneeze (caudal nasal cavity or nasopharynx)
Nasal discharge - req’s characterisation
Swallowing motion (retronasal d/c & swallowing)
Resp sound (stertor)
Resp pattern (normal, open mouth, inspiratory effort)
Duration of clinical signs & onset

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2
Q

What are some differentials for nasal or paranasal disorders?

A

congenital
inflammatory
infectious - fungal
neoplastic
nasal polyps
trauma
foreign body
extension of oral or dental dz

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3
Q

What are some differentials for systemic dz?

A

V/regurg –> reflux content in the nasal cavity
Infection
if epistaxis –> hypertension, coagulopathy, hyperviscosity, vasculitis

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4
Q

Are nasal & nasopharyngeal disorders an emergency?

A

Not often

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5
Q

When is further evaluation required if there is a nasal/ nasopharyngeal disorder suspected?

A

*systemic cause
*chronic signs
*severe hemorrhage, pain, malformation
*suspicion of a FB

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6
Q

How would you approach further eval of nasal/nasopharyngeal disorders?

A
  1. Bloods
  2. Imaging
  3. Direct observations
  4. Sampling
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7
Q

What would you be looking for on a CBC as a sign of a disorder?

A

Neutrophilia (toxic changes) –> inflammation
Epistaxis –> thrombocytopenia, erythrocytosis, Signs of anemia

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8
Q

What would you be looking for on biochemistry +/- protein electrophoresis?

A

Concomitant Dz
Systemic Dz
if epistaxis –> protein electrophoresis, hyperglobulinemia

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9
Q

What clotting tests would you use if you saw epistaxis and what are you looking for with each?

A

PT/PTT: coagulopathy
TEG: thrombopathy, fibrinolysis disorder

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10
Q

What tests might you do when looking for infectious dz in the nasal/nasopharyngeal areas?

A

Cryptococcal Antigen Test
Aspergillus Serology
Angiostrongylus Antigen Test
Faecal flotation
Leishmania/Ehrlichia if recent travel

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11
Q

Why are radiographs difficult of the nasal/nasopharyngeal areas?

A

*difficult to take/time consuming
*heavy sedation/GA often req’d
*less detail than CT
*little/no info on cribriform plate
*bony structure only
*poor qlty

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12
Q

Why is CT better than rads?

A

high sensitivity
allows for eval of bone/soft tissue incl. cribriform plate

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13
Q

Why would you use rhinoscopy?

A

*visualization of nasal mucosa & turbinates
*ID of foreign material, fungal plaques
*Tissue Sampling

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14
Q

What tests would you do on bx samples taken?

A

Histopath: neoplasia, inflammatory, fungal
Bacterial culture
Fungal culture: aspergillus, cryptococcus

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15
Q

What are some common nasal/ nasopharyngeal conditions?

A

FB
infectious dz
inflammatory conditions
neoplasia

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16
Q

What are clinical signs of a nasal FB?

A

acute onset of S
usually out in nature
+/- unilateral serous nasal d/c or epistaxis
later may develop mucopurulent d/c

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17
Q

How would you treat nasal FB?

A

Deep sedation/GA
Direct visualization
Otoscopic exam
Rhinoscopy
Flushing of nasal cavity

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18
Q

What are some common nasal/ nasopharyngeal infectious dz?

A

*Sinonasal aspergillosis
*cryptococcus (esp cats)
*pediatric feline URT dz
* bacterial rhinitis - rarely primary
*parasitic rhinitis –> Pneumonyssoides caninum (canine nasal mite)

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19
Q

What is the common fungi that causes sinonasal aspergillosis?

A

Aspergillus fumigatus

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20
Q

What are clinical signs that may cause you to suspect Sinonasal aspergillosis?

A

*mucopurulent, blood-tinged d/c
*unilateral than bilateral
*facial pain
*potential for CNS invasion
*depigmentation of nares

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21
Q

How would you diagnose sinonasal aspergillosis?

A

nasal CT
rhinoscopy
Bx
culture

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22
Q

What are some treatments that can be done for sinonasal aspergillosis?

A

local/topical
frontal sinus trepanation

23
Q

What medications can be used for sinonasal aspergillosis?

A

Clotrimazole
Enilconazole
Usually both infused

24
Q

What is the prognosis of an animal with Sinonasal aspergillosis?

A

Long-term generally good
Worse if CNS involved

25
Q

What are some environmental factors that can lead to pediatric feline upper respiratory tract dz?

A

poor hygiene
stress

26
Q

What organisms contribute to primary infection in pediatric feline URT dz?

A

Feline herpesvirus-1
Feline Calicivirus
Bordetella bronchiseptica
Chlamydophila felis
mycoplasma
streptococcus

27
Q

what organisms may contribute to a secondary infection in pediatric feline URT dz?

A

pasteurella spp
e. coli

28
Q

What clinical signs are common in pediatric feline URT dz?

A

lethargy & anorexia
sneezing
conjunctival hyperemia
serous & mucopurulent nasal & ocular d/c
resp distress - bronchopneumonia
death

29
Q

What testing could be done to help diagnose feline pediatric URT dz?

A

Bacterial culture
Virus isolation or PCR
PM

30
Q

if feline pediatric URT dz is mild to moderate, how would you treat?

A

Resolves on its own with time (2-3 wks)

31
Q

if feline pediatric URT dz is moderate to severe (mucopurulent d/c), what txt might you use?

A

fluid therapy
antimicrobials
enteral nutrition
nebulization and oxygen if bronchopneumonia is present

32
Q

If a relapse occurs, what txt might you use in feline pediatric URT dz?

A

Antivirals (Famciclovir)
Topical ophthalmic preparations
Other: interferon-mu, lysine

33
Q

How can one manage feline pediatric URT dz?

A

environmental mgmt (stress mgmt, overcrowding, disinfection)
Vx programs

34
Q

What are some inflammatory conditions common to the nasal & nasopharyngeal area?

A

Lymphoplasmacytic rhinitis (dogs)
feline chronic rhinosinusitis
nasopharyngeal polyp (cat)
nasopharyngeal stenosis

35
Q

Idiopathic lymphoplasmacytic rhinitis, aka chronic rhinitis, has what chronic clinical signs?

A

Sneezing
unilateral or bilateral nasal d/c (serous, mucopurulent, bloody)

36
Q

Idiopathic lymphoplasmacytic rhinitis is more common in which animals?

A

young to middle age more common
more common in large breeds/Dachshunds (?)

37
Q

How do you diagnose idiopathic lymphoplasmacytic rhinitis?

A

Exclusion (CT & rhinoscopy & Bx)
ID infiltrating plasmacytes & lymphocytes in nasal mucosa

38
Q

How might you treat idiopathic lymphoplasmacytic rhinitis?

A

Glucocorticoids - oral, topical
Cyclosporine - immune suppressors
Doxycycline - immunomodulating antibiotics
NSAIDs
Avoid irritants

39
Q

Feline chronic rhinosinusitis is suspected to be caused by…

A

Allergens
FHV-1
Mycoplasma, Bordetella

40
Q

How do you treat feline chronic rhinosinusitis?

A
  • Supportive care
  • antibiotics for secondary bacterial infection (culture & sensitivity, Doxycycline or Amoxi-clav)
  • Anti-inflammatories (Meloxicam, Glucocorticoids)
  • Repeated nasal flush with saline
  • Antivirals
41
Q

Feline nasopharyngeal polyps tend to originate from…

A

nasopharynx
middle/outer ear

42
Q

What are clinical signs of feline nasopharyngeal polyps?

A
  • mucopurulent d/c
  • sneezing &/or reverse sneezing
  • stertorous breathing
  • gagging or dysphagia
  • otitis
  • +/- Horner’s syndrome, head tilt
43
Q

How would you diagnose feline nasopharyngeal polyps?

A
  • CT
  • Direct visualisation (oral exam, otoscopy)
44
Q

What txt can be used for feline nasopharyngeal polyps?

A
  • Traction
  • Glucocorticoids
  • Ventral bulla osteotomy if recurrent
45
Q

Nasopharyngeal stenosis can be either…

A

congenital or acquired

46
Q

Nasopharyngeal stenosis is caused by

A

narrowing of nasal passages or nasopharynx causing an obstruction

47
Q

What clinical signs are present in nasopharyngeal stenosis?

A
  • mucopurulent nasal d/c
  • sneezing +/- reverse sneezing
  • stertorous breathing
  • gagging or dysphagia
48
Q

How would you diagnose nasopharyngeal stenosis?

A
  • Visualize stenosis (imaging & retroflex rhinoscopy)
  • balloon dilation
  • stent placement
49
Q

Neoplasia in the nasal & nasopharyngeal areas are often…

A

malignant & locally invasive, but rarely metastasize

50
Q

What are the most common neoplasias?

A
  • Nasal adenocarcinoma
  • nasal lymphoma
  • undifferentiated carcinoma
50
Q

How would you diagnose nasal/nasopharyngeal neoplasia?

A

CT
Bx

51
Q

Physical exam of neoplasia causes…

A
  • asymmetry of the face & muzzle
  • facial deformity or ulceration
  • nasal d/c, epistaxis, sneezing
52
Q

How would you locally treat nasal & nasopharyngeal disorders?

A

Radiotherapy

53
Q

How would you systemically treat nasal/nasopharyngeal neoplasia?

A

Chemotherapy
palliative care (analgesia, NSAIDs, Antibiotics as needed, etc)

clinical respiratory (7 decks)

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