Nasopharyngeal and Nasal Diseases Flashcards by Dakota Weber

Sneezing vs reverse sneezing?

Sneezing:
- Expiratory
- Usually associated with nasal or sinus disease

Reverse Sneezing:
- Inspiratory
- Usually associated with nasopharyngeal, caudal nasal, or sinus disease

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Which of the following is true about nasopharyngeal polyps?

A. More common in young dogs
B. More common in young cats
C. More common in old dogs
D. More common in old cats

B. More common in young cats

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What are causes of nasopharyngeal and middle ear polyps in cats?

Congenital
Chronic inflammation
Viral infection

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What are causes of nasopharyngeal and middle ear polyps in dogs?

Usually secondary to chronic inflammation/rhinitis

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What clinical signs can be present in patients with nasopharyngeal polyps?

- Chronic respiratory and/or otic signs
- Stertor
- Upper airway obstruction (may be in respiratory distress)
- Nasal discharge
- Voice change
- Reverse sneezing
- Gagging, coughing, excessive swallowing

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What abnormal respiratory sounds can be heard in a patient with polyps?

A. Stertor
B. Stridor
C. Wheezes
D. Crackles

A. Stertor (nasopharyngeal region)

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How are polyps causing respiratory distress treated?

Surgical intervention:
1. Traction-avulsion and corticosteroids
or
2. Ventral bulla osteotomy (VBO) if bulla involvement

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What is required for definitive diagnosis of a polyp to R/O neoplasia?

Histopath

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What is the prognosis after surgical resection of a polyp?

Good but recurrence is possible (VBO prevents recurrence)

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What are the causes of nasopharyngeal stenosis?

Regurg or vomiting (esp. under anesthesia)
Chronic inflammation
Post sx scarring
Trauma
Mass

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What is the treatment protocol for patients with nasopharyngeal stenosis?

Balloon dilation most effective

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What clinical signs can be seen in patients with nasopharyngeal stenosis?

-Stertor
- Gagging
- Open mouth breathing
- Nasal discharge
- Inspiratory and Expiratory dyspnea

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A patient with suspect nasopharyngeal stenosis. How to diagnose?

Endoscopy
CT

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What is the most common cause of fungal rhinitis in cats?

Cryptococcus

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What are the clinical signs of fungal rhinitis in cats?

Sneezing
Nasal discharge (mucoid or purulent, often unilateral)

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Which of the following is true about fungal rhinitis in cats?

A. More common in younger cats
B. More common in older cats

A. More common in younger cats

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What mass effects result from fungal rhinitis in cats with cryptococcus?

Decreased/absent nasal airflow
Exopthalmos
Facial asymmetry
Stertor
Mass in pterygopalantine fossa

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What diagnostics need to be ran in a cat with external ulcers around the face, exopthalmos, absent airflow, and unilateral mucopurulent nasal discharge?

All clinical signs of fungal rhinitis (crypto)

MDB, FELV, FIV
Thoracic rads (R/O metastatic neoplasia)
Cytology + culture of nasal d/c
CT (Fungal rhinitis won’t cause bone lysis)
Rhinoscopy with biopsy (after CT- more invasive, can skew results if done before)

What is the drug of choice for treatment of cryptococcus in cats?

Fluconazole PO - continue until Ag agglut test is 0

What is the drug of choice for treatment of aspergillus in cats?

Posaconazole or Itraconazole pO

What is the prognosis for a cat with an aspergillus infection?

Good if no CNS involvement, for for sino-orbital aspergillosis

Which of the following usually does not cause bony destruction and turbinate lysis?

A. Nasal neoplasia
B. Chronic rhinosinusitis
C. Cryptococcus
D. Sino-orbital aspergillosis

C. Cryptococcus

Common CS seen in cats and dogs with nasal neoplasia?

- Upper airway obstruction, decreased nasal airflow, epistaxis, sneezing - Ocular and CNS signs can be present

In cats, __________ usually causes unilateral mucopurulent nasal discharge, while _________ usually causes bilateral mucopurulent nasal discharge

cryptococcus, chronic rhinosinusitis

Nasal airflow is usually preserved in which of the following nasal diseases in cats? A. Nasal neoplasia B. Chronic rhinosinusitis C. Cryptococcus D. Sino-orbital aspergillosis

B. Chronic rhinosinusitis

What clinical signs can be seen in cats with chronic rhinosinusitis?

- Sneezing - **Mucopurulent bilateral nasal discharge** - Usually nasal airflow is preserved

What age of cats are more susceptible to chronic rhinosinusitis?

Any and all ages

What diagnostics should be ran in a cat with suspect chronic rhinosinusitis?

- MDB, FELV, FIV - Thoracic rads - CT (can see bone lysis and inc. fluid density) - Rhinoscopy and biopsy - Dental exam

What is the drug treatment protocol for a cat with chronic rhinosinusitis?

1. Antibiotics (Doxy, Azithromycin, Amoxi/Clav) 2. NSAID (Meloxicam or Piroxicam) or Glucocorticoid (Pred)

What is the most common cause fungal rhinitis in dogs?

Aspergillus

What age and breed signalment in dogs are usually more susceptible to fungal rhinitis?

- Young to mild age - **Dolichocephalics** , long nose breeds! (GSD,etc)

What clinical signs can be seen in dogs with fungal rhinitis?

- Copious mucopurulent nasal discharge, can be uni or bilateral - Sneezing - Epistaxis - Facial pain, depigmentation, ulceration

What can be visualized on CT from a dog with fungal rhinitis?

- Destruction of turbinates and cavitations - Assess the integrity of the cribiform plate

True or False: Dogs and cats with fungal rhinitis must be monitored throughout life as relapse is not uncommon

True

What is the treatment protocol for dogs with fungal rhinitis?

- Topical infusion of Clotrimazole or Enilconazole (catheter placed and soak with solution for 1 hr under GA) - OR depot cream - Antifungal PO if cribiform plate is not intact (Intraconazole, Terbinafine for 3-6 months)

What is the prognosis for a dog with fungal rhinitis?

Fair to good, relapse in common (50%)

What age and breed signalment in dogs are usually more susceptible to idiopathic lymphocytic rhinitis (ILPR)?

- Young to middle age - **Dolichocephalics** , long nose breeds! - Mesaticephalic large breeds - **Dachshunds**

What clinical signs can be present in a dog with idiopathic lymphocytic rhinitis (ILPR)?

- Uni or bilateral mucopurulent nasal discharge - Epistaxis - Excessive mucus/mucosal edema may obstruct airflow

What diagnostics should be ran in a dog with suspect idiopathic lymphocytic rhinitis (ILPR)?

- MDB - Thoracic rads - Blood pressure and coag panel if discharge is hemorrhagic

What can be visualized on CT from a dog with idiopathic lymphocytic rhinitis (ILPR)?

May be normal or may show turbinate lysis and mucus accumulation - Bony destruction and mass lesions are rare with ILPR

What is the treatment protocol for dogs with idiopathic lymphocytic rhinitis (ILPR)?

- Avoid smoke and other allergens - Long term (6+ month) antibiotic with immunomodulatory effects + NSAID - ^^ Doxycycline and Piroxicam

What is the prognosis for a dog with idiopathic lymphocytic rhinitis (ILPR)?

Fair, cure rarely achieved, frustrating if d/c can't be controlled

If nasal discharge is hemorrhagic, which additional diagnostics should be ran?

- Blood pressure and coag panel if discharge is hemorrhagic Have to R/O: Systemi hypertension, coagulopathy, hyperviscosity, vasculitis, etc

Which of the following is least likely to cause epistaxis? A. Nasal neoplasia B. Fungal rhinitis C. Chronic rhinosinusitis D. idiopathic lymphocytic rhinitis (ILPR)

C. Chronic rhinosinusitis