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MODULE 15 - Cardiorespiratory and Haematopoietic Disease > PATHOLOGY - Small Animal Upper Respiratory Disease > Flashcards

PATHOLOGY - Small Animal Upper Respiratory Disease Flashcards

1
Q

What is stridor?

A

Stridor is a harsh, high pitched sound heart on inspiration which will resolve at rest/sleeping and worsen an exercise and excitement

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2
Q

What is indicated by stridor?

A

Stridor indicates upper airway obstruction and laryngeal paralysis

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3
Q

What is laryngeal paralysis?

A

Laryngeal paralysis is when their is failure of the dorsal cricoarytenoid muscle resulting in the glottis being unable to abduct during inhalation

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4
Q

What are the four clinical signs of laryngeal paralysis?

A

Stridor
Dysphonia
Gagging and coughing when eating and drinking
Exercise intolerance

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5
Q

What are the four clinical signs of an acute crisis of laryngeal paralysis?

A

Severe dyspnoea
Stridor
Cyanosis
Collapse

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6
Q

Which can trigger an acute crisis of laryngeal paralysis?

A

Excitement
Heat
Stress
Exercise

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7
Q

How do you diagnose laryngeal paralysis?

A

You diagnose laryngeal paralysis by visualising the larynx as the patient is recovering from anaesthesia. You cannot diagnose this while the patient in under anaesthesia, as all anaesthetic drugs will supress laryngeal function which could result in a false positive

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8
Q

How do you treat and manage an acute crisis of laryngeal paralysis?

A

Oxygen supplementation
Sedation
Steroids
Cooling

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9
Q

What should you do if your patient is not improving following supportive care for an acute crisis of laryngeal paralysis?

A

If your patient is not improving, consider surgical intervention or do an emergency tracheostomy

Have a conversation with the owner about this, and be aware that the surgery is very risky and can affect quality of life - especially as these tend to be older dogs

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10
Q

Which two surgical procedures can be done to treat laryngeal paralysis?

A

Cricoarytenoid lateralisation (tieback) surgery
Partial arytenoidectomy

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11
Q

What lifestyle changes have to be made following surgical correction of a laryngeal paralysis?

A
  • Animals should be encouraged to eat slowly and drink only water, as there is a high risk of aspiration pneumonia
  • Animals will not be allowed to swim as there is a high risk of aspiration pneumonia
  • Use a harness rather than a lead and collar
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12
Q

What are the three main causes of laryngeal paralysis?

A

Idiopathic
Congenital
Secondary to other diseases

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13
Q

What signalement is prone to idiopathic laryngeal paralysis?

A

Old, medium to large breed dogs

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14
Q

Which dog breed is predisposed to laryngeal paralysis?

A

Labrador Retreivers

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15
Q

List six factors which can cause secondary laryngeal paralysis

A

Damage to the recurrent laryngeal nerve
Trauma
Myopathy
Neuropathy
Neoplasia
Hypothyroidism

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16
Q

Which surgical procedure can cause damage to the recurrent laryngeal nerve and subsequent laryngeal paralysis?

A

Thyroidectomy

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17
Q

What is stertor?

A

Stertor low pitch, snoring sound that worsens during excitement and sleeping

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18
Q

What is indicated by stertor?

A

Brachycephalic airway obstruction syndrome (BOAS)

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19
Q

What are the primary anatomical components of brachycephalic airway obstruction syndrome (BOAS)?

A

Stenotic nares
Elongated soft palate
Excess pharyngeal mucosa
Aberrant turbinates
Hypoplastic trachea

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20
Q

What are aberrant turbinates?

A

Aberrant turbinates are structural defromaties where the nasal turbinates extend beyond their normal anatomical limits

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21
Q

In which brachycephalic breed are hypoplastic tracheas more commonly seen?

A

Bulldogs

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21
Q

In which brachycephalic breed are aberrant turbinates more commonly seen?

A

Pugs

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22
Q

Which secondary conditions are seen as a result of brachycephalic airway obstruction syndrome (BOAS)?

A

Everted laryngeal saccules
Tonsillar hyperplasia and eversion
Laryngeal collapse
Regurgitation
Hiatal hernia

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23
Q

What is a hiatal hernia?

A

A hiatal hernia is when part of the stomach herniates into the thorax

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24
Q

What are the main consequences of brachycephalic airway obstruction syndrome (BOAS) that influence day to day life?

A

Inflammation and soft tissue thickening
Increased respiratory effort
Stertor
Regurgitation and aspiration
Exercise intolerance
Dyspnoea
Cyanosis
Heat intolarance
Collapse
Risk of death

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25
Q

How does brachycephalic airway obstruction syndrome (BOAS) cause inflammation and soft tissue thickening?

A

Brachycephalic airway obstruction syndome (BOAS) results in turbulent airflow due to the anatomical abnormalities. This turbulent airflow causes inflammtion and subsequent soft tissue thickening which will worsen the airway obstruction and turbulent airflow

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26
Q

How does brachycephalic airway obstruction syndrome (BOAS) cause heat intolerance?

A

The nasal cavity plays a central role in an animal’s ability to regulate their temperature, in animals with brachycephalic airway obstruction syndrome (BOAS), their nasal cavity is obstructed and thus they are unable to carry out adequate heat exchange. These animals will thus be heat intolerant, which will increase their oxygen demand and worsen their condition

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27
Q

Why does brachycephalic airway obstruction syndrome (BOAS) increase the risk of aspiration?

A

Brachycephalic airway obstruction syndrome (BOAS) increases regurgitation which will increase the risk of aspiration and thus aspiration pneumonia

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28
Q

What is the key clinical sign of an acute episode of brachycephalic airway obstruction syndrome (BOAS)?

A

Severe dyspnoea

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29
Q

How do you manage an acute episode of brachycephalic airway obstruction syndrome (BOAS)?

A

Oxygen supplementation
Sedation
Cooling
Administer steroids

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30
Q

What method of oxygen supplementation should you use for acute episodes of brachycephalic airway obstruction syndrome (BOAS), and why?

A

Flow-by oxygen is the best method as it is the least stressful for your patient so you reduce the risk of stressing the patient out and worsening their dyspnoea

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31
Q

Which sedative is recommended for patients suffering from an acute episode of brachycephalic airway obstruction syndrome (BOAS)?

A

Butorphanol

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32
Q

Why should you administer steroids to patients suffering from an acute episode of brachycephalic airway obstruction syndrome (BOAS)?

A

Steroids should be administered as brachycephalic airway obstruction syndrome (BOAS) causes inflammation and soft tissue thickening and steroids reduce inflammation

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33
Q

Which steroid should you use in an acute episode of brachycephalic airway obstruction syndrome (BOAS)?

A

IV or IM Dexamethasone

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34
Q

What should you do if your patient is not improving following supportive care for acute brachycephalic airway obstruction syndrome (BOAS)?

A

If your patient is not improving, consider putting them under anaesthesia and intubating them, or do an emergency tracheostomy

Have a conversation with the owner about this, and be aware there is a chance the animal may not recover from anaesthesia

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35
Q

What advice should you give to owners to manage brachycephalic airway obstruction syndrome (BOAS)?

A

Weight loss
Use a harness rather than a lead and collar
Short walks in the morning and/or evening (when it is cooler)
Minimise stressors
Consider surgical intervention

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36
Q

What are stenotic nares?

A

Stenotic nares are caused by the collapse of the dorsolateral cartilages after birth

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37
Q

Which surgical intervention can be done to correct stenotic nares?

A

Wedge resection

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38
Q

At what age can you do a wedge resection?

A

You can do a wedge resection from 3 to 6 months old

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39
Q

How do you diagnose an elongated soft palate?

A

You diagnose an elongated soft palate by visualising the soft palate under anaesthesia

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40
Q

Which surgical intervention can be done to correct an elongated soft palate?

A

Soft palate resection

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41
Q

What are the landmarks for diagnosing an elongated soft palate?

A

If the soft palate extends beyond the caudal poles of the tonsils, it is an elongated soft palate

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42
Q

How does brachycephalic obstructed airway syndome (BOAS) cause eversion of the laryngeal saccules?

A

Brachycephalic obstructed airway syndrome (BOAS) causes an increased respiratory effory which will generate a negative pressure which will evert the laryngeal saccules

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43
Q

Which surgical intervention can be done to correct laryngeal saccule eversion?

A

The laryngeal saccules can be removed however this is not always done

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44
Q

How does brachycephalic obstructed airway syndome (BOAS) cause laryngeal collapse?

A

Brachycephalic obstructed airway syndrome (BOAS) causes an increased respiratory effory which will generate a negative pressure which can cause laryngeal collapse

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45
Q

Which two surgical procedures can be done to correct laryngeal collapse?

A

Cricoarytenoid lateralisation (tieback) surgery
Partial arytenoidectomy

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46
Q

What are feline polyps?

A

Feline polyps are benign inflammatory growths of connective tissue that arise from the mucosal lining of the tympanic bulla and extend into the external ear canal - known as an aural polyp - or extend into the nasopharynx - known as a nasopharyngeal polyp

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47
Q

What are the clinical signs of nasopharyngeal polyps?

A

Stertor
Dysphagia
Unilateral nasal discharge

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48
Q

Which surgical procedure can be done to correct nasopharyngeal polyps?

A

Traction evulsion

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49
Q

What are some of the risks of traction evulsions of feline polyps?

A

Horner’s syndome
Vestibular disease

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50
Q

What sugical procedure may be required if feline polyps recur after traction evulsion?

A

Ventral bulla osteotomy

This is referral surgery

51
Q

Which ten questions can be useful to ask when gathering a history when an animal presents with nasal discharge?

A

Has this nasal discharge been acute or chronic?
Is the nasal discharge uni- or bilateral?
What is the nature of the discharge?
Has your pet been sneezing or reverse sneezing?
Has your pet been coughing?
Has there been any head shyness or reluctance to eat?
Has your pet been pawing at or rubbing their face on the ground?
Is there a history of dental disease?
Has there been any trauma?
Vaccinations/worming?
Any recent travel?

52
Q

When is nasal discharge classified as acute or chronic?

A

Nasal discharge is acute is it has been going on for less than three weeks, and it is chronic if it has been going on for more than three weeks

53
Q

What is indicated by acute nasal discharge?

A

Foreign body
Infection

54
Q

What is indicated by chronic nasal discharge?

A

Fungal disease
Neoplasia
Chronic infection

55
Q

What is indicated by unilateral nasal discharge in small animals?

A

Foreign body
Polyp
Tooth root abscesses
Fungal disease
Neoplasia

i.e. more localised disease

56
Q

What is indicated by bilateral nasal discharge in small animals?

A

Systemic disease
Infectious disease
Progressive fungal disease
Progressive neoplasia

57
Q

What are the six different forms of nasal discharge?

A

Serous
Mucoid
Purulent
Sanguineous
Epistaxis
Food containing discharge

58
Q

What is this form of nasal dischage?

A

Serous nasal discharge

59
Q

What are the four main differentials for serous discharge?

A

Normal
Viral infection
Non-infectious inflammatory disease
Early signs of an aetiology that will progress to mucopurulent discharge

60
Q

Which species more commonly experience serous discharge due to viral infections?

A

Cats

61
Q

What is this form of nasal discharge?

A

Mucoid nasal discharge

62
Q

What is the form of this nasal discharge?

A

Purulent nasal discharge

63
Q

What are the differentials for mucopurulent nasal discharge?

A

Mucopurulent nasal discharge is non-specific and can occur with any causes of inflammation as well as diseases of the lower airways

64
Q

List five examples of diseases which can cause mucopurulent discharge

A

Infection
Neoplasia
Foreign bodies
Polyps
Bronchopneumonia

65
Q

What is this form of nasal discharge?

A

Epistaxis

66
Q

What are the differentials for epistaxis?

A

Epistaxis is non-specific and can be indicative of local and systemic disease

67
Q

What are three local causes of epistaxis?

A

Neoplasia
Fungal disease
Acute trauma

68
Q

Which other type of nasal discharge does fungal disease commonly present with in addition to epistaxis?

A

Mucopurulent discharge

69
Q

What is the main systemic cause of epistaxis?

A

Haemostatic disorders

70
Q

Which investigative tests should you always do if a patient presents with epistaxis?

A

Platelet count
Buccal mucosal bleeding time
Prothombin time (PT)
Activated partial thromboplastin time (aPTT)

71
Q

What are the two main differentials for food containing nasal discharge in young animals?

A

Cleft palate
Dysphagic condition

Cleft palate
72
Q

What is the main differential for food containing nasal discharge in older animals?

A

Oronasal fistula

73
Q

(T/F) Reverse sneezing is generally harmless

A

TRUE. Owners will often be very alarmed but generally reverse sneezing is harmless. However, prolonged reverse sneezing can indicate there is chronic nasal disease

74
Q

What should you assess during a clinical exam of an animal with nasal discharge?

A
  1. General clinical examination
  2. Assess facial symmetry
  3. Assess for facial pain
  4. Assess for exopthalmos, third eyelid protrusion and inability to retropulse the eye
  5. Characterise the nasal discharge
  6. Assess for oral, rhinarium and ocular ulceration
  7. Assess for crusting or depigmentation of the rhinarium
  8. Intraoral exam to assess for dental disease, holes, massess or halitosis
  9. Assess for airflow at the nostrils
  10. Assess for signs of haemostatic disorders if indicated
Dog with crusting and depigmentation of the rhinarium
75
Q

What is halitosis?

A

Halitosis means bad smelling breath

76
Q

Which investigative tests can you do for patients presenting with nasal discharge?

A

Radiography
CT/MRI
Rhinoscopy
Nasal biopsy
Nasal flush
Nasal swabs

77
Q

What are the main limitations of radiography for investigating nasal discharge?

A

Superimposition of nasal structures
Poor definition of soft tissue changes
Inability to distinguish between soft tissue and fluid

78
Q

What are the key signs of pathology on radiographs of the nasal cavity?

A

Loss of nasal turbinate pattern
Increased soft tissue/fluid opacity
Increased radio-lucency
Bony destruction
Extra-nasal changes

79
Q

(T/F) Radiography of the nasal cavity requires general anaesthetic

A

TRUE.

80
Q

What are the basic radiograph views that should be used to investigate nasal discharge?

A

Dorsoventral intra-oral
Left lateral oblique
Right lateral oblique

81
Q

What is the main advantage of a dorsoventral intra-oral radiograph view?

A

A dorsoventral intra-oral radiograph view allows for assessment of the nasal cavity without superimposition of the mandible

82
Q

What is the main advantage of lateral oblique radiograph views?

A

A lateral oblique radiograph view seperates the two sides of the skull for assessment

83
Q

Which additional radiograph views can sometimes be done to investigate nasal discharge?

A

Open mouth ventrodorsal
Rostrocaudal

84
Q

What is the main advantage of an open mouth ventrodorsal radiograph view?

A

An open mouth ventrodorsal radiograph view allows for the assessment of more caudal structures (such as the cribriform plate)

85
Q

What is the main advantage of a rostrocaudal radiograph view?

A

A rostrocaudal radiograph view allows you to assess the frontal sinuses

Increased radiolucency of the frontal sinus caused by fungal disease
86
Q

What are the advantages of using CT/MRI to investigate nasal discharge?

A

CT/MRI are more accurate than other forms of imaging

87
Q

What is the main disadvantage of using CT/MRI to investigate nasal discharge?

A

CT/MRI is expensive and less readily available

88
Q

What are the two methods that can be used to do a nasal biopsy?

A

Rhinoscope directed nasal biopsy
Blind biopsy

89
Q

Which landmarks should you use to avoid penetrating the cribriform plate when doing a blind nasal biopsy?

A

Measure the grab biopsy tool from the nose to the medial canthus of the eye and don’t advance the grab biopsy tool beyond that point

90
Q

Why should patients preferably stay in the practice overnight following a nasal biopsy?

A

Nasal biopsies can result in a lot of bleeding which can be distressing for owners and it is important to monitor the patients

91
Q

What further investiagtion can be done on a nasal biopsy?

A

Histopathology
Cytology
Culture

92
Q

What can a nasal flush be used for?

A

Sampling for cytology
Dislodge a foreign body

93
Q

What can nasal swabs be used for?

A

Cytology
Culture

95
Q

What is the typical clinical presentation of cat flu?

A

Acute onset
Bilateral nasal discharge
Serous to mucopurulent nasal discharge
Sneezing
± Ocular discharge
± Ocular ulceration

96
Q

(T/F) Primary bacterial rhinitis is more common than secondary bacterial rhinitis

A

FALSE. Primary bacterial rhinitis is rare whereas secondary bacterial rhinitis is more common

97
Q

Which two pathogens cause primary bacterial rhinitis?

A

Bordetella bronchiseptica
Mycoplasma

98
Q

What is secondary bacterial rhinitis?

A

Secondary bacterial rhinitis is the overgrowth of commensal bacteria secondary to an underlying disease

99
Q

Which antibiotic can be used to treat bacterial rhinitis?

A

Doxycycline

100
Q

What is the typical clinical presentation of a nasal foreign body?

A

Acute onset
Unilateral nasal discharge
Sneezing
± Pawing at or rubbing their face on the ground
± Facial pain
± Epistaxis
± Mucopurulent nasal discharge

101
Q

Which additional clinical signs can be indicative of a chronic nasal foreign body obstruction?

A

Chronic clinical signs
Halitosis
Enlarged regional lymph nodes

In addition to the clinical signs seen in acute presentation

102
Q

What should be done before attempting to remove a nasal foreign body?

A

Diagnostic imaging to assess the nasal cavity and nasopharynx should be done before attempting to remove a foreign body

103
Q

What can be done to remove a nasal foreign body?

A

Rhinoscopy
Nasal flush
May need surgical removal

104
Q

Which fungus most commonly causes canine fungal rhinosinusitis?

A

Aspergillus fumigatus

105
Q

What is the pathophysiology of canine fungal rhinosinusitis?

A

Aspergillus fumigatus is a commensal fungus which for unknown reasons can form fungal plaques, granulomas and cause bony destruction of the nasal turbinates and is severe cases destruction of the maxilla, orbit and cribriform plate

106
Q

What is the typical clinical presentation of canine fungal rhinosinusitis?

A

Chronic, progressive clinical signs
Unilateral to bilateral discharge
Mucopurulent discharge to epistaxis
Sneezing
Head shyness
± Rhinarial depigmentation
± Rhinarial crusting
± Periocular swelling

107
Q

How do you diagnose canine fungal rhinosinusitis?

A

Diagnostic imaging
Rhinoscopy
Nasal biopsy
Nasal flush
Sinoscopy

108
Q

What is the appearance of canine fungal rhinosinusitis on radiography?

A

Increased radio-lucency
Increased soft tissue opacity indicative of granulomas (however could also be discharge)
Loss of nasal turbinate pattern
Bony destruction

109
Q

What is the appearance of canine fungal rhinosinusitis on CT?

A

Loss of nasal tubinates

110
Q

How can rhinoscopy be used to help diagnose canine fungal rhinosinusitis?

A

Visualisation of the fungal plaques
Allows for biopsy of the fungal plaques
Allows for biopsy of the nasal turbinates

111
Q

What further tests should be done on biopsies of the fungal plaques?

A

Histopathology
Culture

112
Q

How do you treat canine fungal rhinosinusitis?

A

Nasal instillation of anti-fungal agents and trephination of the frontal sinuses

113
Q

What is the prognosis for canine fungal rhinosinusitis?

A

Generally the prognosis is fair to good however the treatment for this condition is expensive and often requires multiple treatments. Furthermore, relapses can commonly occur

114
Q

What are the two forms of feline aspergilliosis?

A

Sino-nasal aspergilliosis
Sino-orbital aspergilliosis

115
Q

What is the typical clinical presentation of feline aspergilliosis?

A

Chronic, progressive clinical signs
Unilateral to bilateral nasal discharge
Serous to mucopurulent nasal discharge
Sneezing
± Epistaxis
± Exopthalmus
± Granuloma protruding from the nares
± Stertor

116
Q

What should you always check in cats that present with cryptococcus?

A

Check the FIV/FeLV status in cats that present with cryptococcus as cryptococcus in an opportunistic pathogen that presents in immunodeficient patients

117
Q

What is the most common nasal tumour in dogs?

A

Adenocarcinoma

118
Q

What is the most common nasal tumour in cats?

A

Lymphoma

119
Q

What is the typical clinical presentation of nasal neoplasia?

A

Chronic, progressive clinical signs
Unilateral to bilateral nasal discharge
Mucopurulent to epistaxis
Obstruction of airflow at the nostril(s)
Facial pain
Facial deformity (rare)
Lymph node enlargment
Cachexia, poor body condition

120
Q

What can be used to diagnose nasal neopasia?

A

Diagnostic imaging (remember to image the rest of the body to assess for metastasis)
Rhinoscopy
Nasal biospy

121
Q

What is the typical clinical presentation of chronic rhinitis?

A

Chronic clinical signs
Bilateral nasal discharge
Serous to mucopurulent nasal discharge
Systemically normal

Make sure to rule out any other causes of chronic inflammation

122
Q

How do you manage idiopathic chronic rhinitis?

A

Idiopathic chronic rhinitis is unlikely resolve with treatment, so it is important to educate the owners about this but reassure them that their pet is in no immediate danger

123
Q

What is an oronasal fistula?

A

An oronasal fistula is an abnormal opening between the oral and nasal cavity

124
Q

What can cause oronasal fistulas?

A

Dental disease
Trauma
Oral neoplasia

125
Q

How do you treat an oronasal fistula?

A

Surgical repair

MODULE 15 - Cardiorespiratory and Haematopoietic Disease (21 decks)

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