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RUSVM SAM 1 > Pleural Space Disease And Pulmonary Parenchymal Disease > Flashcards

Pleural Space Disease And Pulmonary Parenchymal Disease Flashcards

1
Q

What is pleural effusion?

A

Abnormal accumulation of fluid in plural space

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2
Q

Pleural effusion causes increased intrathoracic pressure which leads to a __________ breathing pattern

A

Restrictive (shallow and rapid)

—> decreases work of breathing but maintains minute volume

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3
Q

What are the types of effusion and which is most common?

A

Transudate

Modified transudate (most common)

Exudate

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4
Q

What disease causes a transudate pleural effusion in dogs and cats?

A

Hypoalbuminemia

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5
Q

What diseases causes modified transudate, pleural effusion in cats and dogs?

A

Neoplasia

CHF
-L or R in cat, only Left in dog

Pericardial disease (dog only)

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6
Q

What can cause an exudative pleual effusion in cats and dogs?

A

Septic - pyothorax

Non-septic

  • neoplasia
  • FIP (cats)
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7
Q

What are causes of a chylous pleural effusion in cats and dogs?

A 
Trauma
Neoplasia 
CHF
Cranial vena cava bstruction (mass thrombus) 
HWD
Idiopathic
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8
Q

What are causes of hemorrhagic pleural effusion in cats and dogs?

A

Trauma
Toxicity
Neoplasia
Lung lobe torsion

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9
Q

How would heart sounds change in moderate-severe pleural effusion?

A

Muffled or absent

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10
Q

Large pleural effusion is life-threatening. What procedure needs to be performed as soon as possible?

A

Thoracocentesis

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11
Q

T/F: thoracic radiographs should be done before thoracocentesis to confirm presence of fluid

A

False

—> fluid is life-threatening, patients can die suddenly while trying to do imaging.. thoracocentesis first!!

Perform radiographs once fluid has been removed

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12
Q

What is the initial treatment of pleural effusion ?

A

Thoracocentesis
Therapeutic –> moderate/severe effusion to releive dyspnea

Diagnostic —> in all patients for fluid analayis and cytology

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13
Q

NT-proBNP in pleural effusion of cats is highly sensitive for what disease in cats?

A

CHF

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14
Q

You have confirmed pleural effusion in your patient via thoracocentesis.. what additional diagnostics will you do now?

A

Minimum database
Thoracic radiographs
NT-proBNP in cats

Advanced

  • Echo
  • Abdominal US
  • CT
  • Lymphangiogram
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15
Q

What is the treatment for pleural effusion?

A

Treat underlying process

-if cannot resolve or idiopathic —> periodic thoracocentesis or pleural port

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16
Q

What is the treatment for pyothorax?

A

Drainage via thoracotomy tube
Antibiotics

Sometimes requires surgical intervention for drainage and resection of severely affected tissues

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17
Q

What is a mesothelioma and how would you treat?

A

Malignant neoplasm of serosal surfaces —> surgical biopsy for definitive diagnosis

Treat: intracavitary chemo, periodic thoracocentesis or pleural port

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18
Q

What is an idiopathic chylothorax? Diagnosis?Treatment ?

A

Accumulation of chyle due to abnormalities in thoracic duct system

Diagnosis: plural fluid triglyceride >serum triglyceride

Treatment: surgical, low fat diet, rutin, corticosteroid

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19
Q

What are potential complications of pleural effusion?

A

Fribosing pleuritis: pleura becomes fibrosis and non-compliant due to chronic inflammation

Lung lobe torsion

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20
Q

How is diagnosis of pneumothorax done?

A

Thoracocentesis
Radiographs
Ultrasound

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21
Q

What is a tension pneumothorax?

A

Volume of air is so significant that is depresses cardiac output

Fatal if not treated promptly

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22
Q

What are the 3 types of pneumothorax?

A

Traumatic
Spontaneous
Iatrogenic

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23
Q

What are causes of spontaneous pneumothorax ?

A

Primary- pulmonary blebs or bullae that rupture

Secondary- lung disease

—>treatment involves surgical resection of diseased lung

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24
Q

What are cause of iatrogenic pneumothorax?

A

Lung damage or laceration during thoracocentesis

Positive pressure ventilation

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25
Q

What are the most common causes of pneumomediastinum in cats?

A

General anesthesia with endotracheal intubation and PPV

—> improper tube management and pop-off valve

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26
Q

What is the treatment for pneumomedastium?

A

Analgesia
O2
Close monitoring

—> secondary pneumothorax is common —> require thoracocentesis

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27
Q

Clinical signs of pneumomediastinum?

A

Tachypnea
Dyspnea
Subcutaneous emphysema (crunchy skin)
Vomiting in cats

28
Q

The primary function of the pulmonary parenchyma is?

A

Gas exchange

Rate of tans free is proportional to the tissue area and difference in partial pressure

29
Q

What are the diseases of the pulmonary parenchyma ?

A 
Pneumonia 
Idiopathic pulmonary fibrosis 
Non-cardiogenic pulmonary edema 
Eosinophilic pneumonia 
Neoplasia
30
Q

What are the routes of infection of bacterial pneumonia?

A

Inhalation
Aspiration
Extension from nearby tissues
Hematogenous

31
Q

What are the common opportunistic pathogens in dogs causing bacterial pneumonia?

A 
Ecoli 
Pasturella 
Kelbsiella 
Staphylococcus
Streptococcus 
Bordetella 
Mycoplasma
32
Q

What are common opportunistic pathogens causing bacterial pneumonia in cats?

A 
Mycoplasma 
Pasturella 
Bordetella 
Streptococcus 
Ecoli
33
Q

T/F: strep equi subspecies zooepidemicus is a virulent primary pathogen causing bacterial pneumonia

A

True

34
Q

What are the classifications of bacterial pneumonia?

A

Community-acquired pneumonia (CAP): in patient that has not been recently hospitalized

Hospital-acquired pneumonia (HAP): in patient >48 hours after hospital admission

35
Q

T/F: treatment for CAP and HAP is different, but treatment for CAP and aspiration pneumonia is similar

A

True

36
Q

What is the signalment for bacterial pneumonia?

A

Dogs>cats
Young or old (but any can be affected)

No breed predispositions

37
Q

What are common clinical signs of bacterial pneumonia?

A 
Cough
Exercise intolerance 
Nasal discharge
Increase respiratory rate/effort
Lethargy 
Hyporexia
Pyrexia
38
Q

What are potential physical exam findings in a patient with bacterial pneumonia?

A 
Abnormal lung sounds 
Tachypnea/dsypnea 
Nasal discharge 
Pyrexia
Cyanosis 
Sinus arrhythmia (due to increased vagal tone)
39
Q

What is the classic distribution and pattern of bacterial pneumonia on radiographs?

A

Alveolar and predominantly ventral

Interstitial/bronchial pattern may be present

40
Q

A diffuse distribution of bacterial pneumonia is more common with what type of infection?

A

Hematogenous

41
Q

What type of pneumonia usually only involves one lobe ?

A

Aspiration
Foreign body
Tumor

42
Q

Diagnosis of bacterial pneumonia is usually based on thoracic radiographs but definitive diagnosis requires??

A

Identification of sepsis form lower airway samples (obtained via transtracheal or bronchoalveolar lavage)

43
Q

What would you see on a minimum database for in a bacterial pneumonia case?

A

Neutrophillia

44
Q

What is the treatment for bacterial pneumonia ?

A

Antibiotics for 10-14days

Or 1 week beyond clinical resolution

45
Q

Is it ever appropriate to not obtain lower airway samples for bronchial pneumonia

A

Yes

If patient has a community acquired pneumonia, no history of pneumonia AND no recent history of antibiotic therapy

46
Q

What drug therapies do you use in a hospital acquired pneumonia?

A

Multi-drug resistant pathogens are common in hospitals: therefore patients with HAP are at increased risk for MDR infection —-> especially important to do culture and sensitivity testing

Dog:

  • 1st generation cephalosporin +2/3rd generation
  • carbapenem or amikacin + amoxicillin or ticarcillin

Cat: same as above +/- enrofloxacin or doxycyline to treat mycoplasma spp

47
Q

What other treatments can be done in addition to antibiotic therapy in bacterial pneumonia?

A

O2 in hypoxemia

Fluid therapy ->maintain tissue perfusion and mucocilliary defected

Nebulizaiton —> enhance mucus fluidity

Courage to encourage coughing

Bronchodilator and/or mucolytic

48
Q

What re common pathogens in mycotic pneumonia?

A

Blastomyces
Histoplasma
Coccidioides

49
Q

In addition to lower respiratory signs, what can you see in mycotic pneumonia ?

A

Lymphadenopathy and weight loss

50
Q

What is the pattern and distribution of mycotic pneumonia on radiographs?

A

Nodular or miliary

Interstitial and perihilar lymphadenopathy may be present

51
Q

How can you definitively diagnose mycotic pneumonias?

A

Cytologically
Urine fungal antigen test

The DDx is neoplasia
Must differentiate

52
Q

What is the treatment for mycotic pneumonia?

A

Blastomyces and histo: itraconazole

Cocci: fluconzaole or itraconazole

53
Q

Pneumocystis carinii is associated with severe morbidity and mortality in immunocompromised patients.

What breeds is it common in and what is the treatment?

A

Miniature dashunds and King Charles spaniel

Potentiates sulfonamides and supportive care

54
Q

What is the EDX of viral pneumonias in dogs?

A 
Parainfluenza
Influenza 
Distemper 
Coronavirus 
Infectious hepatitis 
Herpesvirus
55
Q

What is the EDX of viral pneumonias in cats?

A

Coronavirus
Calicivirus
Herpesvirus

56
Q

What is the treatment for viral pneumonias?

A

Supportive

Antibiotic therapy is indicated if there is a secondary bacterial infection

57
Q

What is the most common protozoal pneumonia? And how is it treated?

A

Toxoplasma gondii

Potentiated sulfonamides or clindamycine

58
Q

What is idiopathic pulmonary fibrosis?

A

Interstitial lung disease that is characterized by fibrosis

59
Q

What breeds are predisposed to idiopathic pulmonary fibrosis?

A

West highland terrier
Shafforshire bull terrier
Middle age to older

60
Q

On PE of a dog with idiopathic pulmonary fibrosis, what do you hear on auscultation in all lung fields?

A

Crackles

61
Q

Why may you see a polycythemia due to idiopathic pulmonary fibrosis?

A

Secondary to hypoxemia

Usually only in advanced disease

62
Q

What pattern do you see with idiopathic pulmonary fibrosis on radiographs?

A

Dogs: DIFFUSE bronchointersitial pattern

Cat: DIFFUSE Bronchial, intersitial, and alveolar patterns are possible

63
Q

How do you treat idiopathic pulmonary fibrosis?

A

No specific therapy

Cough suppressant
Sildenafil and exercise restriction in patients with pulmonary hypertension

Corticosteroids or bronchodilators may improve clinical signs

—> poor long term prognosis once symptomatic

64
Q

What is non-cardiogenic pulmonary edema?

A

Edema is not the disease, it is a consequence of disease

  • increased hydrostatic pressure
  • decreased oncotic pressure
  • increased vascular permeability
  • impaired lymphatic drainage
65
Q

What are causes of non-cardiogenic pulmonary edema?

A

Acute respiratory distress syndrome secondary to primary/secondary pulmonary disease

Airway obstruction

Seizure

Electrocution

Vasculitis

Hypoalbuminemia

Pulmonary arterial hypertension

66
Q

What is the treatment for non-cardiogenic pulmonary edema?

A

Supplemental oxygen in hypoxemic

Reduce stress

Mechanical ventilation

Low dose furosemide

Therapy for underlying cause

67
Q

What is acute respiratory distress syndrome ?

A

Pulmonary inflammatory disorder characterized by non-cardiogenic pulmonary edema, neutrophilic inflammation, and hypoxemia

—>potential component of systemic inflammatory response syndrome (SIRS) —> can have infectious or non-infectous origin

RUSVM SAM 1 (26 decks)

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