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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
What are the most common causes of pneumomediastinum in cats?
General anesthesia with endotracheal intubation and PPV —> improper tube management and pop-off valve
26
What is the treatment for pneumomedastium?
Analgesia O2 Close monitoring —> secondary pneumothorax is common —> require thoracocentesis
27
Clinical signs of pneumomediastinum?
Tachypnea Dyspnea Subcutaneous emphysema (crunchy skin) Vomiting in cats
28
The primary function of the pulmonary parenchyma is?
Gas exchange Rate of tans free is proportional to the tissue area and difference in partial pressure
29
What are the diseases of the pulmonary parenchyma ?
``` Pneumonia Idiopathic pulmonary fibrosis Non-cardiogenic pulmonary edema Eosinophilic pneumonia Neoplasia ```
30
What are the routes of infection of bacterial pneumonia?
Inhalation Aspiration Extension from nearby tissues Hematogenous
31
What are the common opportunistic pathogens in dogs causing bacterial pneumonia?
``` Ecoli Pasturella Kelbsiella Staphylococcus Streptococcus Bordetella Mycoplasma ```
32
What are common opportunistic pathogens causing bacterial pneumonia in cats?
``` Mycoplasma Pasturella Bordetella Streptococcus Ecoli ```
33
T/F: strep equi subspecies zooepidemicus is a virulent primary pathogen causing bacterial pneumonia
True
34
What are the classifications of bacterial pneumonia?
Community-acquired pneumonia (CAP): in patient that has not been recently hospitalized Hospital-acquired pneumonia (HAP): in patient >48 hours after hospital admission
35
T/F: treatment for CAP and HAP is different, but treatment for CAP and aspiration pneumonia is similar
True
36
What is the signalment for bacterial pneumonia?
Dogs>cats Young or old (but any can be affected) No breed predispositions
37
What are common clinical signs of bacterial pneumonia?
``` Cough Exercise intolerance Nasal discharge Increase respiratory rate/effort Lethargy Hyporexia Pyrexia ```
38
What are potential physical exam findings in a patient with bacterial pneumonia?
``` Abnormal lung sounds Tachypnea/dsypnea Nasal discharge Pyrexia Cyanosis Sinus arrhythmia (due to increased vagal tone) ```
39
What is the classic distribution and pattern of bacterial pneumonia on radiographs?
Alveolar and predominantly ventral Interstitial/bronchial pattern may be present
40
A diffuse distribution of bacterial pneumonia is more common with what type of infection?
Hematogenous
41
What type of pneumonia usually only involves one lobe ?
Aspiration Foreign body Tumor
42
Diagnosis of bacterial pneumonia is usually based on thoracic radiographs but definitive diagnosis requires??
Identification of sepsis form lower airway samples (obtained via transtracheal or bronchoalveolar lavage)
43
What would you see on a minimum database for in a bacterial pneumonia case?
Neutrophillia
44
What is the treatment for bacterial pneumonia ?
Antibiotics for 10-14days | Or 1 week beyond clinical resolution
45
Is it ever appropriate to not obtain lower airway samples for bronchial pneumonia
Yes If patient has a community acquired pneumonia, no history of pneumonia AND no recent history of antibiotic therapy
46
What drug therapies do you use in a hospital acquired pneumonia?
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
What other treatments can be done in addition to antibiotic therapy in bacterial pneumonia?
O2 in hypoxemia Fluid therapy ->maintain tissue perfusion and mucocilliary defected Nebulizaiton —> enhance mucus fluidity Courage to encourage coughing Bronchodilator and/or mucolytic
48
What re common pathogens in mycotic pneumonia?
Blastomyces Histoplasma Coccidioides
49
In addition to lower respiratory signs, what can you see in mycotic pneumonia ?
Lymphadenopathy and weight loss
50
What is the pattern and distribution of mycotic pneumonia on radiographs?
Nodular or miliary Interstitial and perihilar lymphadenopathy may be present
51
How can you definitively diagnose mycotic pneumonias?
Cytologically Urine fungal antigen test The DDx is neoplasia Must differentiate
52
What is the treatment for mycotic pneumonia?
Blastomyces and histo: itraconazole Cocci: fluconzaole or itraconazole
53
Pneumocystis carinii is associated with severe morbidity and mortality in immunocompromised patients. What breeds is it common in and what is the treatment?
Miniature dashunds and King Charles spaniel Potentiates sulfonamides and supportive care
54
What is the EDX of viral pneumonias in dogs?
``` Parainfluenza Influenza Distemper Coronavirus Infectious hepatitis Herpesvirus ```
55
What is the EDX of viral pneumonias in cats?
Coronavirus Calicivirus Herpesvirus
56
What is the treatment for viral pneumonias?
Supportive | Antibiotic therapy is indicated if there is a secondary bacterial infection
57
What is the most common protozoal pneumonia? And how is it treated?
Toxoplasma gondii Potentiated sulfonamides or clindamycine
58
What is idiopathic pulmonary fibrosis?
Interstitial lung disease that is characterized by fibrosis
59
What breeds are predisposed to idiopathic pulmonary fibrosis?
West highland terrier Shafforshire bull terrier Middle age to older
60
On PE of a dog with idiopathic pulmonary fibrosis, what do you hear on auscultation in all lung fields?
Crackles
61
Why may you see a polycythemia due to idiopathic pulmonary fibrosis?
Secondary to hypoxemia Usually only in advanced disease
62
What pattern do you see with idiopathic pulmonary fibrosis on radiographs?
Dogs: DIFFUSE bronchointersitial pattern Cat: DIFFUSE Bronchial, intersitial, and alveolar patterns are possible
63
How do you treat idiopathic pulmonary fibrosis?
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
What is non-cardiogenic pulmonary edema?
Edema is not the disease, it is a consequence of disease - increased hydrostatic pressure - decreased oncotic pressure - increased vascular permeability - impaired lymphatic drainage
65
What are causes of non-cardiogenic pulmonary edema?
Acute respiratory distress syndrome secondary to primary/secondary pulmonary disease Airway obstruction Seizure Electrocution Vasculitis Hypoalbuminemia Pulmonary arterial hypertension
66
What is the treatment for non-cardiogenic pulmonary edema?
Supplemental oxygen in hypoxemic Reduce stress Mechanical ventilation Low dose furosemide Therapy for underlying cause
67
What is acute respiratory distress syndrome ?
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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