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Cardiopulmonary test 1 > pneumonia > Flashcards

pneumonia Flashcards

1
Q

Radiographic lung patterns: interstitial pattern

A

blood vessel margins are indistinct/hazy

infiltration within extracellular space of lung

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2
Q

Radiographic lung patterns: bronchial pattern

A

doughnut, tramlines

thickening of airway walls, infiltrates in or around airway walls

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3
Q

radiographic lung patterns: alveolar pattern

A

air bronchograms

fluid/infiltrate within airspace, alveolar space

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4
Q

pneumonia

A

inflammation of pulmonary parenchyma

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5
Q

types of pneumonia

A

broncho

interstitial

granulomatous (fungal)

mixed: bronchinterstitial (viral)

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6
Q

bronchopneumonia

A

grossly affects cranial ventral lung

consolidation

micro lesions: inflammatory exudative airway

bacterial, aspiration

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7
Q

interstital pneumonia

A

grossly diffuse, locally extensive

micro lesions: alveolar septa

causes: viral, toxoplasmosis, toxin, sepsis, Leptosporosis, hypersensitivity

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8
Q

etiology of pneumonia

A

bacterial

fungal

aspiration

viral

parasitic

protozoal

trauma/hemorrhage

allergic/immune mediated

foreign body

neoplasia

uremia

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9
Q

causes of viral pneumonia

A

Canine distemper virs

FIP

FCV

CAV2

Canine parainfluenza virus

canine influenza

H1N1-cats

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10
Q

Canine influenza virus

A

caused by type A Orthomyxovirus

first outbreak in 2004 in FL

winter and summer to early fall

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11
Q

Canine influenza virus transission

A

aerosolized resp secretion

contaminated fomites

2-5 day incubation period

almost all exposed dogs become infected

80% develop clin sxs

other 20% shed virus

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12
Q

Canine inluenza virus clinical signs

A

DDx: kennel cough

mild form-Cough for 2-3 weeks, purulent nasal d/c, low grade fever, most common

severe form-high grade fever, pneumonia (bacterial), tachypnea, dyspnea

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13
Q

Canine influenza: dx

A

no reliable rapid dx test

serology-most reliable and sensitive

PCR on TTW, oropharyngeal swab-use early in inf

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14
Q

Canine influenza: tx

A

supportive care

broad spectrum abx with severe nasal d/c, pneumonia

fluid and nutritional support

isolation

disinfection

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15
Q

canine influenza: px

A

80% morbidity

5-8% mortality

vax

easily killed by common disinfectants

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16
Q

bacterial pneumonia causes

A

combo of factors

compromise of defense mechanisms

pathogenic potential of offending bacteria

nature of exposure to bacteria

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17
Q

Bacterial pneumonia: pathogens

A

primary: Bordetella, Mycoplasma (cats)
secondary: Strep, Saph, Pasteurella, E coli, Klebsiella, mixed, anaerobes

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18
Q

Bacterial pneumonia: routes of infection

A

aspiration of various substances

hematogenous spread

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19
Q

Bacterial pneumonia: predisposing factors

A

primary resp innf

d/o of swallowing

trauma

recumbency, CNS dz

smoke inhalation

FB rxn

noeplasia

sepsis

ciliary dyskinesia

immune suppression

breed predisposition

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20
Q

Bacterial pneumonia: hx and clin sxs

A

soft, moist cough during daytime

tachypnea, poss dyspnea

nasal d/c

anorexia, lethargy

hx of v, regurg

ADR

fever

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21
Q

Bacterial pneumonia: PE findings

A

Depression, dehydration

fever (<50%)

cyanosis

crackles, wheezes, decreased lung sounds

chest auscultation may be normal

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22
Q

Bacterial pneumonia: dx

A

CBC

chest rads

arterial blood gas

airway sampling

PCR

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23
Q

T/F: the absence of fever rules out bacterial pneumonia

A

False, only 50% of case report fevers

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24
Q

True or false: an alveolar pattern is usually present in a dog with bacterial pneumonia

A

True

cats usually have bronchial pattern

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25
Q

Bacterial pneumonia: dx-airway sampling

A

TTW, bAL

septic inflammation

intracellular bacteria

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26
Q

Bacterial pneumonia: dx- arterial blood gas

A

-hypoxemia, hypocapnea

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27
Q

bacterial pneumonia: dx-chest rads

A

alveolar pattern (cats-bronchial pattern),

ventral region of cranial and middle lobes,

localized if lobar,

lung lobe consolidation,

caudodorsal if hematogenous

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28
Q

Bacterial pneumonia: dx-CBC

A
  • leukocytosis, left shift
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29
Q

Bacterial pneumonia: dx-PCR

A

Canine infectious respirator PCR panel

includes Bordetella, Strepococcus zooepidemicus, plus viral pathogens

nasal, conjunctiva swabs

pharyngeal swabs

airway wash sample

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30
Q

Bacterial pneumonia: tx

A

Abx

fluid therapy

oxygen therapy

humidification of airways

physical therapy

poss bronchodilators

address underlying cause

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31
Q

Bacterial pneumonia: tx-abx

A

-based on C&S, bactericidal preferred

mild to modrate case: doxy, clavamox, TMPS, cephelosporins

Severe cases: flouroquinolones + amp/clavamox

cats: doxy
lifethreatening: Unisyn + flouroquinolone or aminoglycoside

all IV initially

cont 1-2 weeks after resolution of sxs

32
Q

Bacterial pneumonia: patient monitoring

A

expect clin improvement within 3-5 d

daily auscultation

monitor temp

follow up chest rad-esp prior to stopping abx

blood gas analysis-improvement in PaO2

improvement on CBC

33
Q

Bacterial pneumoia: Px

A

good in general

poss recurrence

prevention: fasting prior to sedation, PEG tube feedings, etc

34
Q

Aspiration pneumonia-causes and predisposing factors

A

entry of foreign material into airway

esophageal dz, oropharyngeal dz, CNS dz, anesthesia, chronic V, iatrogenic

35
Q

Aspiration pneumonia: Clinical findings

A

cough, tachypnea, dyspnea

acute resp distress

chronic cough poss

crackles, wheezes, esp cranial ventral (absence of resp sxs poss)

fever

poss neurologic deficits

poss oral cavity abn

36
Q

Aspiration pneumonia: Chest rads

A

alveolar pattern most common (esp right middle and right cranial)

interstitial pattern 2nd most common

lung lobe consolidation poss

mineral oil can cause diffuse interstitial or nodular pattern

37
Q

Aspiration pneumonia: airway fluid analysis

A

inflammatory cels

intracellular bacteria

foreign debris

use in chronic pneumonia cases

38
Q

Aspiration pneumonia: tx

A

bronchoscopy

airway suctioning and flushing

oxygen therapy

abx therapy

proper feeding techniques

39
Q

Aspiration pneumonia: Px

A

variable but usually good

40
Q

Blastomycosis

A

most common respiratory fungal inf in MN and great lakes region

soil saprophyte

41
Q

Blastomycosis: hx and clin sxs

A

travel to endemic area

cough, dyspnea

depression, lethargy

ocular signs: choriorenititis, blindness, glaucoma

skin lesions

fever-104.5-105

lymphadenopathy

lameness

42
Q

Blastomycosis: pathogenesis

A

spores inhaled and deposited in alveoli

phagocytized by macs

transformed from mycelial to yeast phase

multiplies in macs

yeast cells released into alveoli–> infl

incubation time: 5-12 weeks

43
Q

Blastomycosis: clinical forms

A

Primary pulmonary

disseminated-hematogenous, lymphatic

local cutaneous

44
Q

Blastomycosis: rad findings

A

small or large interstital nodules

alveolar pattern

masses

unstrcutred perihilar infiltrate

lymphadenopathy

lung lobe consolidation

pleural effusion

45
Q

Blastomycosis: Dx

A

consider geography

Cytology of lung node skin or bone-most common

histopath

fungal culture

fungal titers

urine ag test

response to tx

46
Q

Blastomycosis: Dx-cytology

A

pyogranulomatous inflammation

large, thick-walled budding yeast

47
Q

Blastomycosis: antifungal drug therapy

A

imidazole drugs-expensive, given with food, poss liver and GI toxicity, Itraconazole

Amphotericin B-risk of renal toxicity, must be infused with IV fluids, poor penetration, combine with Itraconazole

48
Q

Blastomycosis: supportive care

A

IV fluid therapy

oxygen therap

anti-inflammatory meds-NSAIDs, low dose steroids

nutritional support

49
Q

Blastomycosis: patient monitoring

A

repeat chest rads in 4-6 weeks

recheck rad no shorter than monthly

rad lesions resolve within 185 days

urine ag test

50
Q

blastomycosis: Px

A

~60% survival rate

poor for dogs in resp distress at presentation

poor with CNS dz

fair for dogs treated early in dz course

relapse common

enucleation may be necessary

51
Q

Noncardiogenic Pulmonary Edema

A

abnormal accumulation of lfuid within the lung

caused by increased vascular endothelial permeabiilty

high protein fluid

52
Q

Noncardiogenic Pulmonary Edema: etiology

A

lung injury-examples: aspiration of gastric contents, smoke inhalation, near drowning, trauma, handing, choking, prolonged high conc oxygen inspiration

Extrapulmonary causes: SIRS, sepsis, neurologic dz, pulmonary thromboembolism, pancreatitis, uremia

53
Q

Noncardiogenic Pulmonary Edema: Clinical sxs

A

acute dyspnea, tachypnea

diffuse crackles

poss cardiac abn

fever

CNS signs

burns in oral cavity

evidence of strangulation

54
Q

Noncardiogenic Pulmonary Edema: Dx workup

A

chest rads if stable

arterial blood gas

ECG

CBC, chem UA

55
Q

Noncardiogenic Pulmonary Edema: Dx-Chest rads

A

early signs: interstitial pulmonary edema

progression to mixed insterstitial-alveolar or alveolar

typically caudodorsal lung lobes

symmetric cahnges with extrapulmonary causes

asymmetrical with primary lung insult

56
Q

Noncardiogenic Pulmonary Edema: dx-arterial blood gas

A

hypoxemia

intially hypocapnia

later hypercapnia

57
Q

Noncardiogenic Pulmonary Edema: Tx

A

eliminate underlying cause

descrease vascular infl with steroids, other anti-inflammatories

support resp and cardiac function-oxygen, ventilator, fluid therapy (colloids)

diuertic therapy

vasodilators

support bp-dopamine dobutamine

58
Q

Noncardiogenic Pulmonary Edema: Px

A

fair to poor

59
Q

Pulmonary thromboembolism

A

thrombus formation in pulmonary artery

60
Q

pulmonary thromboembolism: cause

A

injury to vessel endothelium

impairment of blood flow

development of pro-thrombotic tendencies in blood

61
Q

pulmonary thromboembolism: Risk factors

A

hypercoaguable state

IV catheters

prolonged recumbency

blood transfusions

glucocorticoid excess-endogenous or exogenous

62
Q

pulmonary thromboembolism: disease association

A

Heartworm dz

IMHA, ITP

pancreattitis

PLE

PLN

cardiac dz

sepsis

DIC

Cushing’s

DM

Polycythemia

vasculitis

hyperlipidemia

63
Q

pulmonary thromboembolism: Clinical presentation

A

acute onset tachypnea, dyspnea

cyanosis

lethargy

hemopytsis

increased bronchovesicular sounds

known predisposing conditions

64
Q

pulmonary thromboembolism: Dx

A

high index of suspicion

CBC, coag

arterial blood gas-hypoxemia, hypocapnia

Chest rads

D-Dimer

ventilation perfusion scan

angiography

CT scan with angiography

necropsy

65
Q

pulmonary thromboembolism: Dx-chest rads

A

may be normal

hyperlucency

pulmonary infiltrates

pleural effusion

PA changes

severe of changes may not match severity of signs

66
Q

pulmonary thromboembolism: Dx-D-dimer

A

fibrin degradation product

elevation signify active coag and fibrinolysis

short half life

not specific

67
Q

pulmonary thromboembolism: Tx

A

ICU care

oxygen therapy

thrombolytic therapy

address underlying cause

vasodilator therapy

68
Q

pulmonary thromboembolism: Cats

A

rare

severe concurrent clinical dz

69
Q

pulmonary thromboembolism: prevention

A

ID at risk patients

heparin therapy

low molecular weight heparin

Plavix

low dose aspirin

warfarin

70
Q

7 yo MC Rottweiler

presenting complaint: anemia, recurrent IMHA

Current therapy: SID Pred

PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting

lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal

problem list?

A

IMHA

Iatrogenic Cushing’s

leukocytosis

increased liver enzymes

increased biliruing

tachycardia

panting

71
Q

7 yo MC Rottweiler

presenting complaint: anemia, recurrent IMHA

Current therapy: SID Pred

PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting

lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal

tx plan?

A

blood transfusion

increase pred dose

add cyclosporine

ICU monitoring

72
Q

7 yo MC Rottweiler

presenting complaint: anemia, recurrent IMHA

Current therapy: SID Pred

PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting

lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.

next night:

HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral

DDx?

A

Pulmonary thromboembolism

noncardiogenic pulmonary edema

heart failure

pleural space dz

pneumnoia

cushing’s

lung lobe torsion

laryngeal dz

73
Q

7 yo MC Rottweiler

presenting complaint: anemia, recurrent IMHA

Current therapy: SID Pred

PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting

lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.

next night:

HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral

Next step?

A

pulse oximeter

arterial blood gas

chest rads

74
Q

7 yo MC Rottweiler

presenting complaint: anemia, recurrent IMHA

Current therapy: SID Pred

PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting

lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.

next night:

HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral

chest rads-normal; arterial blood gas: pH7.39, pO2=64, pCO2=36

A

alkalosis

pO2 very low-hypoxemia

pCO2 decrease-hypocapnia

75
Q

7 yo MC Rottweiler

presenting complaint: anemia, recurrent IMHA

Current therapy: SID Pred

PE: pale, tachycardic, lethargic, pot-belly, splenomegaly, thin hair coat, panting

lab: HCT 16%, spherocytes, RBC agglutanation, leukocytosis with mature neutrophilia, ALP and ALT increased, Bilirubin increased, PT/PTT normal.

next night:

HCT:23%, panting more heavily, cyanotic, uncomfortable, unable to walk outside, harsh lung sounds bilateral

chest rads-normal; arterial blood gas: pH7.39, pO2=64, pCO2=36

Most likely dx?

A

pulmonary thromboembolism

76
Q

a

A

Cardiopulmonary test 1 (9 decks)

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